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Otitis Externa ear PowerPoint presentation
- 1. OTITIS EXTERNA DR VISHNU VANDANAKAVATUR SIR H N RELIANCE FOUNDATION HOSPITAL
- 2. Definition It isa generalised condition of the skin in EAC It is characterised by general oedema & erythema which may be associated with itchy discomfort with or without ear discharge
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- 4. Aetiology INFECTIVE : Bacterial Localised otitisexterna (furuncle) Diffuse otitis externa Malignant otitis externa Fungal Otomycosis Viral Herpes zoster oticus Otitis Externa Haemmorhagica
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- 6. Aetiology REACTIVE: Eczematous otitis externa Seborrheicotitis externa Irritant/Allergic Up to 25% of patients may be clinically hypersensitive to topical medication. Steroids may also sensitize the ear and can be a major exacerbating factor in some patients. This hypersensitivity can be through both atopic and non-atopic ‘allergic’ mechanisms and may or may not involve IgE.
- 7. Pathogenesis Clinical course ofotitis externa can be divided into: Pre-inflammatory stage Acute inflammatory stage Chronic inflammatory stage
- 8. Pre-inflammatory Stage Protective lipid/acidbalance is lost Stratum Corneum – oedematous Blocks sebaceous/apocrine glands - aural fullness/itching
- 9. Acute Inflammatory Stage Thereis progressively thickening exudate, increasing oedema obliteration of lumen and increasing pain 3 grades: mild: little or no obliteration moderate: sub-total obliteration severe: complete obliteration Severe stage – cervical lymphadenopathy
- 10. Chronic Inflammatory Stage Inflammationslasting > 6 months Thickening of external canal skin Fibrous canal stenosis Acquired Atresia of the external ear
- 11. Diagnosis Otitis externais a clinical diagnosis based on symptoms and signs: pain, itch, oedema and erythema of the external auditory canal with or without purulent otorrhoea and debris in the meatus An active Chronic otitis media may be identifiable in some cases
- 13. Epidemiology Otitis externais estimated to have a prevalence of 0.4% per year It affects approximately 10% of the population during their lifetime
- 14. Outcome If untreated,mild attacks of otitis externa often spontaneously resolve as the epithelial barrier becomes re-established, the piloapocrine units produce normal secretions and the PH of the canal returns to normal. If the inflammation progresses faster than repair, increasing pain, otorrhoea and oedema of the canal occurs and the patient‘s condition will deteriorate
- 15. Complications Lymphadenopathy Erysipelas Parotitis Perichondritis/ Chondritis/ Cellulitis Malignant otitis externa Canal fibrosis and stenosis
- 16. Management The principles oftreatment of otitis externa are as follows: thorough and regular aural toilet topical medication to the external auditory canal, with or without a wick analgesia treatment of regional and/or systemic complications with systemic antibiotics prevention of aetiological factors that could lead to exacerbation or recurrence.
- 17. Treatment of AcuteOtitis Externa Ear toilet - Toilet remains the most effective single treatment for otitis externa Medicated wicks Glycerol and ichthammol (90% : 10%) Antibiotic-steroid preparation Acidifying/antiseptic agents – gentian violet Mild astringent – 8% aluminium acetate/3% silver nitrate
- 18. Treatment of AcuteOtitis Externa Antibiotics Topical antibiotics – (Neomycin/Ciprofloxacin/Ofloxacin) with/without corticosteroids Broad spectrum systemic antibiotics Analgesics
- 19. Treatment of ChronicOtitis Externa GOAL- prevent stenosis & restore normal skin in EAC Frequent inspection & debridment of EAC Antibiotic-corticosteroid topical applications EAC can be painted with gentian violet/ triamcinolone/nystatin Treat underlying causes – Seborrhoea, Psoriasis, Neurodermatitis Canalplasty with skin grafting – restore canal patency and hearing
- 20. Prevention Avoid waterentry/ avoid using cotton buds/avoid digital manipulation of ear canal Swimmers are instructed to use ear plugs