otitis externa en ingles, Diapositivas de Inglés Técnico

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Otitis externa

Cruz Luna Keyla

Otitis externa

Otitis externa is defined as an infection of the cutis and subcutis of the external auditory canal,

possibly involving the tympanic membrane and the pinna as well.

● is one of the more common diseases in otorhinolaryngological practice

● frequently encountered in primary and pediatric care.

Its different forms include: ❏ acute diffuse otitis externa ❏ circumscribed otitis externa ❏ chronic otitis externa, and ❏ malignant (i.e., necrotizing) otitis externa.

The pathogenesis of otitis externa is

multifactorial

More than 90% of cases of

otitis externa are due to

bacteria

❏ Pseudomonas aeruginosa (22–62%)

❏ and Staphylococcus aureus (11–34%)

❏ Polymicrobial infection is common

❏ Fungi are a rare cause (10%)

a more common cause of chronic otitis

externa; typical pathogens are

Aspergillus (60–90%)

❏ and Candida species (10–40%)

Diagnosis

examination of the pinna, the surrounding lymph nodes, and the skin.

Otitis externa is diagnosed from the history and physical examination

otosopic or otomicroscopic examination of the ear canal and tympanic membrane

Especially if the tympanic membrane cannot be seen, screening tests of hearing or an audiological examination should be performed to rule out inner ear involvement.

Diagnosis

Secretion is common and can be swabbed for culture and pathogen resistance testing.

the tuning-fork examination and the tone threshold audiogram typically reveal conductive hearing loss.

the skin of the ear canal can be either erythematous or pale because of edema

Treatment

The treatment of uncomplicated acute otitis externa consists of ❏ cleansing the ear canal, ❏ topical antiseptic and ❏ antimicrobial treatment, and adequate analgesia.

Primary oral antibiotic treatment should be given if the infection has spread beyond the ear canal, in the setting of poorly controlled diabetes mellitus or immunosuppression, or if topical treatment is not possible

Cleansing the ear canal

Atraumatic cleansing of the ear canal consists of the removal of cerumen and exudate

Cleansing should be performed by an experienced otorhinolaryngologist under microscopic vision with suction or an aural hook

injury to the ear canal must be avoided.

Patients should not clean their own ears with cotton swabs, because microtrauma encourages bacterial invasion.

he ear canal can alternatively be cautiously rinsed with distilled water or normal saline.

Topical antibiotics

Topical antibiotics should cover the most common pathogens, i.e., Pseudomonas aeruginosa and Staphylococcus aureus.

The approved types of antibiotic eardrops contain quinolones (ciprofloxacin), aminoglycosides (neomycin), or polymyxins (polymyxin B)

Quinolones are highly effective and cause no local irritation, but prolonged exposure to them can lead to resistance against this important class of antibiotics

Neomycin is effective but ototoxic and should be given only if the eardrum is intact.

Topical corticosteroids

Antifungal treatment

In case of fungal infection, strips soaked in a solution of antifungal drug (ciclopirox, nystatin, clotrimazole, or miconazole) should be laid in the ear canal.

are used mainly because they lessen edema High-potency corticosteroids are probably more effective than low-potency corticosteroids against pain, inflammation, and swelling

Analgesia

analgesia should be provided, e.g., with ibuprofen or acetaminophen.

Oral antibiotic treatment

oral antibiotics are indicated to treat acute otitis externa if the patient suffers from poorly controlled diabetes mellitus or immunosuppression, or if the infection extends beyond the ear canal.

● Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis Externa. Deutsches Arzteblatt international , 116 (13), 224–234. https://doi.org/10.3238/arztebl.2019. 24

References

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