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Acute Otitis Externa


Presentation

  • METHODS: We reviewed the medical records of 209 patients who presented to our ear, nose, and throat (ENT) clinic with acute OE that was resolved with oral and/or topical antibiotics.[ncbi.nlm.nih.gov]
  • It should be noted, however, that these signs may not be present or they may be very mild, especially in a patient who presents early in the course of infection.[contemporaryclinic.pharmacytimes.com]
Varicella-Zoster Virus Infection
  • Viral Rarely, a viral etiology such as a varicella-zoster virus infection of the external ear canal is possible manifesting as Ramsay Hunt syndrome.[radiopaedia.org]
Foul Smelling Discharge
  • Sometimes, a foul-smelling discharge and hearing loss occur if the canal becomes swollen or filled with purulent debris. Exquisite tenderness accompanies traction of the pinna or pressure over the tragus.[msdmanuals.com]
Trismus
  • […] evaluation for alternate diagnoses are warranted in some cases ( Sidebar 2 2-6 ). 2-4,6 SIDEBAR 2: RED FLAGS FOR FURTHER INVESTIGATION 2-6 Fever 101 F Severe otalgia that is not diminished with oral analgesics and/or otic medications Lymphadenopathy Trismus[contemporaryclinic.pharmacytimes.com]
  • […] immunocompromised with refractory purulent otorrhea and otalgia worse at night, what can you dx clinical findings: -granulation tissue in external auditory canal esp. at bone-cartilage junction -extension of infxn beyond auditory canal can cause lymphadenopathy, trismus[quizlet.com]
  • Extension of the infection beyond the auditory canal can cause lymphadenopathy, trismus, and facial nerve and other cranial nerve palsies. In chronic otitis externa, the symptoms and signs listed in Table 2 4 occur for more than three months.[aafp.org]
Decreased Lacrimation
  • In addition to the lesions and otalgia, individuals with Ramsay Hunt syndrome may experience facial paralysis, decreased lacrimation on the affected side, and loss of taste sensation.[contemporaryclinic.pharmacytimes.com]
Otalgia
  • Clinical efficacy, in terms of otalgia, oedema, erythema and tenderness of the external auditory canal, was assessed before packing was applied and at follow up on the 3rd and 7th days of presentation.[ncbi.nlm.nih.gov]
  • The most common symptoms related to AOE described by patients are otalgia and otorrhea. Complaints of otalgia can range from mild pruritus to severe discomfort. Patients have also described a feeling of fullness or pressure in the ear.[contemporaryclinic.pharmacytimes.com]
Tinnitus
  • There is a history of increasing otalgia with or without: custard-like, thick ear discharge conductive hearing loss tinnitus dizziness or dysequilibrium (sometimes true vertigo) It is important to note any significant risk factors for severe AOE or development[entsho.com]
  • Additional information on balance disorders can be found at: Tinnitus Tinnitus is the medical term for hearing noise when there is no outside source of the sound.[otonomy.com]
  • Feeling of increased pressure inside the ear due to fluid accumulation The external auditory canal becomes narrowing Ringing sensation inside the ear or tinnitus Occasional fever Itching sensation develops particularly in chronic otitis externa or infectious[medicalfoxx.com]
  • OTO-311 is an NMDA receptor antagonist for the treatment of tinnitus that has completed a Phase 1 clinical safety trial with a Phase 2 trial expected to be initiated in the second half of 2017.[globenewswire.com]
  • The patient should be questioned about difficulty hearing or complete loss of hearing on the affected side as well as whether he or she has experienced any tinnitus. If discharge is present, further descriptions of the discharge should be assessed.[contemporaryclinic.pharmacytimes.com]
Ear Discharge
  • NIH: National Institute on Deafness and Other Communication Disorders Cholesteatoma Ear discharge Ear examination Ear infection - acute Ear infection - chronic Ear tube insertion Earache Eardrum repair Infectious myringitis Labyrinthitis Labyrinthitis[icdlist.com]
  • There is a history of increasing otalgia with or without: custard-like, thick ear discharge conductive hearing loss tinnitus dizziness or dysequilibrium (sometimes true vertigo) It is important to note any significant risk factors for severe AOE or development[entsho.com]
  • Bacteria Significant swelling of canal is common Discomfort is often severe enough to require oral analgesics Fever may be present Lymphadenopathy (swollen lymph nodes) around the base of the ear Discharge is usually scant white mucus, but occasionally[dermnetnz.org]
  • Common symptoms include itch, ear discharge, temporary dulled hearing and pain. Your ear may feel blocked or full. Both ears can be affected; however, more often otitis externa affects one ear only.[patient.info]
  • People may also experience ear discharge and itchiness. When enough swelling and discharge in the ear canal is present to block the opening, external otitis may cause temporary conductive hearing loss.[en.wikipedia.org]
Hearing Problem
  • If your child isn't old enough to say "My ear hurts," here are a few things to look for Tugging at ears Crying more than usual Fluid draining from the ear Trouble sleeping Balance difficulties Hearing problems Your health care provider will diagnose an[icdlist.com]
Facial Numbness
  • numbness/paralysis, severe pain, loss of taste Treatment includes antivirals, systemic corticosteroids Referred pain Normal ear examination Look for other causes based on patterns of referred pain Seborrhea Itching and rash on hairline, face, scalp Treatment[aafp.org]

Workup

  • […] for patients w bacterial rhinosinusitis who cannot tolerate amoxicillin-clavulanate for pts with rhinosinusitis from bacterial and have a penicillin allergy can be given doxycycline or resp. fluoroquinolone like levofloxacin or monofloxacin further workup[quizlet.com]
  • […] better depicts bony erosion [5] Radionucleotide bone scanning Gallium scanning Magnetic resonance imaging (MRI) - Not used as often as the other modalities; may be considered secondarily or if soft-tissue extension is the predominant concern [6] See Workup[emedicine.medscape.com]
Gram-Positive Bacteria
  • Wearing of hearing aids, earphones, and diving caps Etiology Gram negative bacteria: Pseudomonas aeruginosa (50-65%), Proteus species, Kleibsiella, and Hemophilus, 30% are Polymicrobial Gram positive bacteria: Staphylococcus aureus and Streptococcus pyogenes[pedclerk.bsd.uchicago.edu]

Treatment

  • The raw data for the treatment failure rates from the two studies were combined to calculate the overall treatment failure rates of each treatment group.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Topical treatment, sometimes containing antibiotics/antifungals, or corticosteroids to relieve symptoms, or a combination of the above are prescribed. Aural toileting to remove excess earwax/cerumen can be considered.[radiopaedia.org]
  • Prognosis Most cases of otitis externa resolve within a few days of starting treatment. The condition will tend to recur unless underlying causative factors are addressed.[patient.info]
  • Malignant external otitis: report on therapy with ceftazidime and review of therapy and prognosis. Rev Infect Dis 1990 Mar-Apr; 12(2): 173–80 PubMed CrossRef Google Scholar 23. Chandler JR.[link.springer.com]
  • Inclusion of steroids in the drops improves prognosis. (Roland et al. 2003) Uncommon treatments: Steroids -- oral, nasal and injected steroids are occasionally used but their use is presently controversial.[dizziness-and-balance.com]
  • Prognosis [ edit ] Otitis externa responds well to treatment, but complications may occur if it is not treated.[en.wikipedia.org]

Etiology

  • CONCLUSION: depending on the etiological agent, some plants presented satisfactory results, however we still need more detailed studies in order to better use these plants.[ncbi.nlm.nih.gov]
  • The book contains advanced information on these entities including breakthroughs on new insights into epidemiology, risk factors, pathogenesis, etiology, new vaccines, and antimicrobial agents (oral, parenteral, and ototopical).[books.google.com]
  • Viral Rarely, a viral etiology such as a varicella-zoster virus infection of the external ear canal is possible manifesting as Ramsay Hunt syndrome.[radiopaedia.org]
  • Wearing of hearing aids, earphones, and diving caps Etiology Gram negative bacteria: Pseudomonas aeruginosa (50-65%), Proteus species, Kleibsiella, and Hemophilus, 30% are Polymicrobial Gram positive bacteria: Staphylococcus aureus and Streptococcus pyogenes[pedclerk.bsd.uchicago.edu]

Epidemiology

  • Because the overall burden and epidemiology of AOE in the United States have not been well described, data from national ambulatory-care and emergency department (ED) databases were analyzed to characterize the incidence, demographics, and seasonality[ncbi.nlm.nih.gov]
  • The book contains advanced information on these entities including breakthroughs on new insights into epidemiology, risk factors, pathogenesis, etiology, new vaccines, and antimicrobial agents (oral, parenteral, and ototopical).[books.google.com]
  • This is the first report to describe overall U.S. epidemiology and associated costs of AOE.[cdc.gov]
  • Back to Journals » Therapeutics and Clinical Risk Management » Volume 7 Review R Mösges, M Nematian-Samani, A Eichel Institute of Medical Statistics, Informatics and Epidemiology, Faculty of Medicine, University of Cologne, Germany Background/objective[dovepress.com]
  • Epidemiology It is quite a common condition and may affect up to 10% of people during their lifetime.[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • This article will summarize the basic anatomy and physiology of the external auditory canal, the pathophysiology and microbiology of acute otitis externa, the clinical presentation and diagnosis of this disease, and its potential complications and treatment[ncbi.nlm.nih.gov]
  • Pathophysiology Otitis is inflammation and/or an infectious process of the ear. Three types of otitis can occur, and their names are indicative of the area of the ear they affect.[contemporaryclinic.pharmacytimes.com]
  • Synonym(s): swimmer’s ear Epidemiology Incidence Unknown; higher in the summer months and in warm, wet climates Predominant age: all ages Predominant sex: male female Prevalence Acute, chronic, and eczematous: common Necrotizing: uncommon Etiology and Pathophysiology[unboundmedicine.com]
  • Pathophysiology OE is a superficial infection of the skin in the EAC.[emedicine.medscape.com]
  • Pathophysiology of atopic dermatitis. Clin Dermatol 2003;21:116–121. Wang MC, Liu CY, Shiao AS, Wang T (August 2005). "Ear problems in swimmers". J Chin Med Assoc. 68 (8): 347–52. doi : 10.1016/S1726-4901(09)70174-1. PMID 16138712.[en.wikipedia.org]

Prevention

  • To reduce the national incidence of AOE, additional preventive measures should be investigated, and effective prevention messages should be developed and disseminated.[ncbi.nlm.nih.gov]
  • With the substantial costs imposed by AOE in health-care expenditures and clinicians' time, prevention of AOE could yield considerable savings. Few studies exist on AOE prevention, and controlled trials of potential prevention measures are needed.[cdc.gov]
  • Prevention from otitis externa Otitis externa sensitive patients require some preventive measures and even this is applicable to every individual: During bathing or taking shower caution should take to avoid soap or shampoo entrance into the ear canal[medicalfoxx.com]
  • Care and Screening: Tobacco Use: Screening and Cessation Intervention #317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Download PQRS AOE Measures Group Form: Measure Group Description (from CMS) Measure Group[mdinteractive.com]

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