acute diffuse otitis externa

7/27/2019 Acute Diffuse Otitis Externa

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ACUTE DIFFUSE

OTITIS EXTERNABy

Elena Mahotsaha V M.Izza naufal F

Sri Murti Sari Ningsih Ilham Isnin Dolyanov


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ANATOMY


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Glandular secretions combine with sloughed squamepithelium to form an acidic coat of cerumen, one of the primbarriers to infection of the canal.

The alveoli of the sebaceous and apocrine glands empty short, straight excretory ducts, which drain into follicular caObstruction of any part of the ductal system predispose

infection.

PHYSIOLOGY


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The canal is normally a self-protecting and self-cleansing struccerumen coat gradually works its way past the isthmus to the latethe canal and sloughs externally.

Instrumentation and excessive cleansing of the canal disturb thprotective barrier and may lead to infection.

Individual variations in the anatomy of the canal or the consistecerumen produced may predispose some people to wax accumulati

PHYSIOLOGY


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Diffuse inflammation of the external ear canal, which mayalso involve the pinna or tymphanic membrane.

Rapid onset, within 48 hours in the past 3 weeks..

Hallmark sign of diffuse AOE is tenderness of the tragus,pinna or both, that is often intense and disproportionate to

what might be expected based on visual inspection

(Bailey, 4th ed

DEFINITION


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RISK FACTOR

Previous history of external ear infecton.

Swimming, diving, water activities.

Warm and humid weather.

Use of hearing aid.

DM, AIDS, malnutrition.

instrumenting the canal with a cotton swab or fingernail .


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CAUSATIVEAGENTS

Pseudomonas aeroginosa (50%).

Proteus mirabilis.

Staphylococcus aureus (23%).

Anaerobic and gram negative organisms (12,5%).

Fungal (12,5%).


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If moisture is trapped in the EAC, it may cause maceration of theprovide a good breeding ground for bacteria.

It may occur after swim or take a bath, or in hot humid weather. Oof the EAC by excessive cerumen, debris, surfers exostosis, or a ntortuous canal may also lead to infection by means of moisture rete

Trauma to the EAC allows invasion of bacteria into the damaged skin

This often occurs after attempts at cleaning the ear with a cotton swclip, or any other utensil that can fit into the ear.

Once infection is established, an inflammatory response occurs edema. Exudate and pus often appear in the EAC as well. If seinfection may spread and cause a cellulitis of the face or neck.

PATHOGENESIS


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DIAGNOSIS


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STAGESOFEXTERNALOTITIS

Senturia et al. divided the clinical course of external otitis into the fostages:

1. Pre inflammatory stage

2. Inflammatory stage

-Mild acute inflammatory stage

-Moderate acute inflammatory stage

-Severe acute inflammatory stage

3. Chronic stage


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Name : Mr. S

Age : 22 y.o.

Gender : Male

Occupation : Student

Address : Klaten

Date : 22 Oct 2013

IDENTITY


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Main complaint : pain in the right ear

History of present illness :

Patient presents with right ear pain for the past two dadecrease in hearing, also a fullness sensation. No itching nor disccomplained. Patient often uses the cotton bud to clean his ears. Patie

the history of swimming three days ago. No history of trauma. The pno complaint of the left ear.

Complaints like fever, cough, and common cold were deniednot have any complaints regarding nose or throat.

ANAMNESIS


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History of past illness :

Same symptoms before (-)

History of foreign body insertion (-)

History of allergy (-)

History of trauma (-)

History of DM (-)

History of illness in the family members :

History of similar complaints (-)

History of allergy (-)

ANAMNESIS


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ANAMNESISRESUME

Pain in the right ear for the past two days

Decrease in hearing

Fullness sensation

History of swimming three days ago and the usage of cotton bud


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General status : compos mentis, well nourished

Vital signs :

Blood pressure : 120/80 mmHg

Pulse : 82x/min

Respiration : 18x/menit

Temperature : 36,3 C

PHYSICAL EXAMINATION


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ENT

EXAMINATI


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EAR EXAMINATION

Tragus pain (+),

auricular

movement

tenderness (+),

swelling and

redness of CAE.

Within normal

limit

Intact tymphanic

membrane, cone

of light visible

Intact tymphanic

membrane, cone

of light visible


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NOSE EXAMINATION

Inspection

Deformity (-)

Nasal septum deviation (-)

Concha inferior D/S within normal limit

Discharge D/S (-)

Palpation

Tenderness (-)

Crepitation (-)


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THROAT EXAMINATION

Inspection

Cavum oris within normal limit

Uvula in the middle, edema (-)

Arcus pharynx simetris

Tonsils hypertrophy (-)

Pharyngeal wall hyperemic (-),

granulation (-)

Palpation

Lymph node enlargement (-)


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TUNING FORK EXAMINATIONRight Ear Left Ear

Rinne AC < BC AC > BCWeber Lateralization to the RIGHT

Swabach Increase Same withexaminer

Conclusion Conductive hearing loss of rightear


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ACUTE DIFFUSE OTITIS EXTERNA AURIS DEXTRA

DIAGNOSIS


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Medication :

Otopain ear drop 3 x 4 gtt AD (Polymyxin B sulfate + Neomycin sulFludrocortisone acetate + lidoqain Hcl)

Na diclofenac tablet 2 x 50 mg

Education :

Keep the ear in dry condition.

Dont use cotton bud to clean the ears.

Follow up in three days.

TREATMENT


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Therapy

PROBLEM


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DISCUSSION

Treatment and Management

Primary treatment of diffuse otitis externa :

1. Removal of debris from EAC

2. Administration medication to control edema and infection

3. Avoidance of contributing factors

4. Management of pain


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REMOVALOFDEBRISFROM EAC

Removal of debris from the ear canal improves the effectiveness of tmedication.

Gentle cleaning with soft plastic curette or a small suction tip under vision is appropriate

Irrigation with a mix of peroxide and warm water may be useful for

debris from the canal, but only if the tympanic membrane is intact


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ADMINISTRATIONMEDICATIONTOCONTROLED

ANDINFECTION

Treatment of Diffuse

Otitis Externa

Topical

Oral Medications

Antibiotic

Aminoglycoside and

quinolone

Ear pad

Quinolone

Ciprofloxacin


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CONT..

An aminoglycoside combined with a second antibiotic and a topical (eg, neomycin-polymyxin B-Hydrocortisone) used to be the most coprescribed topical preparation.

Otic antibiotic and steroid combinations have shown to be hughly suin treatment, with cure rates of 87-97 %.

Use of aminoglycoside antibiotic eardrops in the presence of a perfoventilation tube may cause problems. Amonoglycoside eardrops maototoxic if they enter the middle ear

Floroquinolones are not associated with autotoxicity and ofloxacin iscases of perforated tympanic membrane.


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CONT..

Most persons with OE do not require oral medications. Oral antibiotgenerally reserved for patients with fever, immunosuppression, diabadenopathy, or an infection extending outside the ear canal. We canbroad-spectrum antibiotics (cephalosporins first gen or fluoroquino


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AVOIDANCEOFCONTRIBUTINGFACTORS

Elliminate any self-inflicted trauma to ear canal.

Avoid frequent washing of the ears with soap.

Avoid swimming in polluted waters.

Ensure that ear canals are emptied of water after swimming or bath


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MANAGEMENTOFPAIN

Simple nonsteroid anti-inflammatory drugs (NSAIDs) reduce inflammirritation.

Acetaminophen is appropriate for most patient


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SUMMARY

Have been reported, patient, male, 22 years old, based on history physical examination diagnosed with otitis externa diffusa auricular dpatient treated by Otopain (Polymyxin B sulfate + NeomyFludrocortisone acetate + lidoqain Hcl ) and Na-diclofenac and edprevent reccurent infections.

Otopain eardrop was given to the patient because the membrane

was intact and the edema was not blocking the ear canal.


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TERIMA KASIHBy

Elena Mahotsaha V M.Izza naufal F

Sri Murti Sari Ningsih Ilham Isnin Dolyanov

acute diffuse otitis externa

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