Otitis10 - Otitis John H. Isaacs, M.D. Department of...

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Otitis John H. Isaacs, M.D. Department of Otolaryngology University of Florida
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pathogen source for otitis externa source for otitis +/- intact TM
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Acute OE “Swimmer’s ear” Usually self-limited Symptoms Otalgia Otorrhea Findings Ear canal edema Otorrhea Tender to pinna traction
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Acute Otitis Externa debris and swelling of ear canal, very tender! May require wick
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Microbiology of the Ear Canal Normal v. Acute Otitis Externa Roland & Stroman. Laryngoscope 2002 Stroman, Roland, Dohar, & Burt Laryngoscope 2001 Mostly S. auricularis, S. epidermidis, Turicella otitidis , Alloiococcus otitis Mostly P. aeruginosa Mostly S. epidermidis (9%) S. aureus (7.5%), coryneform bacteria (eg, Microbacterium otitidis ) AOE: more P. aerug, S. aureus, & microbacterium sp.
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Pathogenesis of AOE Water exposure Loss of protective barriers Removal of wax Irritation of EAC skin Accumulation of exfoliated skin debris Obstruction
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Antibiotic v. Placebo in AOE NNT = 2 Rosenfeld et al. Otolaryngol Head Neck Surg. 2006
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Quinolone v. Nonquinolone Clinical Cure Rate in AOE Rosenfeld et al. Otolaryngol Head Neck Surg. 2006
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Quinolone v. Nonquinolone Bacteriological Cure in AOE Rosenfeld et al. Otolaryngol Head Neck Surg. 2006
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Antibiotic v. Antibiotic-Steroid in AOE Rosenfeld et al. Otolaryngol Head Neck Surg. 2006
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Steroid v. Antibiotic in AOE Rosenfeld et al. Otolaryngol Head Neck Surg. 2006
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Necrotizing OE Osteomyelitis of the skull base High morbidity & mortality Risk factors Diabetic Immunocompromised Pathogens Pseudomonas aeruginosa (most) Staphylococcus aureus Aspergillus sp. (rarely) Parenteral antibiotics critical Quinolones 3rd generation cephalosporin Aminoglycoside + SS-PCN Extended duration Minimum 6 weeks Normal gallium scan Regular cleaning Diabetes control Watch renal function*
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Necrotizing OE Symptoms Otalgia Otorrhea Hearing loss Fever Hoarseness Aspiration Dysphagia Facial palsy Signs Granulation tissue * Otorrhea Canal edema Cranial neuropathies Distinguishes from routine Acute OE *
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Necrotizing OE CT Bone Scan demineralized bone tracer uptake
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External canal inflammation Symptoms: primarily pruritus Aggravating factors Cleaning ears Contamination
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Otitis10 - Otitis John H. Isaacs, M.D. Department of...

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