*Otitis Externa - Commonest organism causing -Pseudomonas +
S.aureus.
Rx of benign otitis Externa = combination of hydrocort + aceti acid or polymyxin B sulfate + neomycin sulfate + hydrocort
*Malignant otitis Externa-in elderly diabetic organism-pseudomonas
Rx surgical debridement with 6wks of Abx
*Ac otitis media - triad of otalgia, URTI, impaired hearing, fever not a prominent feature, H.influenza slightly more prevalent than S.Pneumoniae
*Amoxycillin most appropriate 1st line Tx
Otitis media with effusion (clear colored fluid seen behind the eardrum) -commonest cause = eustachian tube obstruction (also called serous otitis media).
Rx-antihistamine, decongestants, hydration
Ear infections may have serious consequences in some pts who have congenital communication with subarach space due to developmental bone defects.
Temporal bone trauma is commenest cause for CSF otorrhea (clinical picture painted - clear liquid ± blood seen after trauma).
Meniere's disease: Deafness, dizziness and drumming (Hearing loss, vertigo and tinnitus) Middle aged patient with the above clinical features or may have two of them or all three.
Etiology is believed to be an alteration in pressure in the endolymph of the semicircular canal area.
Treatment for acute episodes of Meniere's: Glycopyrrolate 2 mg bid prn for 2 weeks.
Prophylaxis in quiet stage: Acetazolamide.
Middle ear pain during air travel: Oral decongestants are useful in adults. Not so in children.
Chewing gum may be helpful. Need is more during landing than during takeoff. This is because the external pressure can close the eustacian tube. This prevents spontaneous equalization of pressure between the middle ear and the atmosphere.