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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