Otitis externa refers to infections of the external ear canal. It can be acute or chronic. Acute otitis externa is commonly known as swimmer's ear and is caused by bacterial or fungal infections due to water exposure. Chronic otitis externa is defined as lasting over 4 weeks and is often due to bacterial, fungal, or dermatological causes. Necrotizing external otitis is a potentially lethal infection seen in immunocompromised patients like diabetics. Treatment involves topical or oral antibiotics, cleaning of the ear canal, and surgery in severe cases. Proper diagnosis depends on history, exam, and sometimes imaging or labs.
This document discusses chronic otitis media, including tubotympanic and atticoantral types. Tubotympanic type is a safe inflammation of the middle ear lining, while atticoantral type involves a cholesteatoma sac. Symptoms include ear discharge and deafness. Examination may reveal perforations or debris in the ear canal. Investigations include culture, endoscopy and imaging. Management involves medical treatment like cleaning or antibiotics, with surgery for more severe cases like mastoidectomy or tympanoplasty.
Chronic suppurative otitis media (CSOM) is a long-standing ear infection characterized by ear discharge and permanent ear drum perforation. It is clinically divided into two main types - tubotympanic and atticoantral. Tubotympanic CSOM involves the lower middle ear and has a low risk of complications, while atticoantral CSOM involves the upper middle ear and carries a higher risk of complications like cholesteatoma due to bone erosion. Surgical treatment is the mainstay for atticoantral CSOM to remove disease while reconstructive surgery can help restore hearing.
This document discusses various conditions affecting the external ear canal, including:
- Otitis externa (swimmer's ear), which can range from mild to severe bacterial infections. Pseudomonas and Staph are common causes. Treatment involves cleaning, topical antibiotics, and pain control.
- Otomycosis is a fungal infection of the ear canal most often caused by Aspergillus or Candida. Symptoms are similar to bacterial otitis but with more pruritus. Treatment involves thorough cleaning and topical antifungals.
- Necrotizing external otitis is a potentially lethal Pseudomonas infection seen in diabetics and immunocompromised patients.
This document discusses diseases that can affect the external ear. It begins by describing the anatomy of the external ear. It then discusses various congenital and traumatic conditions that can affect the pinna, including bat ear, preauricular appendages, and haematoma of the auricle. It also covers inflammatory conditions of the pinna like perichondritis. The document further discusses diseases of the external auditory canal, including conditions like otitis externa, otomycosis, and impacted cerumen. Foreign bodies in the ear are also mentioned. Finally, various diseases of the tympanic membrane are briefly outlined.
Acoustic neuroma is a benign tumor of the eighth cranial nerve. The document discusses the definition, histopathology, etiology, classification, clinical features, investigations, differential diagnosis, and management of acoustic neuroma. The key signs and symptoms include progressive hearing loss, tinnitzus, imbalance, and cranial nerve involvement including facial numbness. MRI with gadolinium is the gold standard for diagnosis. Treatment options include surgical removal via middle cranial fossa, translabyrinthine, or suboccipital approaches or stereotactic radiotherapy using gamma knife or cyber knife.
Labyrinthitis is inflammation of the inner ear labyrinth that can be caused by viral or bacterial infections, drugs, head injuries, or other conditions. It produces vestibular symptoms like vertigo and nausea as well as hearing loss. The infection can spread from the meninges, middle ear, or bloodstream. Bacterial labyrinthitis has toxic or suppurative forms, with the latter invading the inner ear directly. Diagnosis involves a history of ear problems and dizziness as well as physical exams and tests. Treatment focuses on relieving vertigo and nausea with drugs while antibiotics target bacterial causes. Surgery may be needed in severe cases. Complications can include meningitis, permanent balance issues
This document discusses diseases of the external ear and their management. It covers topics such as:
1. Congenital anomalies of the pinna including microtia and anotia.
2. Inflammatory conditions of the external ear canal including diffuse otitis externa, malignant otitis externa, and otomycosis.
3. Tumors of the external ear including basal cell carcinoma and squamous cell carcinoma.
4. Miscellaneous conditions like wax impaction, foreign bodies, and keratosis obturans are also covered.
Treatment options discussed include antibiotics, antifungals, surgical excision and debridement depending on the specific condition
This document discusses chronic otitis media, including tubotympanic and atticoantral types. Tubotympanic type is a safe inflammation of the middle ear lining, while atticoantral type involves a cholesteatoma sac. Symptoms include ear discharge and deafness. Examination may reveal perforations or debris in the ear canal. Investigations include culture, endoscopy and imaging. Management involves medical treatment like cleaning or antibiotics, with surgery for more severe cases like mastoidectomy or tympanoplasty.
Chronic suppurative otitis media (CSOM) is a long-standing ear infection characterized by ear discharge and permanent ear drum perforation. It is clinically divided into two main types - tubotympanic and atticoantral. Tubotympanic CSOM involves the lower middle ear and has a low risk of complications, while atticoantral CSOM involves the upper middle ear and carries a higher risk of complications like cholesteatoma due to bone erosion. Surgical treatment is the mainstay for atticoantral CSOM to remove disease while reconstructive surgery can help restore hearing.
This document discusses various conditions affecting the external ear canal, including:
- Otitis externa (swimmer's ear), which can range from mild to severe bacterial infections. Pseudomonas and Staph are common causes. Treatment involves cleaning, topical antibiotics, and pain control.
- Otomycosis is a fungal infection of the ear canal most often caused by Aspergillus or Candida. Symptoms are similar to bacterial otitis but with more pruritus. Treatment involves thorough cleaning and topical antifungals.
- Necrotizing external otitis is a potentially lethal Pseudomonas infection seen in diabetics and immunocompromised patients.
This document discusses diseases that can affect the external ear. It begins by describing the anatomy of the external ear. It then discusses various congenital and traumatic conditions that can affect the pinna, including bat ear, preauricular appendages, and haematoma of the auricle. It also covers inflammatory conditions of the pinna like perichondritis. The document further discusses diseases of the external auditory canal, including conditions like otitis externa, otomycosis, and impacted cerumen. Foreign bodies in the ear are also mentioned. Finally, various diseases of the tympanic membrane are briefly outlined.
Acoustic neuroma is a benign tumor of the eighth cranial nerve. The document discusses the definition, histopathology, etiology, classification, clinical features, investigations, differential diagnosis, and management of acoustic neuroma. The key signs and symptoms include progressive hearing loss, tinnitzus, imbalance, and cranial nerve involvement including facial numbness. MRI with gadolinium is the gold standard for diagnosis. Treatment options include surgical removal via middle cranial fossa, translabyrinthine, or suboccipital approaches or stereotactic radiotherapy using gamma knife or cyber knife.
Labyrinthitis is inflammation of the inner ear labyrinth that can be caused by viral or bacterial infections, drugs, head injuries, or other conditions. It produces vestibular symptoms like vertigo and nausea as well as hearing loss. The infection can spread from the meninges, middle ear, or bloodstream. Bacterial labyrinthitis has toxic or suppurative forms, with the latter invading the inner ear directly. Diagnosis involves a history of ear problems and dizziness as well as physical exams and tests. Treatment focuses on relieving vertigo and nausea with drugs while antibiotics target bacterial causes. Surgery may be needed in severe cases. Complications can include meningitis, permanent balance issues
This document discusses diseases of the external ear and their management. It covers topics such as:
1. Congenital anomalies of the pinna including microtia and anotia.
2. Inflammatory conditions of the external ear canal including diffuse otitis externa, malignant otitis externa, and otomycosis.
3. Tumors of the external ear including basal cell carcinoma and squamous cell carcinoma.
4. Miscellaneous conditions like wax impaction, foreign bodies, and keratosis obturans are also covered.
Treatment options discussed include antibiotics, antifungals, surgical excision and debridement depending on the specific condition
Otomycosis is a fungal infection of the ear that causes symptoms like itching, pain, and hearing problems. It is more common in warm, tropical areas and among people who swim frequently or have diabetes. The infection is caused by fungi like Aspergillus and Candida growing in the moist, warm environment of the ear. Treatment involves cleaning the infected ear and using antifungal ear drops or oral medication. Prevention includes avoiding getting water in the ears while swimming and drying ears after showers or baths.
Acute mastoiditis is an inflammation of the mucosal lining of the mastoid air cells caused by bacteria or viruses. It presents with earache, fever, and ear discharge. On examination, the mastoid area is tender and the posterior meatal wall may be sagging. Complications can include abscesses, meningitis, or thrombophlebitis if left untreated. Treatment involves antibiotics and sometimes myringotomy or cortical mastoidectomy surgery.
Acute suppurative otitis media is an infection of the middle ear cavity that occurs more commonly in children and infants, especially during winter/spring and after upper respiratory infections. The infection is usually caused by bacteria like Streptococcus pneumoniae and Haemophilus influenzae. It begins with occlusion of the Eustachian tube and progresses through stages of pre-suppuration, suppuration, and sometimes resolution or complications. Symptoms include earache, fever, hearing loss, and a bulging eardrum. Treatment involves antibiotics, analgesics, myringotomy if needed, and treating any predisposing conditions.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
This document defines and describes nasal polyps and two main types - ethmoid and antrochoanal polyps. Ethmoid polyps arise from the ethmoid sinuses and appear as grape-like structures visible on anterior rhinoscopy. Antrochoanal polyps originate in the maxillary sinus and may extend through the nasal cavity and choana. Both cause nasal obstruction and other symptoms. Diagnosis involves nasal endoscopy, imaging, and biopsy. Treatment options include medical management, functional endoscopic sinus surgery, steroids, and polypectomy.
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Malignant otitis externa is an aggressive infection of the external ear and skull base that commonly affects older diabetics. It is caused mainly by Pseudomonas aeruginosa bacteria invading the external ear canal and spreading through fissures in the bone. Symptoms include severe ear pain, discharge, and potentially cranial nerve palsies. Diagnosis involves culture, imaging like CT showing bone destruction, and ruling out other causes. Treatment requires long-term antibiotics like ciprofloxacin, tight blood sugar control, and sometimes hyperbaric oxygen or surgery. Prognosis has improved but mortality remains high if the infection spreads intracranially or causes multiple cranial neuropathies.
Tumours of the ear can arise in the external ear, middle ear, and inner ear. Benign tumours of the external ear include sebaceous cysts, dermoid cysts, haemangiomas, and papillomas. Malignant tumours include basal cell carcinoma and squamous cell carcinoma. Glomus tumours are the most common benign tumour of the middle ear, arising from glomus bodies. Malignant tumours of the middle ear may be primary carcinomas or sarcomas or may spread secondarily from other sites. Tumours are diagnosed using imaging such as CT or MRI and treated with surgery, radiation, or embolization depending on the type and extent of disease.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Complications of suppurative otitis mediaSidra Nawaz
This document discusses complications that can arise from suppurative otitis media, including mastoiditis, petrositis, facial paralysis, and others. It outlines factors that influence the development of complications such as age, socioeconomic status, and immune status. It also describes various pathways of infection spread and classifications of intracranial complications. Specific complications are then discussed in more detail including their causes, symptoms, treatments and more.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
This document discusses diseases of the inner ear. It begins with an overview of inner ear anatomy and how the body maintains balance. Key points include that balance involves input from the vestibular, visual, and somatosensory systems. Common causes of inner ear diseases include infections, tumors, trauma, autoimmune disorders, and degenerative conditions like Meniere's disease and benign paroxysmal positional vertigo. Specific inner ear disorders like vestibular neuritis and traumatic temporal bone fractures are also summarized.
Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal caused by bacteria or fungi. It commonly affects children ages 7-12 and the elderly. Symptoms include ear pain, itching, discharge and temporary hearing loss. Diagnosis is made through physical exam, microscopy and culture of discharge. Treatment focuses on removing debris, using antibiotic/antifungal ear drops, and dry ear precautions to prevent recurrence, especially in high-risk groups like diabetics who are prone to the more serious malignant otitis externa infection.
This document provides an overview of otitis externa (ear infection of the outer ear canal). It defines the condition and describes the anatomy of the external auditory canal. The stages of otitis externa are outlined from pre-inflammatory to acute and chronic. Common types are discussed including localized furuncles, diffuse acute infections, and chronic cases. Potential causes and the microbiology are summarized. Diagnosis, classification, signs and symptoms, and treatment approaches are covered for the main types of otitis externa infections. Complications are also briefly mentioned.
This document discusses epistaxis (nosebleeds), including:
1. Epistaxis is bleeding from the nasal cavity and can occur in all age groups, though it is most common in children and young adults. The nasal cavity has a rich blood supply making it prone to bleeding.
2. Common causes of anterior epistaxis include local trauma, inflammation, infections, and physiological factors like climate. Systemic causes include hypertension, liver/kidney disease, and coagulation disorders.
3. Treatment begins with first aid and locating the bleeding site. Definitive treatments include chemical or electrocautery, vasoconstrictor sprays, and anterior nasal packing. Refractory epist
This document discusses chronic suppurative otitis media (CSOM), which is a long-standing middle ear infection characterized by ear discharge and a permanent perforation of the eardrum. It describes the two main types of CSOM - tubotympanic and atticoantral - and covers their etiology, pathology, clinical features, investigations, treatment, and complications. Cholesteatoma, a growth of skin cells in the middle ear, is also discussed in detail including its origin, classification, expansion and bone destruction potential, and role in increasing risk of complications from middle ear infections.
This document discusses chronic otitis media (COM), a long-standing middle ear infection characterized by persistent ear discharge through a perforated eardrum. It defines the two main types - tubotympanic and atticoantral disease - and describes their signs, symptoms, causes, investigations, and treatment options including medical management and surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty. COM is more common in developing nations and usually starts in childhood, affecting hearing if left untreated. Accurate diagnosis involves examination, tests like audiograms and CT scans, and ruling out complications.
Acute suppurative otitis media is an infection of the middle ear caused most commonly by Streptococcus pneumoniae or Hemophilus influenzae in children. It begins with blockage of the Eustachian tube by inflammation, followed by invasion of pathogens and exudation of fluid into the middle ear space. Signs include a retracted, bulging eardrum and conductive hearing loss. Treatment involves antibiotics to control the infection over 10 days as well as pain medications. Myringotomy may be needed to drain pus if symptoms are not improving. Complications can include persistent fluid, abscess, or spread to the mastoid bone.
Este documento describe el crup, una enfermedad respiratoria caracterizada por estridor inspiratorio y tos perruna causada por la obstrucción de la laringe. Generalmente es causada por virus como el parainfluenza. Afecta a niños menores de 6 años, con mayor incidencia entre los 9 y 36 meses. El tratamiento incluye humidificación, adrenalina nebulizada y corticoides para reducir la inflamación y los síntomas.
Este documento proporciona información sobre el crup viral, una de las causas más comunes de obstrucción aguda de la vía aérea superior en niños. El crup se caracteriza por estridor, tos y dificultad respiratoria y suele ser de origen viral, causado comúnmente por el virus parainfluenza. El tratamiento incluye oxígeno, adrenalina nebulizada y corticoides para reducir la inflamación y los síntomas. El pronóstico suele ser bueno pero pueden presentarse complicaciones como cuadros broncoobstructivos
Otomycosis is a fungal infection of the ear that causes symptoms like itching, pain, and hearing problems. It is more common in warm, tropical areas and among people who swim frequently or have diabetes. The infection is caused by fungi like Aspergillus and Candida growing in the moist, warm environment of the ear. Treatment involves cleaning the infected ear and using antifungal ear drops or oral medication. Prevention includes avoiding getting water in the ears while swimming and drying ears after showers or baths.
Acute mastoiditis is an inflammation of the mucosal lining of the mastoid air cells caused by bacteria or viruses. It presents with earache, fever, and ear discharge. On examination, the mastoid area is tender and the posterior meatal wall may be sagging. Complications can include abscesses, meningitis, or thrombophlebitis if left untreated. Treatment involves antibiotics and sometimes myringotomy or cortical mastoidectomy surgery.
Acute suppurative otitis media is an infection of the middle ear cavity that occurs more commonly in children and infants, especially during winter/spring and after upper respiratory infections. The infection is usually caused by bacteria like Streptococcus pneumoniae and Haemophilus influenzae. It begins with occlusion of the Eustachian tube and progresses through stages of pre-suppuration, suppuration, and sometimes resolution or complications. Symptoms include earache, fever, hearing loss, and a bulging eardrum. Treatment involves antibiotics, analgesics, myringotomy if needed, and treating any predisposing conditions.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
This document defines and describes nasal polyps and two main types - ethmoid and antrochoanal polyps. Ethmoid polyps arise from the ethmoid sinuses and appear as grape-like structures visible on anterior rhinoscopy. Antrochoanal polyps originate in the maxillary sinus and may extend through the nasal cavity and choana. Both cause nasal obstruction and other symptoms. Diagnosis involves nasal endoscopy, imaging, and biopsy. Treatment options include medical management, functional endoscopic sinus surgery, steroids, and polypectomy.
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Malignant otitis externa is an aggressive infection of the external ear and skull base that commonly affects older diabetics. It is caused mainly by Pseudomonas aeruginosa bacteria invading the external ear canal and spreading through fissures in the bone. Symptoms include severe ear pain, discharge, and potentially cranial nerve palsies. Diagnosis involves culture, imaging like CT showing bone destruction, and ruling out other causes. Treatment requires long-term antibiotics like ciprofloxacin, tight blood sugar control, and sometimes hyperbaric oxygen or surgery. Prognosis has improved but mortality remains high if the infection spreads intracranially or causes multiple cranial neuropathies.
Tumours of the ear can arise in the external ear, middle ear, and inner ear. Benign tumours of the external ear include sebaceous cysts, dermoid cysts, haemangiomas, and papillomas. Malignant tumours include basal cell carcinoma and squamous cell carcinoma. Glomus tumours are the most common benign tumour of the middle ear, arising from glomus bodies. Malignant tumours of the middle ear may be primary carcinomas or sarcomas or may spread secondarily from other sites. Tumours are diagnosed using imaging such as CT or MRI and treated with surgery, radiation, or embolization depending on the type and extent of disease.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Complications of suppurative otitis mediaSidra Nawaz
This document discusses complications that can arise from suppurative otitis media, including mastoiditis, petrositis, facial paralysis, and others. It outlines factors that influence the development of complications such as age, socioeconomic status, and immune status. It also describes various pathways of infection spread and classifications of intracranial complications. Specific complications are then discussed in more detail including their causes, symptoms, treatments and more.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
This document discusses diseases of the inner ear. It begins with an overview of inner ear anatomy and how the body maintains balance. Key points include that balance involves input from the vestibular, visual, and somatosensory systems. Common causes of inner ear diseases include infections, tumors, trauma, autoimmune disorders, and degenerative conditions like Meniere's disease and benign paroxysmal positional vertigo. Specific inner ear disorders like vestibular neuritis and traumatic temporal bone fractures are also summarized.
Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal caused by bacteria or fungi. It commonly affects children ages 7-12 and the elderly. Symptoms include ear pain, itching, discharge and temporary hearing loss. Diagnosis is made through physical exam, microscopy and culture of discharge. Treatment focuses on removing debris, using antibiotic/antifungal ear drops, and dry ear precautions to prevent recurrence, especially in high-risk groups like diabetics who are prone to the more serious malignant otitis externa infection.
This document provides an overview of otitis externa (ear infection of the outer ear canal). It defines the condition and describes the anatomy of the external auditory canal. The stages of otitis externa are outlined from pre-inflammatory to acute and chronic. Common types are discussed including localized furuncles, diffuse acute infections, and chronic cases. Potential causes and the microbiology are summarized. Diagnosis, classification, signs and symptoms, and treatment approaches are covered for the main types of otitis externa infections. Complications are also briefly mentioned.
This document discusses epistaxis (nosebleeds), including:
1. Epistaxis is bleeding from the nasal cavity and can occur in all age groups, though it is most common in children and young adults. The nasal cavity has a rich blood supply making it prone to bleeding.
2. Common causes of anterior epistaxis include local trauma, inflammation, infections, and physiological factors like climate. Systemic causes include hypertension, liver/kidney disease, and coagulation disorders.
3. Treatment begins with first aid and locating the bleeding site. Definitive treatments include chemical or electrocautery, vasoconstrictor sprays, and anterior nasal packing. Refractory epist
This document discusses chronic suppurative otitis media (CSOM), which is a long-standing middle ear infection characterized by ear discharge and a permanent perforation of the eardrum. It describes the two main types of CSOM - tubotympanic and atticoantral - and covers their etiology, pathology, clinical features, investigations, treatment, and complications. Cholesteatoma, a growth of skin cells in the middle ear, is also discussed in detail including its origin, classification, expansion and bone destruction potential, and role in increasing risk of complications from middle ear infections.
This document discusses chronic otitis media (COM), a long-standing middle ear infection characterized by persistent ear discharge through a perforated eardrum. It defines the two main types - tubotympanic and atticoantral disease - and describes their signs, symptoms, causes, investigations, and treatment options including medical management and surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty. COM is more common in developing nations and usually starts in childhood, affecting hearing if left untreated. Accurate diagnosis involves examination, tests like audiograms and CT scans, and ruling out complications.
Acute suppurative otitis media is an infection of the middle ear caused most commonly by Streptococcus pneumoniae or Hemophilus influenzae in children. It begins with blockage of the Eustachian tube by inflammation, followed by invasion of pathogens and exudation of fluid into the middle ear space. Signs include a retracted, bulging eardrum and conductive hearing loss. Treatment involves antibiotics to control the infection over 10 days as well as pain medications. Myringotomy may be needed to drain pus if symptoms are not improving. Complications can include persistent fluid, abscess, or spread to the mastoid bone.
Este documento describe el crup, una enfermedad respiratoria caracterizada por estridor inspiratorio y tos perruna causada por la obstrucción de la laringe. Generalmente es causada por virus como el parainfluenza. Afecta a niños menores de 6 años, con mayor incidencia entre los 9 y 36 meses. El tratamiento incluye humidificación, adrenalina nebulizada y corticoides para reducir la inflamación y los síntomas.
Este documento proporciona información sobre el crup viral, una de las causas más comunes de obstrucción aguda de la vía aérea superior en niños. El crup se caracteriza por estridor, tos y dificultad respiratoria y suele ser de origen viral, causado comúnmente por el virus parainfluenza. El tratamiento incluye oxígeno, adrenalina nebulizada y corticoides para reducir la inflamación y los síntomas. El pronóstico suele ser bueno pero pueden presentarse complicaciones como cuadros broncoobstructivos
El documento describe la tos perruna o crup, una enfermedad respiratoria común en niños de 3 meses a 3 años causada principalmente por virus. Los síntomas incluyen tos perruna, afonía y estridor inspiratorio. Se evalúa la gravedad usando la escala de Westley o de Taussig. El tratamiento de elección es la adrenalina nebulizada y corticoides. Los casos leves se tratan de forma ambulatoria mientras que los moderados y graves requieren hospitalización y monitoreo continuo.
La otitis externa es una inflamación del conducto auditivo externo causada por una infección bacteriana, fúngica o viral de la piel del conducto. Existen varios tipos como la otitis externa bacteriana circunscrita (forúnculo), difusa, micótica y vírica. El diagnóstico se basa en el examen físico y la otoscopia. El tratamiento incluye antibióticos tópicos y sistémicos, antifúngicos y medidas no farmacológicas. La prevención consiste
El documento proporciona información sobre el Síndrome de Obstrucción Bronquial (SOB) en lactantes. Explica que el SOB se caracteriza por sibilancias, tos y dificultad respiratoria, y puede ser causado por varias etiologías. Luego describe los factores de riesgo, manifestaciones clínicas, exámenes auxiliares, diagnóstico diferencial y tratamiento de la bronquiolitis aguda, que es un tipo común de SOB causado principalmente por el virus sincitial respiratorio.
Este documento describe diferentes tipos de otitis, incluyendo la otitis externa, media y mastoiditis. La otitis externa es la inflamación del conducto auditivo externo causada por infección secundaria a la ruptura de la barrera mecánica del cerumen. La otitis media es la inflamación e infección de la caja timpánica y celdillas mastoideas, a menudo acompañada de exudado en la cavidad. La otitis media aguda dura menos de 3 semanas, mientras la crónica d
Cuidados De EnfermeríA Del NiñO Con Problemas Respiratoriosguest376df4
El documento habla sobre los cuidados de enfermería para niños con problemas respiratorios. Describe las principales causas de mortalidad y morbilidad en niños, como la neumonía y las infecciones respiratorias agudas (IRAs). Explica las estrategias implementadas en Chile para reducir la mortalidad, como programas de vacunación y campañas de prevención. También clasifica las IRAs, describe factores de riesgo, agentes causales comunes, signos y síntomas, y tratamientos para afecciones específicas como la faringo
Este documento presenta el caso de un niño masculino de 3 años de edad que acude a consulta por tos ronca persistente y dificultad para respirar. Al examen físico presenta rinorrea, disfonía, taquipnea, estridor inspiratorio y disminución del murmullo vesicular pulmonar, lo que sugiere un diagnóstico de laringotraqueobronquitis (croup).
La otitis media es muy común en niños menores de 2 años, afectando al 90% y causando episodios recurrentes en el 25%. Se clasifica en aguda, con efusión y crónica supurativa. La otitis media aguda se trata generalmente con antibióticos por 10 días, mientras que la recurrente puede requerir tratamiento prolongado o cirugía. La otitis crónica supurativa causa pérdida auditiva de largo plazo si no se trata.
1. La otitis media aguda es una de las enfermedades más frecuentes en pediatría, especialmente entre los 6 y 18 meses de edad.
2. El documento revisa los criterios diagnósticos y opciones de tratamiento de la otitis media aguda desde atención primaria, incluyendo tratamiento sintomático, conducta expectante versus tratamiento antibiótico, y criterios para tratamiento antibiótico inmediato.
3. Se concluye que el tratamiento de elección es la analgesia y que en la mayoría de casos leves una conducta
The document discusses diseases of the external ear. It begins with anatomy and physiology of the external ear. It then discusses classifications of external ear diseases including congenital, inflammatory/infectious, reactive, trauma, and tumors. Specific conditions are then discussed in more detail such as preauricular sinus, otitis externa, furunculosis, malignant otitis externa, perichondritis, relapsing polychondritis, herpes zoster oticus, bullous myringitis, granular myringitis, eczema, and auricular hematoma. For each condition, symptoms, signs, causative organisms, diagnosis, and treatment approaches are outlined.
This document discusses various infections and conditions that can affect the external ear. It begins with the anatomy and physiology of the external ear. It then covers specific conditions like acute and chronic otitis externa, furunculosis, otomycosis, granular myringitis, bullous myringitis, necrotizing external otitis, perichondritis, relapsing polychondritis, herpes zoster oticus, erysipelas, and radiation-induced otitis externa. For each condition, it discusses symptoms, signs, diagnosis, and treatment approaches. Throughout it emphasizes the importance of a thorough history and physical exam in diagnosing and managing infections of the external ear
This document summarizes various diseases of the external ear, including congenital conditions, infections, and other abnormalities. It describes conditions such as Darwin's tubercle, Wildermuth's ear, Mozart's ear, microtia, macrotia, bat ears, lop ear, cup ear, accessory auricles, preauricular sinus, hematoma auris, perichondritis, furunculosis, otitis externa, otitis media, granular myringitis, bullous myringitis, necrotizing otitis externa, and malignant otitis externa. For each condition, it provides details on causes, signs, symptoms, pathology,
Mastoiditis is an inflammation of the mastoid process behind the ear and air spaces connecting it to the middle ear that can develop as a complication of acute otitis media or chronic otitis media with symptoms of otalgia, swelling over the mastoid bone, and purulent discharge from the ear. It is typically treated with antibiotics, ear irrigation to remove discharge, analgesics, and may require surgical treatments like mastoidectomy or myringotomy if medical management is insufficient.
This document provides information about otitis externa (ear infection of the outer ear canal). It discusses the anatomy and physiology of the outer ear, classifications and causes of otitis externa including bacterial, viral and fungal infections. It describes the signs and symptoms of acute and chronic otitis externa and treatments including ear cleaning, topical and oral antibiotics, antifungals and corticosteroids. Complications are outlined along with malignant otitis externa, a potentially lethal infection seen in immunocompromised individuals like diabetics.
- Ear diseases can affect the external ear, middle ear, or inner ear. Common diseases include otitis media (middle ear infection), otosclerosis (middle ear bone abnormality), Meniere's disease (inner ear disorder), and deafness.
- Trauma to the external ear is common and can cause hematomas, lacerations, or fractures. Cellulitis and infections like swimmer's ear can also affect the external ear.
- Otitis media is inflammation of the middle ear that can be acute or chronic. It often starts as a viral upper respiratory infection and can become bacterial. Symptoms include ear pain and hearing loss. Treatment involves antibiotics and sometimes surgery.
This document discusses deformities and conditions of the external ear, including congenital abnormalities and inflammation. It describes several congenital conditions involving abnormal development of the pinna, such as Darwin's tubercle, Wildermuth's ear, and Mozart's ear. External ear inflammation, including perichondritis, furunculosis, otitis externa, and other conditions are also covered. Signs, symptoms, causes, and treatments are provided for each condition. The aim is to comprehensively review deformities and inflammatory conditions that can affect the external ear.
This document discusses various ear disorders including infections of the external ear like otitis externa. It describes the anatomy of the ear and the causes, symptoms, diagnosis and treatment of acute and chronic otitis externa. It also covers otitis media, explaining the types like acute suppurative, non-suppurative and chronic suppurative otitis media. The causes, symptoms, investigations and management of different types of otitis media are outlined. Complications of chronic suppurative otitis media and differences between tubotympanic and atticoantral diseases are summarized as well. The pathology of otosclerosis is also briefly explained.
The document summarizes ear disorders including external ear infections, middle ear infections, chronic suppurative otitis media, otosclerosis, and their causes, symptoms, diagnosis, and treatment. For external ear infections, it describes different types like acute diffuse otitis externa and fungal otitis externa. It outlines the anatomy of the ear and discusses acute and chronic middle ear infections. Chronic suppurative otitis media is divided into tubotympanic and atticoantral types. Otosclerosis involves abnormal bone growth affecting the middle ear bones.
This document provides information on managing common ear disorders in a low resource setting. It begins with the clinical approach and objectives of diagnosis and primary management. It then covers anatomy of the ear and physiology of hearing. Major sections discuss external ear disorders like ear wax, trauma, and infections. Middle ear disorders like otitis media, chronic suppurative otitis media, and serous otitis media are covered. Facial nerve palsy, Ramsay Hunt syndrome, and earache are also discussed. Treatment protocols are provided along with referral criteria and pathways.
Chronic suppurative otitis media (CSOM) is a long-standing ear infection characterized by persistent ear drainage through a perforated eardrum. It is more common in developing countries and affects all ages. CSOM can be tubotympanic type, confined to the middle ear space, or atticoantral type, involving the mastoid air cells. Atticoantral disease poses greater risks of complications due to bone erosion and possible cholesteatoma formation. Treatment involves topical and oral antibiotics as well as surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty to repair damaged structures and stop drainage.
This document discusses different types of ear infections:
- Otitis externa is inflammation of the external ear canal and can be caused by bacteria, fungi, or other factors. Acute cases involve pain while chronic cases involve pruritus. Treatment involves cleaning and antibiotics.
- Acute otitis media is a common childhood infection involving the middle ear. It is usually caused by viruses but can become bacterial. Symptoms include ear pain, fever, and hearing loss. Treatment is usually with amoxicillin or other antibiotics.
- Otitis media with effusion involves fluid in the middle ear without infection. It often follows acute otitis media and can cause temporary hearing loss. Most cases
This document discusses different types of ear infections, including otitis externa (infection of the external ear canal), otitis media (infection of the middle ear), and mastoiditis (infection of the mastoid bone behind the ear). It describes the anatomy of the ear canal and risk factors for ear infections like age and environment. Common bacteria that cause ear infections are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Symptoms, treatment, and diagnostic testing for each type of ear infection are provided.
Furunculosis is a localized infection of a single hair follicle in the external ear canal caused mainly by Staphylococcus aureus bacteria. It presents as a painful, blocked ear with discharge and tender swelling around the pinna. Treatment involves antibiotics, incision and drainage of abscesses, and topical antiseptic ear drops. Without treatment, it can cause scarring and narrowing of the ear canal.
Furunculosis is a localized infection of a single hair follicle in the external ear canal caused mainly by Staphylococcus aureus bacteria. It presents as a painful, blocked ear with tender swelling and scanty discharge. Treatment involves oral or intravenous antibiotics depending on severity, with topical treatments like antibiotics also used. Granular myringitis is a form of external otitis characterized by granulation tissue on the tympanic membrane and possibly in the ear canal. It typically causes foul-smelling discharge but little pain. Diagnosis is based on appearance during otoscopy. Topical steroid/antibiotic drops are the main treatment approach.
Diseases of the external ear are common conditions to be encountered in ENT practice. This presentation is about the major conditions of pinna and EAC including pinna defects, pseudocyst of pinna, perichondritis, hematoma, pseudocyst of pinna, otitis externa, otomycosis, malignant otitis externa, keratosis obturans etc.
Diseases of the external ear can be congenital, traumatic, inflammatory, or neoplastic in nature. Common inflammatory conditions include otitis externa, perichondritis, and keratosis obturans. Otitis externa may be localized like furunculosis or diffuse. Malignant otitis externa is a severe infection that can spread to the skull base. Preauricular sinus and hematoma of the pinna are examples of traumatic external ear diseases. Treatment involves cleaning, topical or oral antibiotics, incision and drainage of abscesses, and sometimes surgery. Recurrence is possible with some conditions.
Acute suppurative otitis media (ASOM) is an inflammation of the middle ear caused by bacterial infection. It peaks in children aged 6-12 months and is more common in boys. The infection enters via the Eustachian tube. Clinically it presents as ear pain and fever, and progresses through stages of tubal blockage, pre-suppuration, and suppuration. Treatment involves antibiotics, analgesics, and myringotomy to drain pus if the eardrum is bulging. Nursing care focuses on pain relief, drainage, prevention of complications, and educating families on signs of recurrence or complications like mastoiditis.
Renal trauma can occur from blunt or penetrating mechanisms. CT imaging is the gold standard for evaluation. Most renal injuries can be managed non-operatively with conservative treatment. Higher grade injuries or those with signs of failure like hematuria may require intervention like stenting or embolization. Operative management is only indicated for life threatening hemorrhage or other injuries requiring exploration. With proper evaluation and treatment, complications can often be avoided and renal function preserved.
This document reviews surgical options for treating simple meconium ileus in newborns. Non-operative treatments include hydration, gastric decompression, antibiotics, and hyperosmolar enema washouts. Operative options are considered if non-operative treatments fail or complications occur. Surgical techniques include manual evacuation of the meconium mass, enterotomies with irrigation, and resections with anastomoses or stoma creations. Post-operative management focuses on resuscitation, fluid replacement, and use of hyperosmolar solutions via feeding tubes or stomas.
This document provides an overview of the management of obstructive jaundice. It begins with definitions and classifications of jaundice. Obstructive jaundice can be intrahepatic or extrahepatic in origin. Common causes of intrahepatic cholestasis include viral hepatitis, alcoholic hepatitis, and drug toxicity. Extrahepatic obstructions are often due to choledocholithiasis (gallstones in the common bile duct), tumors, or strictures. Diagnostic imaging includes ultrasound, MRCP, ERCP, and intraoperative cholangiography. Treatment depends on whether the obstruction is pre-operative or discovered during cholecystectomy, and may involve ERCP, laparoscopic or open CBD exploration, or
A breif discussion on some of the available options in the reconstruction of pilonidal sinus defect. Post excision of pilonidal sinus. A plastic surgery view of the problem.
Carcinoids are rare neuroendocrine tumors that originate from enterochromaffin cells. They most commonly occur in the gastrointestinal tract and bronchopulmonary system. Carcinoids are classified based on their site of origin and pathological features. Well differentiated carcinoids tend to grow slowly, while poorly differentiated carcinoids are more aggressive. Treatment involves surgical removal of localized tumors. For metastatic disease, treatment focuses on controlling carcinoid syndrome symptoms caused by secreted hormones and peptides. Prognosis depends on tumor stage, grade, and site of origin. Long term monitoring is important after treatment due to the risk of recurrence.
Atrial flutter is an abnormal heart rhythm where the atria beat too fast, usually between 240-340 beats per minute. It often occurs in patients with underlying heart conditions that cause enlargement or damage to the atria, such as rheumatic heart disease, congenital heart disease, or COPD. Common symptoms include palpitations, chest discomfort, and fatigue. Treatment options include medications to slow the heart rate or restore normal rhythm, cardioversion, catheter ablation, or implanting a pacemaker.
Refractive errors occur when there is a mismatch between the eye's optical power and its axial length, causing light rays to focus in front or behind the retina. The most common refractive errors are myopia, hyperopia, and astigmatism. Diagnosis involves using instruments like autorefractors and retinoscopes to measure how light enters the eye. Optical corrections include spectacle lenses, contact lenses, and intraocular lenses, with the type chosen based on factors like comfort, durability, and amount of correction needed.
The document discusses the analysis of wounds from a forensic perspective. It describes how a pathologist can determine details about wounds like type, dimensions, and location. It also discusses analyzing specifics of different wound types like bruises, abrasions, incised wounds, and stab wounds. Details like shape, size, depth, and other characteristics can provide information about the weapon and force used. Analysis of wounds is important forensic evidence that can provide details about crimes and injuries.
This document provides an overview of blood spatter analysis as a field of forensic examination. It discusses key concepts such as the types of bloodstain patterns that can be analyzed, including passive drops, transfer stains, cast-off stains, and projected stains created by force. Specific terminology used in blood spatter analysis is defined. Factors that can be determined from bloodstain pattern analysis are listed, such as the type and velocity of the weapon used. The stages of blood drop impact onto a surface are described. The relationship between bloodstain size and impact velocity is outlined.
Thoracic aortic aneurysms can occur in the ascending aorta, aortic arch, or descending aorta. They are generally asymptomatic but can potentially rupture or dissect, leading to death. Surgical repair is recommended for thoracic aortic aneurysms over 5.5 cm in the ascending aorta or over 6.5 cm in the descending aorta, or if the aneurysm is growing rapidly. Both open surgical graft replacement and endovascular stent grafting are options for repair, with endovascular approaches having shorter recovery but risk of complications like endoleaks. Untreated thoracic aortic aneurysms have high mortality from rupture.
Surgical drains, tube, catheters and central linesAhmed Almumtin
This document provides an overview of different types of surgical drains, tubes, and lines, including their purposes, uses, and potential complications. It discusses open and closed drainage systems, as well as active and passive drains. Specific drains covered include Jackson-Pratt drains, Penrose drains, negative pressure wound therapy, chest tubes, T-tubes, and Redivac drains. Guidelines are provided for drain placement, management, and removal. Complications related to poor drain selection, placement, and postoperative care are also summarized.
Overview management of postpartum haemorrhageAhmed Almumtin
Hemorrhage remains a leading cause of maternal mortality. Postpartum hemorrhage (PPH) is defined as blood loss over 500mL within 24 hours of delivery or blood loss of any amount with hemodynamic changes. The main causes of PPH are uterine atony, trauma, and retained placental tissue. Prevention focuses on risk factor identification and active management of the third stage of labor with uterotonics. Treatment involves fluid resuscitation, blood transfusion, uterotonics, uterine massage, and in severe cases, surgical interventions like hysterectomy.
1. Mr. Al-Momtan, a 56-year-old male, presented with epigastric abdominal pain for 2 weeks which was worse after eating. Clinical exams and tests diagnosed him with a peptic ulcer disease.
2. He was prescribed a triple therapy of antibiotics and a PPI for 3 weeks to treat his condition.
3. Dyspepsia is a common gastrointestinal condition with many potential causes including non-ulcer dyspepsia, GERD, peptic ulcers, and H. pylori infection. Guidelines recommend lifestyle changes, antacids, and empirical PPI therapy as first-line treatment options.
orthopedic and rheumatologic disorders of the knee jointAhmed Almumtin
The document provides an overview of common knee joint conditions and injuries, including:
1) Meniscal tears, which are common in young adults and cause pain, swelling, and locking or giving way of the knee.
2) Osteochondritis dissecans, where a fragment of bone and cartilage separates from the femoral condyle, most often in males aged 15-20. It causes intermittent pain and swelling.
3) Osteoarthritis, a common cause of knee pain in those over 50, characterized by cartilage breakdown, bone changes, and deformities like varus. Conservative care is usually tried initially.
This document provides an overview of regional anesthesia techniques including spinal anesthesia, epidural anesthesia, and Bier block. Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, while epidural anesthesia involves injection into the epidural space. Bier block, also called intravenous regional anesthesia, involves exsanguinating a limb and injecting local anesthetic near the tourniquet. The document describes anatomy, procedures, indications, advantages, complications, and pharmacology for each technique.
Psychotic disorders involve hallucinations and/or delusions where the person loses contact with reality. Schizophrenia is a type of psychosis characterized by disturbances in thought, emotion and behavior. It affects about 1% of the population and usually develops in early adulthood. Symptoms include delusions, hallucinations, disorganized speech and behavior. Treatment involves antipsychotic medications and psychosocial support. Prognosis depends on several factors but schizophrenia generally involves long-term impairment.
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to vascular compromise and tissue necrosis. Initial symptoms are vague abdominal pain that localizes to the right lower quadrant as inflammation spreads. A physical exam may reveal tenderness at McBurney's point. Imaging studies like CT scans can help diagnose appendicitis, especially in atypical cases. Treatment is an appendectomy along with preoperative antibiotics to prevent infection.
The document discusses the anatomy and clinical presentation of appendicitis. It describes the location and blood supply of the appendix, noting that it can be in different positions which can affect the pain experienced. It also summarizes that the pain of appendicitis initially occurs centrally in the abdomen but becomes localized as inflammation spreads, and that variations in anatomy can cause atypical presentations of the condition.
2. Anatomy and Physiology
• Consists of the auricle and EAM
• Skin-lined apparatus
• Approximately 2.5 cm in length
• Ends at tympanic membrane
3. Anatomy and Physiology
• Auricle is mostly skin-lined cartilage
• External auditory meatus
• Cartilage: ~40%, Bony: ~60%
• S-shaped, Narrowest portion at bony-cartilage junction
4. Anatomy and Physiology
• EAC is related to
various contiguous
structures
• Tympanic membrane
• Mastoid
• Glenoid fossa
• Cranial fossa
• Infratemporal fossa
5. Anatomy and Physiology
• Innervation: cranial nerves V, VII, IX, X,
and greater auricular nerve
• Arterial supply: superficial temporal,
posterior and deep auricular branches
• Venous drainage: superficial temporal and
posterior auricular veins
• Lymphatics
6. Anatomy and Physiology
• Squamous
epithelium
• Bony skin – 0.2mm
• Cartilage skin
• 0.5 to 1.0 mm
• Apopilosebaceous
unit
7. Otitis Externa
• Bacterial, viral or fungal infection of
external auditory canal
• Categorized by time course
• Acute
• Chronic
8. Speculum findings:
• the canal may be so swollen that a view into
the ear is impossible
• In swimmers, divers and surfers, chronic water
exposure can lead to the growth of bony
swellings in the canal known as exostoses.
These can interfere with the drainage of wax
and predispose to infection.
9. Differential diagnoses:
• Otitis media
• Ramsay Hunt syndrome
• Furuncle
• Skull base osteomyelitis
• Preauricular cyst and fistula
• Lacerations
• Atopic dermatitis
• Cerumen impaction
• Exostosis and osteoma
• Foreign body
• Acute (bullous) and chronic (granular)
myringitis
14. Factors contributing to AOE
• High humidity
• Water exposure
• Maceration of canal skin
• High environmental temperature
• Local trauma
• Perespiration
• Allergy
• Stress
• Removal of normal skin lipids
• Absence of cerumen
• Alkaline pH of canal
15. AOE: Preinflammatory Stage
• Oedema of stratum corneum and plugging
of apopilosebaceous unit
• Symptoms: pruritus and sense of fullness
• Signs: mild edema
• Starts the itch/scratch cycle
17. AOE: Severe Stage
• Severe pain, worse
with ear movement
• Signs
• Lumen obliteration
• Purulent otorrhoea
• Involvement of
periauricular soft
tissue
18. AOE: Treatment
• Most common pathogens: P. aeruginosa and S. aureus,
E.coli and proteus.!
• Four principles
• Frequent canal cleaning; swap or suction
• With sever EO, palcement of a wick made of sponge or
gauze provides a pathway for drops to be delivered to the
EAC wall skin for 48-72 hours!
• Topical antibiotics, and if sever>> Systemic PO,ABT
• Pain control
• Instructions for prevention
19. AT A GLANCE. . .
• Ostalgia
• Tenderness on palpation or manipulation
(tragus sign)
• Ear fullness
• Conductive hearing loss.
• Erythaema of meatus and canal
• Swelling and obstruction of canal
• Crusting and discharge
• Odor!
20. Furunculosis
• Acute localized infection
• Lateral 1/3 of posterosuperior canal
• Obstructed apopilosebaceous unit
• Pathogen: S. aureus
23. Furunculosis: Treatment
• Local heat
• Analgesics
• Oral anti-staphylococcal antibiotics
• Incision and drainage reserved for
localized abscess
• IV antibiotics for soft tissue extension
- tri-adcortyle!
24. Erysipelas
• Acute superficial
cellulitis
• Group A, beta hemolytic
streptococci
• Skin: bright red; well-
demarcated, advancing
margin
• Rapid treatment with
oral or IV antibiotics if
insufficient response
25. Otomycosis
• Mostly in children who are
exposed to warm, moist
climates or who have a Hx
of chronic use of antibiotic
ear drops.
• Fungal infection of EAC
skin
• Primary or secondary
• Most common organisms:
Aspergillus and Candida
26. Otomycosis: Signs
• Canal erythaema
• Mild oedema
• White, gray, green,
yellow or black
fungal debris
Otomycosis: Symptoms
• Often indistinguishable from
bacterial OE
• Pruritus deep within the ear
• Otorrhoea
• Dull pain
• Hearing loss (obstructive)
• Tinnitus
27. Otomycosis: Treatment
• Thorough cleaning and drying of canal
• Topical antifungals (clotrimazole for eg.,
amphotericine B, oxytetracycline-polymyxin, and
nystatin are very effective!)
• Acidifying of the EAC with drops like 2% acetic acid,
3% boric acid or sulzberger’s powder are also helpful
in the t/t of fungal infections.
28. Necrotizing (malignant) External Otitis(NEO)
• Potentially lethal infection of EAC and
surrounding structures
• Pseudomonas aeruginosa is the usual
culprit
• Risk Factors:
- Diabetes Mellitus
- Elderly
- Immunocompromised state
- Human Immunodeficiency Virus (HIV)
• Typically seen in diabetics and
immunocompromised patients
29. NEO: Signs & Symptoms
• Similar to Otitis Externa except
• Severe, unrelenting Ear Pain and Headache
• Persistent discharge
• Does not respond to topical medications
• Commonly associated with Diabetes Mellitus
• Granulation tissue in posterior and inferior canal
• Pathognomonic for necrotizing otitis
• Occurs at bone-cartilage junction
• Extra-auricular findings
• Cervical Lymphadenopathy
• Trismus (TMJ involvement)
• Facial Nerve Palsy or paralysis (Bell's Palsy)
• Associated with poor prognosis
30. NEO: Dx, Prevention and T/T:
• Prognosis; Reportedly mortality 20-53%
• Dx: Hx, PE, Labs and Imaging:
- Labs; FBC, Culture of discharge, ESR, Serum glucose, Serum
creatinine.
- Radiology; CT, or MRI (ear),Tc 99m medronate methylene bone
scanning, Ga 67 scintography.
• Prevention:
- Avoid use of cotton swabs in ear and other canal trauma.
- Use caution when irrigating ear of high risk patients.
- Treat eczema of ear canal and other pruritic dermatitis
31. NEO: Treatment
• Intravenous antibiotics for at least 4 weeks
– with serial gallium scans monthly
• Local canal debridement until healed
• Pain control
• Use of topical agents controversial
• Hyperbaric oxygen experimental
• Surgical debridement for refractory cases
32. NEO: Diagnosis
• Cohen and Friedman – criteria from review: They were divided into two
categories: obligatory and occasional. The obligatory criteria are: pain, edema,
exudate, granulations, microabscess (when operated), positive bone scan or
failure of local treatment often more than 1 week, and possibly pseudomonas in
culture. The occasional criteria are diabetes, cranial nerve involvement, positive
radiograph, debilitating condition and old age. All of the obligatory criteria must
be present in order to establish the diagnosis. The presence of occasional
criteria alone does not establish it. The importance of Tc99 scan in detecting
osteomyelitis is stressed. When bone scan is not available, a trial of 1-3 weeks
of local treatment is suggested. Failure to respond to such treatment may assist
in making the diagnosis of MEO.
33. NEO: Mortality
• Death rate essentially unchanged despite
newer antibiotics (37% to 23%)
• Higher with multiple cranial neuropathies
(60%)
• Recurrence not uncommon (9% to 27%)
• May recur up to 12 months after treatment
34. Perichondritis/Chondritis
• Infection of perichondrium/cartilage
• Result of trauma to auricle
• May be spontaneous (overt diabetes)
• Usual pathogens include pseudomonas
species and mixed flora
35. Perichondritis: Symptoms
• Pain over auricle and deep in canal
• fever
• Pruritus
Perichondritis: Signs
• Tender auricle
• Induration
• Oedema
• erythaema
• Advanced cases
• Crusting & weeping
• Involvement of soft
tissues
36. Perichondritis: Treatment
• Aspiration of the pus
• Use antibiotics of gram-negative coverage, specifically
anitpseudomonals.
• If frank chondritis develops, incisions should be made in
the cartilage in order to provide adequate drainage.
• Mild: debridement, topical & oral antibiotic
• Advanced: hospitalization, IV antibiotics
• Chronic: surgical intervention with excision of necrotic
tissue and skin coverage
37. Relapsing Polychondritis
• Uncommon progressive inflammatory disorder that
may affect children, but more commonly in adults.
• Episodic and progressive inflammation of cartilages
• Autoimmune etiology?
• External ear, larynx, trachea, bronchi, and nose may
be involved
• Involvement of larynx and trachea causes
increasing respiratory obstruction
38. Relapsing Polychondritis
• Fever, pain
• Swelling, erythaema
• Arthralgia!
• Tenderness of the nasal
septum may progress to
complete destruction of the
septum
39. Dx and T/t
• Weak +ve RF -Systemic steroids
• ANA +ve such as prednisolone
• High ESR, -In resistant cases;
• Anaemia dapsone,
cyclophosphamide or
• And difinitve Dx is made azithioprine may be
by a biopsy from the used
affected cartilage
40. Herpes Zoster Oticus
(Ramsay Hunt Syndrome)
• J. Ramsay Hunt described in 1907
• Viral infection caused by varicella zoster
• Infection along one or more cranial nerve
dermatomes (shingles).
- herpes zoster of the pinna with otalgia.
- facial paralysis
- sensorineural hearing loss
- Bullus myringitis
- A vesicular eruption of the concha of the
pinna and the EAC.
41. Symptoms
• Early: burning pain in one ear,
headache, malaise and fever
• Late (3 to 7 days): vesicles,
facial paralysis
Treatment
• Corneal protection
• Oral steroid taper (10 to 14 days)
• Antivirals (eg. Valacyclovir)
• Facial nerve decompression
(controversial)!
42. Bullous Myringitis
• Viral infection
• Confined to tympanic membrane
• Primarily involves younger children
43. Bullous Myringitis: Symptoms
• Sudden onset of severe pain
• No fever
• No hearing impairment
• Bloody otorrhoea (significant) if rupture
Bullous Myringitis: Signs
• Inflammation limited to TM & nearby canal
• Multiple reddened, inflamed blebs.
• Hemorrhagic vesicles
44. Bullous Myringitis: Treatment
• Self-limiting
• Analgesics
• Topical antibiotics to prevent secondary
infection
• Incision of blebs is unnecessary
45. Chronic Otitis Externa
• Acute otitis externa occurs in 4 of every 1000 people
per year
• Otitis externa is defined as chronic when the duration
of the infection exceeds 4 weeks or when more than
4 episodes occur in 1 year
• Bacterial, fungal, dermatological aetiologies
COE: Symptoms
• Unrelenting pruritus
• Mild discomfort
• Dryness, Crusting, and flaking of canal skin
47. COE: Treatment
• Similar to that of AOE
• Topical antibiotics, frequent cleanings
• Topical Steroids
• Surgical intervention
• Failure of medical treatment
• Goal is to enlarge and resurface the EAC
48. Radiation-Induced Otitis Externa
• OE occurring after
radiotherapy
• Often difficult to treat
• Limited infection treated
like COE
• Involvement of bone
requires surgical
debridement and skin
coverage
49. Granular Myringitis (GM)
• Deepithelization of the TM
• Localized chronic inflammation of pars
tensa with granulation tissue
• Sequela of primary acute myringitis,
previous OE, perforation of TM
• Common organisms: Pseudomonas,
Proteus
50. GM: Symptoms
• Foul smelling discharge from one ear
• Often asymptomatic
• Slight irritation or fullness
• No hearing loss or significant pain
GM: Signs
• TM obscured by pus
• “peeping” granulations
• No TM perforations
51. GM: Treatment
• Careful and frequent debridement
• Topical anti-pseudomonal antibiotics
• Occasionally combined with steroids
• At least 2 weeks of therapy
• May warrant careful destruction of granulation tissue if
no response
52. Eczema
• External clue to OE (atopic, contact and
sebrrheoic) dermatitis
• Usual symptom is itching.
• P/E; erythaema, oedema, flaking and crusting.
• T/t:
- Local cleansing.
- Usage of corticosteroid and drying agents.
• Metal sensitivity is the most common form of
chronic dermatitis involving the ear.!
• Nickel is the most common offending metal.
• Women are affected more than men.
- Ear peircing is an important cause of primary
sensitization to nickel.
53. Conclusions
• Careful History
• Thorough physical exam
• Understanding of various disease
processes common to this area
• Vigilant treatment and patience
Ramsay Hunt syndrome: This condition, more accurately known as herpes zoster oticus, is caused by varicella-zoster viral infection. Ramsay Hunt syndrome is characterized by facial nerve paralysis and sensorineural hearing loss, with bullous myringitis and a vesicular eruption of the concha of the pinna and the EAC. A painful otitis externa may be present as well. Treatment includes use of an antiviral agent (eg, valacyclovir) and systemic steroids. The role of facial nerve decompression remains controversial. Furuncle: Staphylococcal infection of a hair follicle is the usual cause of a furuncle. This infection occurs in the lateral cartilaginous hair-bearing portion of the EAC. On otoscopic examination, a furuncle is a localized infection, which may develop into an abscess, rather than the diffuse inflammatory process characteristic of otitis externa. Skull base osteomyelitis: This serious infection, also known as malignant otitis externa, occurs most often in patients who are diabetic or immunocompromised. The pathogenic bacteria are usually Pseudomonas aeruginosa . Other predisposing conditions include arteriosclerosis, immunosuppression, chemotherapy, steroid use, and other immunodeficient states. The diagnosis is strongly suggested by a history of diabetes mellitus, severe otalgia, cranial neuropathies, and characteristic EAC findings.The EAC may be filled with friable granulation tissue, which is primarily found inferiorly. Because this presentation may be identical to that of a soft tissue malignancy, prudence dictates a tissue biopsy, even if a history of diabetes mellitus is present. Bare bone of the EAC floor may be exposed; small bony sequestra may be observed as well.CT scanning demonstrates bone erosion, and gallium scanning can be performed at points throughout treatment to monitor resolution. Treatment consists of administration of an antipseudomonal IV antibiotic such as ceftazidime (in some cases) or oral ciprofloxacin (in less dramatic cases). Extended treatment for at least 6 weeks is most appropriate. Hyperbaric oxygen therapy may also be effective. Surgical debridement is reserved for granulation tissue and bony sequestra. Preauricular cyst and fistula: Abnormal development of the first and second branchial arch may result in the formation of a preauricular cyst or fistula, which may manifest as persistent discharge or recurrent infection. A draining sinus may be present anterior to the tragus; when infected, the cyst distends with pus and the overlying skin is erythematous. These lesions are managed by complete surgical excision if they become repeatedly infected. The facial nerve is at risk of injury during the excision of these lesions because of the close relationship of the preauricular cyst or fistula to the superior branches of the facial nerve within the parotid gland.First branchial cleft anomalies have a more complex embryologic origin than preauricular cysts and fistulas. These lesions may not have an obvious sinus tract on the skin and may manifest as an abscess extending deeply into the EAC, parotid, and/or neck. Lacerations: Full-thickness auricular lacerations may be observed after blunt or sharp trauma. These injuries are managed surgically by closing both the perichondrium and the skin. In contrast, external canal lacerations may occur after attempts at cleaning the ear canal using cotton-tipped applicators. These lacerations are usually managed by microscopically placing any skin flaps in their normal position, packing the ear canal, and administering topical antibiotic drops. Atopic dermatitis: Drug sensitivity to topical antibiotic solutions is well known. Neomycin allergy occurs in up to 5% of patients treated with the medication. Suspect drug sensitivity if worsening of symptoms associated with skin excoriation and weeping occurs in the distribution of the topical medication exposure after application of drops.Metal sensitivity also manifests as excoriation, erythema, and edema around the exposure site (eg, a piercing hole). A common allergen is nickel, an impurity that may be present in precious metals. Atopic dermatitis is managed by removal of the allergen, such as an earring, and beginning topical steroid and antibiotics if the wound is secondarily infected. The diagnosis of metal sensitivity is confirmed by performing a skin patch test. Cerumen impaction: Cerumen impaction is the most common abnormality found on otoscopic examination, yet only a small proportion of the general population requires regular disimpaction because the EAC has the innate ability to produce and clear itself of cerumen. Cerumen may vary in color and consistency and may exist with other pathologies. Of note, debris in the EAC from cholesteatoma or tumors may be confused with cerumen, indicating that considerable care is required when attempting debridement of the EAC. Debridement may be accomplished with microinstruments or by aspirating the ear canal contents with a No 5 or No 7 Barton suction, while under direct vision through the otoscope or microscope. Irrigation of the ear canal is another option, but use of a pressurized irrigation system entails the risk of trauma. Exostosis and osteoma: The 2 most common bony lesions of the EAC, exostoses and osteomas, differ histologically and clinically. Exostoses tend to arise from the anterior and/or posterior floor of the medial EAC. Exostoses have a sessile base and are covered with normal-appearing skin. Both anterior and posterior exostoses may be found simultaneously.Osteomas may arise from any region of the bony EAC and often are pedunculated. Osteomas may also be either single or multiple and are covered by normal skin. Exostosis and osteomas require surgical treatment only if they are so large that they lead to a conductive hearing loss or intractable otitis externa. Foreign body: Foreign bodies are not infrequently encountered in the EAC. In children, parts of toys or even food may be found in the EAC, and, thus, appearance varies. In adults, fragments of cotton swabs are the most common finding. Erythema and edema surrounding the foreign body are commonly present. Using microinstruments, the foreign body may be removed under a microscope, depending on the patient's ability to cooperate. Acute (bullous) and chronic (granular) myringitis: Acute myringitis is usually caused by a mycoplasma or viral infection and is observed in adults and children. It is characterized by hemorrhagic bullae involving the tympanic membrane and a flulike syndrome. It is self-limiting and requires pain and fever management.Chronic myringitis is defined as deepithelization of the tympanic membrane, granulation tissue formation, and discharge. Treatment includes topical application of eardrops, a caustic solution in unresponsive cases, and mechanical removal of polypoidal granulations.
In the early stages of EO, heat, humidity, maceration, or other factors may act to remove cerumen or change the pH of the canal. These changes may cause itching that then elicits digital manipulation or instrumentation of the canal that traumatizes the skin, thus allowing bacteria to enter the surrounding soft tissue. An increase in infection and iflammation may cause canal oedema or complete obstruction of the canal in sever cases.
-lateral one third >> hair bearing portion of the canal.
Localized furucle infection but may proress into an abscess.
Both the moisture and ab alter the cerumen and normal bacterial flora of the EAC. These black dots (spores) are the appearance of fungal infection ( aspergillus niger ), with other fungi the spores may be white or yellow chronic otitis externa : Although the canal wall is not swollen, the skin is excoriated and red. The drum is essentially normal.
Some may aquire histo o granulation tissue. Galium has high sensitivity for current infx, and usefull for F/U.
Admit to hospital Anti-pseudomonal antibiotics Intravenous Antibiotic options Ciprofloxacin 400 mg IV q12 hours Imipenem 0.5 mg IV q6 hours Meropenem 1.0 grams IV q8 hours Ceftazidime 2.0 grams IV q8 hours Cefepime 2.0 grams IV q12 hours Gentamicin 1 to 1.66 mg/kg IV or IM/IV with Ticarcillin or Piperacillin Timentin 3.0 grams IV q4 hours Oral antibiotic options (after initial IV course) Ciprofloxacin 750 mg PO q12 hours Course Start with IV antibiotics Continue antibiotics for 4-8 weeks Consult Otolaryngology (ENT) Surgical debridement may be required Clean ear canals meticulously on a daily basis Clean and debride canal Apply topical antibiotic agents Other modalities to consider Hyperbaric oxygen chamber
Blood and/or serum collects in the potential space between the cartilage and perichondrium and infection of this fluid results in perichondritis and chondritis.
Destruction of the cartilage due to inflammatory infiltrates is often followed by granulation and then fibrosis and calcification
Destruction of the septum ultimately lead to a nasal-suddle deformity in some cases. DDx: rheumatoid arthritis (juvnile) lymphoma or infectious perichondritis