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Pharmacology for Advanced PracticeNurses

Acute and Chronic Ear Infections

Ken Stein, PA-C, Oklahoma City ENT Clinic

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Ear Anatomy

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Ear Anatomy

Pinna or Auricle

External auditory canal

2.5 cm long in adults, migratory squamous epithelium

Lateral 1/3 is cartilaginous and contains hair follicles,sebaceous and ceruminous glands

Medial 2/3 is bony and lined with very thin skin contiguouswith the tympanic membrane

Middle ear

Medial to tympanic membrane

Contains ossicles

Connected to nasopharynx via eustachian tube and to themastoid air cells

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TM Migratory Epithelium

A 1 WeekB 2 Weeks

C 3 Weeks

D 7 Weeks

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Otitis Media

Serous Otitis Acute Otitis Media

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Otitis Externa

General term for inflammatory condition of theEAC

Bacterial

Fungal/Yeast

Viral

Malignant otitis externa

Folliculitis

Dermatitis - iatrogenic, psoriasis, exzema, etc.

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Bacterial Otitis Externa

Management consists of cleaning and primarilytopical antimicrobials

Cleaning

Must clean before treatment

Suction aspiration is best and least painful

Do not irrigate!

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Bacterial Otitis Externa

Antimicrobials

Intact TM

Neomycin/polymyxin B/hydrocortisone solution or

suspensionAcetic acid 2%/hydocortisone 1% solution

Open Ear/Tympanostomy tubes

Ciprofloxicin otic with or without corticosteroid

Ofloxacin oticSupplemental Care

Oral steroid taper

Ear wick

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Otitis Externa

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Otomycosis AKA Fungal OtitisExterna

Etiology

Aspergillus and candida are most common

Other saprophytic fungi

Over use of topical antimicrobials

Presentation

Similar to bacterial, but usually not as painful

It feels like my ear is all stopped up.

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Otomycosis AKA Fungal OtitisExterna

Management consists of cleaning and primarilytopical antimicrobials

Cleaning

Must clean before treatment

Suction aspiration is best and least painful

Do not irrigate!

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Malignant Otitis Externa

Diabetic, immunocompromised and/or elderlypatient

Psuedomonas most common

Can be fatal

Severe pain, granuloma in canal atbony/cartilage junction

Cranial nerve VIII, IX, X, XI XII palsyImmediate referral to ENT

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Other External Ear Conditions

Viral Herpes Zoster Oticus

Folliculitis

Dermatitis

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Otitis Media

Nearly all middle ear disease is due toeustachian tube dysfunction

Acute otitis media

Serous otitis media

Chronic otitis media

Unilateral ETD/SOM in adult; R/O

nasopharyngeal obstruction/neoplasm

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Acute Otitis Media

Suppurative infection of the middle ear space

Etiology

S. pnuemoniae

H. influenza

M. catarrhalis

Viral/no pathogen cultured 29%

PresentationOtalgia

Fever with or without rhinorrhea

Fussy, pulling on ears, trouble sleeping/eating

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Acute Otitis Media

Antimicrobial treatment

Penicillin/amoxicillin with or without anti-betalactamase

Cephalosporin 1st or 2nd generation is usuallyadequate

Trimethoprim/sulfamethoxazole

Supplemental treatment

Nasal steroid spray

Anthistamine/decongestant

Antipyretic of choice

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Bullous Myringitis

Bacterial or viral infection of tympanicmembrane

Exquisitely painful

Otoscopy reveals fluid filled (serous orserosanquinous) blebs on TM

Topical antimicrobials as for bacterial otitis

externaTopical analgesics and steroids

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Bullous Myringitis

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Serous Otitis Media

Accumulation of mucus in the middle ear space

Etiology

Eustachian tube dysfunction

Treatment

Nasal steroid spray

Decongestant/antihistamine

Oral steroidsAllerx:psuedoephedrine/methscopolamine/chlorpheniramine

Auto inflation

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Chronic Otitis Media

Tympanic membrane perforation with or withoutinfection

Persistent serous otitis media despite treatment

Cholesteatoma

Ossicular erosion

Chronic or recurrent drainage from the ear

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Tube Granuloma

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Cholesteatoma

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Otitis Media

Indications for ventilation tubes

Draining tubes

Craniofacial patients

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Tympanostomy Tube

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Mastoiditis

Inflammation/infection of mastoid air cells

Same organisms as AOM

Pediatrics complication of AOM

Adults chronic otitis, cholesteatoma

Post-auricular erythema, cellulitis, tender,lateral displacement of auricle

Treatment ENT consult, IV antibiotics, surgery

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Mastoiditis

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Mastoiditis

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Other Ear Conditions

Auricular hematoma/seroma/abscess

Chrondritis

ExostosisAKA Surfer's Ear

Tympanosclerosis benign, no hearing loss

Glomus tumor: pulsatile tinnitus

Auricular pits and skin tags

Barotrauma

Battle's sign

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Thank You