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Perichondritis, Auricular Hematoma, Cerumen, Otitis Externa, Malignant OE, FB
Terms in this set (65)
Outer 1/3 of EAC consists of
sebaceous and ceruminous glands
fibrous lining that covers surface of cartilage
infection of perichondrium of the pinna, pus accumulates
Causes of Perichondritis
Trauma (ear peircing, incision), insect bite
Signs and Sx of Perichondritis
Redness, Pain, Swelling
Tx of Perichondritis if no abcess
Abx and Systemic Steroids
Tx of Perichondritis if abcess present
I&D, Drain 24-72 hours, always culture. Warm Compress, Mattress Suture through the ear..... Abx
What Abx would you prescribe for perichondritis?
Fluoroquinolones best (good cartilage penetration)... Can use aminoglycoside + PCN
Why are quinolones awesome?
Broad Spectrum, Gram +, Gram -, intracellular, anaerobes, kidney and bone distribution......
inhibits DNA synthesis by acting o DNA gyrase, 100% bioavailability
Pregnant/Breast Feeding, kids w/o epiphysial plates closed, interacts with warfarin
4 Quinolone Drugs
Cipro, Levo, Moxi, Gati (Floxacin)
Which of the 4 quinolones is great against pseudomonas?
Ciprofloxacin (Cipro ®)
Aminoglycoside-- MOA, and name 2 drugs
Bind 30s, Gentamycin & Tobermycin
results from avascular necrosis from either auricular hematoma or perichondritis
blood clot between perichondrium and cartilage from blunt trauma
Treatment for Auricular Hematoma
I&D with bolster (sewn on dressing), Pressure Dressing Oral Abx
What Abx would you give for auricular hematoma?
Cephalexin (Keflex ®) 500 mg TID, 5 days
1 gen Cephalosporins are
Cephalexin (Keflex ®) ,, Cephadroxil (Duricef)
1st Gen Cephalosporins good for
Gram +, MSSA
2nd Gen Cephalosporins
Cefaclor (Ceclor ®) ,, Cefprozil (Cefzil ®) , ,, Cefuroxime Axetil (Ceftin ®)
2nd Gen Cephalosporin Facts
More coverage than 1st gen, 30% bioavialbility, better IV
3rd Gen Cephalosporins
Cefdinir (Omnicef ®), Cefixime (Suprax ®) , Cefpodoxime (Vantin ®), Ceftriaxone (Rocephrin ®)
3rd Gen Cephalosporin facts
Gram + & -..... Anaerobic/ear infections// ****
Does not cover Staph
Comlications of Auricular Hematoma
reforming hematoma, avascular necrosis, Fibrosis (Cauliflower ear)
Prevention of Auricular Hematoma
Cerumen made of
glandular secretions (outer 1/3 EAC) and epithelium
Cerumen Protects ear by
Risk Factors for Serumen Impaction
Q-tips, Hearing Aid, Ear Plugs, Osteoma, Exostosis, Stenosis of EAC
benign bony growth.... No treatment unless blocking canal
benign bony groth from exposure to cold water "Surfer's Ear"
Sx of Cerumen Impaction
none, hearing loss, tinitus, itching, pain, cough, odor
Tx Cerumen Impaction
Cerumenolytics, Mineral Oil, Irrigation, Manual Removeal
What OTC Cerumenolytics would you recommend to a pt?
Murine or Debrox Earwax removal kits ($5.52 on amazon prime)
When should you not give murine or debrox
When is irrigation contraindicated?
After ear wash what should you do?
Dry canal with isopropyl alcohol and hair dryer
Otitis Externa also known as
Most common cause of pain in external ear
What is Otitis Externa?
Inflammation and edema of the ear canal
Causes of Otitis Externa
Bacteria/Fungi,,,, absense of cerumen, water (change pH of ear), Trauma
Prevention of Otitis Externa
irrigate ears with 1:1 mixture of rubbing alcohol and vinegar immediately after swimming.
Sx of Otitis Externa
Hallmark- Pain while pulling on Pinna... Pruritis, Otalgia (pressure over tragus), Erythema, Purulent Discharge
Dx of Otitis Externa
Common Bacteria in Otitis Externa
Pseudomonas Aeruginosa and Staph Aureus
Tx for Bacterial Otitis Externa
Abx Drops...... with or without steroids
Knowing that Pseudomonas is a common cause of Otitis Externa, What would you prescribe?
Ciprodex Otic (cipro/Dexamethasone) ;...OR.... Cortisporin Otic (neomycin/polymyxinB/hydrocortisone) ........... Or other floroquinolones.
What is Dexamethasone?
What Abx to give if TM is compromised?
Cipro will be safe. This is what Talia
What ABX are Ototoxic?DO NOT GIVE IF TM compromoised
If Gentamicin is an Ototoxic Aminoglycoside, in what circumstance would you use it for ear treatment?
Gentamicin, an antibiotic that's toxic to your inner ear, reduces the balancing function of your ear, and your other ear assumes responsibility for balance. The procedure, which can be performed during local anesthesia in your doctor's office, often reduces the frequency and severity of vertigo attacks. There is a risk, however, of further hearing loss.
How to tell if otitis extern is a fungal infection?
White fluffy discharge, looks like mold.
Fungal infections of ear often caused by
Aspergillus Niger or Candida
Tx for Fungal Otitis Externa
2% acetic acid with or without steroid......... or... Clotrimazole rops
What is Malignant External Otitis?
Complication/Progression of OE---- Pseudomonas Osteomyelitis of the Temporal Bone
Malignant External Otitis Seen in
Sx of Malignant External Otitis
severe earache, foulsmelling otorrhea,granulation of ear canal, if Severe --> facial nerve paralysis
Dx of Maliganant External Otitis
C&S, ESR (erythrocyte sedmintation rate)... and Definitely CT.
Tx of Malignant External Otitis
6 wk IV floroquinolone...... If caught early can do Cipro 1000mg BID... Always Refer
Complications of Maliganant External Otitis
facial nerve palsy, matsoiditis, meningitis, death
How to diferentiate Malignant External Otitis from Acoustic Neuroma
Both have facial nerve palsy, Acoustic Neuroma has more tinnitus and Vertigo.. And then on PE you wouldn't see the gross malignant external otitis.
Sx of FB in EAC
Pain, Puritis, Purulent Discharge, Fowl Smelling, Cough not responsive to treatment (iritation of CN 9)
Removeal of FB in EAC
cerumen loops, aligator forceps, irrigation,
What objects should you not use irrigation with
insects or food because they swell.
If insect in ear what should you put in it the ear first?
mineral oil/ lidocaine--- kills insect :)
THIS SET IS OFTEN IN FOLDERS WITH...
Dizziness, Tinnitus, Menieres, Acoustic Neuroma
Caries and Periodontitis
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