malignant otitis media
TRANSCRIPT
Presented by
Kiran Patil
Introduction:
Chandler published the first series of patients with progressive osteomyelitis of the temporal bone and termed the condition malignant otitis externa.
Definition
Invasive infection in external auditory canal and skull base.
Antomy of external auditory canal
Causes and pathophysiology
Risk Factor
Age
Diabetes mellitus
Any condition causing immunosuppression,
Especially elderly patients
Microbiology
The causative agent - Pseudomonas aeruginosa ( a gram-negative – aerobe)
Other bacteria, including Staphylococcus aureus , S epidermidis , Proteus mirabilis , Klebsiella,
fungal organism is Aspergillus fumigatus
Process of disease
Infection from the EAC spreads
Through the fissures of Santorini, small perforations in the cartilaginous portion of the EAC
Infection spreads medially to the tympanomastoid suture, and along venous canals and fascial planes
The compact bone of the skull base becomes replaced with granulation tissue,
Bone destruction
Progressive spread of infection to skull base foramina causes cranial neuropathies(more Fascial)
Spread of infection to the sigmoid sinus can lead to septicthrombosis of the sigmoid sinus and internal jugular vein; meningitis and cerebral abscess may also complicate MOE
Clinical presentationOtalgia –throbbing pain Nocturnal pain and aggravated by chewing
Otorrhea – pus discharge - yellow, yellow-green, foul smelling, persistent
Hearing loss
Fever
Trouble swallowing
Weakness in the face
Voice loss
Physical examination
Otoscope- purulent otorrhea with a swollen, tender external auditory canal are hallmarks.
Granulation tissue or exposed bone is frequently seen on the floor of the canal at the bony–cartilaginous junction.
Diagnosis History and physical examination Laboratory- ESR level, culture swab Radiology and imaging studies CT scan- sensitive in diagnosing abscess formation and involvement of the mastoid, temporomandibular joint, infratemporal fossa, nasopharynx, petrous apex, and carotid canalMRI- MRI better shows changes in soft tissue, particularly dural enhancementand involvement of medullary bone spacesbiopsy – to rule malignanceNuclear imaging- Technetium Tc 99m, scintigraphy (bone scan) , Gallium Ga 67 citrate
Management
Medical Management Long-term antibiotic- for at least 6 to 8 weeks- oral
and intravensous ciprofloxacin (750 mg twice daily) has been proposed as the preferred initial antibiotic regimen
Fluoroquinolones are active against P aeruginosa, ,
Cephalosporins -ceftazidime, provide an alternative to ciprofloxacin in the treatment of MOE
Aminoglycoside
Amphotericin B is the most commonly used antifungal agent for fungal
Hyperbaric oxygen (HBO)-
HBO increases the partial pressure of oxygen, improving hypoxia and allowing greater oxidative killing of bacteria. HBO requires daily treatments for several weeks and side effects include oxygen toxicity, barotrauma, and tympanic membrane perforation
Surgical Management: Surgical excision play no role in the treatment.
Debridement and or biopsy only indicated in rule the cancer.
Complication Damage to the cranial nerves, skull, or brain
Return of infection, even after treatment
Spread of infection to the brain or other parts of the body
Prevention To prevent an external ear infection:
Dry the ear thoroughly after it gets wet.
Avoid swimming in polluted water.
Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections).
After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.
Nursing Management Pain assessment and Management
Fever management
Obtaining the Laboratory Samples especially cultures in aseptic ways.
Medication Administration
Infection Prevention
Diet and Nutrition
Health education
Geriatric Care
Nursing Problem Altered comfort related ear Pain.
Altered Body Temperature related to Infection
Altered hearing perception related to ear discharge
Knowledge deficit related to disease process, nutrition, and management.
Conclusion