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Dr Komol Praphasit ENT PPK
OTITIS EXTERNA
OTITIS MEDIA
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OTITIS EXTERNA• ���������� ����� ����� ���������
• S. aureus , P. aeruginosa
• ����� ����������������� ������! "����#$! targus ����������
• ���%�&'��
• Acute diffuse OE (swimmer’s ear) - P. aeruginosa
• Acute localized OE (furuncle) – S. aureus
• Rx...#������&� ���� ������� ��� �������&) ear wick
• Four principles of Rx.• Frequent canal cleaning
• Topical antibiotics
• Pain control
• Instructions for prevention
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Chronic otitis externa
-- diffuse low grade infection
- irritation & iching of EAC
- atrophy of skin
- cause bacteria staph. Epidermidis
asteatosis
senile atrophy of skin
chronic irritation from allergy or manipulation
Rx. Get rid of infection steroid/antibiotic cream
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Malignant otitis externa
- Pseudo. Aeruginosa
- progressive &necrosis of tissue
- common in DM old age cancer pt.With radiation or chemo therapy
- toxin…cause… necrotizing & invade to deep tissue :mastoid CN 7,9,10,11,12
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Malignant otitis externa
- S/S :
- persistent and severe otalgia
- ear d/c granulation tissue EAC
- host…DM or immunocompromise
- CN involvement: 7,,9,10,11,12
- Ix.:- CBC UA FBS pus c/s
-x-ray:CT,MRI of temporal bone
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Malignant otitis externaRx. - admit
- control DM
- local debridement
- I.V. ATB cover P. aeruginosa
- topical gentamicin ear drop
- if less severe… oral Ciproflox.
If.. No improve or progress-->
mastoidectomy, temporalbone resection
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��������� ����������� (otitis media) ����������� ���� < 7 ��������� !" ������Eustachian tube obstruction
�Allergy , infection , immature / impair
immune
�other : day care center , passive smoking
lake of breast feeding
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If Eustachian tube & otitis media
Function of ET : 1. Ventilation
2. Protection
3. Drainage
factors alteration of ET-function
- poor function in children
- patulous ET
- mechanical obstruction:
- intrinsic… inflammation/ allergy
- extrinsic…adeniod /NP mass
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������������������������ ( Acute otitis media)Etiology : Streptococcal pneumoniae
Hemophilus influenzae
Branhamella catarrhalis
other organism : gr. A strept. S. aureus P. aeruginosa
Symptoms & signs:- fever , otalgia , pus d/c , eardrum….swelling
redness
- dullness , air-fluid level
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TreatmentTreatment
1. Antibiotics : penicillin / amoxicillin…#other .bactrim , erythromycin , cefaclor ,
Augmentin
#…..Treat….10 -14 days
2. Analgesics & antipyritics
3.Myringotomy …Severe otalgia, for c/scomplication…facial paralysis,low -immune host
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Amoxicillin 500 mg 1 tab po tid x 10 days
Penicillin V 500 mg po tid-qid x 10 days
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SOM OR OME
• ������ ET dys-fx (child <8 yrs) or obstruction ,infection
• CHL )*��+��, )*�*!)-. )*�*!-�/��0+���1���,
• retractionTM , air-fluid level
• pneumaticscope :
• TM decrease movement
• dullness of TM
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SOM OR OME• ��223�4�
• �,�56*��/)�.7���� 3 ��8��
•Antibiotc,decongestant/Rx.allergy
• 0��9113���!"�/ ; ;�<� =+3����2!"
• Valsalva maneuver• “Myringotomy /pressure equalizing tube
ID: ��������� � 3 ���� , bilatCHL
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��>�7�+? !"�,@3A��0�/�3�����28A�23/ ��>�B ���B �28���>��C�����3���>�2?�?�+0����B 56"/D,.�<+�1?*!��2 ?0�-�/E�.+�,E0?*!���/��0����/�28A�23/
�@8A� !" ������@8A� !" �����Pseudomonas aeruginosaStaphylococus aureusDiphtheroidsAnaerobic bacteria
chronic otitis media
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@�C�-�/@�C�-�/ COMCOM
1. simple chronic otitis media (safe ear)2. Chronic otitis media with cholesteatoma
( dangerous ear)
Symptoms & signsSymptoms & signs ::-active phase-non- active phase-signs of cholesteatoma :foul smell d/c keratin debris ( cholesteatoma) aural polyp -hearing loss , vertigo
chronic otitis media
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chronic otitis media TreatmentTreatment
-23�4���2�C��@8A����,@3A��0�/ : ��.��antibiotics - 3A/E������ E0?23��2? ��- F�=+�*�?���@��/�, (ear toilet ) �.+� suction- C1�2G�D���3��*8"�
-*!7�+?E 2�5.�� , 2, ?0�)*��H���/ ,-*!��2�C��@8A��28A�23/23�4� �/��E0.+)*��!-6A� ,-*!��2��8"�*�7� -�/�2?�,��,
-�I�/�3��*���.��C���2�C��@8A�5AF�.. 2?+3/)*���.�AF��-.��, , D���3��H�E�.+�,-E�.)-��2�,J��!���2)�.�C�… ��2D���3�5��*E5*E�.+�,E0?�2?�,��F���!�/
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