otitis externa , also called swimmer's ear , is inflammation of the ear canal. Often accompanied by earache, swelling of the ear canal, and sometimes hearing loss. Usually there is pain with the movement of the outer ear. High fever is usually absent except in severe cases.
External otitis may be acute (lasting less than six weeks) or chronic (lasting more than three months). Acute cases are usually caused by bacterial infections, and chronic cases are often caused by allergies and autoimmune disorders. Risk factors for acute cases include swimming, minor trauma from cleaning, using hearing aids and ear plugs, and other skin problems, such as psoriasis and dermatitis. Diabetics are at risk of having severe forms of otitis externa maligna . Diagnosis is based on signs and symptoms. Raising the ear canal may be useful in chronic or severe cases.
Acetic acid ear drops can be used as a precautionary measure. Treatment of acute cases is usually with antibiotic drops, such as ofloxacin or acetic acid. Steroid doses may be used in addition to antibiotics. Pain medications such as ibuprofen can be used for pain. Oral antibiotics are not recommended unless the person has poor immune function or there is an infection of the skin around the ear. Typically, repairs occur within a day of commencement of treatment. Treatment of chronic cases depends on the cause.
External otitis affects 1-3% of people per year; more than 95% of cases are acute. About 10% of people are affected at some point in their lives. This happens most commonly among children between the ages of seven and twelve and among the elderly. This happens with almost the same frequency in men and women. Those living in warm and wet climates are more frequently affected.
Video Otitis externa
Signs and symptoms
Ear pain is the main complaint and the only symptom that is directly related to the severity of acute external otitis. Unlike other forms of ear infections, the pain of acute external otitis worsens when the outer ear is touched or gently pulled. Encouraging the tragus, the arklike part of the earlobe protruding out right in front of the opening of the ear canal, also usually causes pain in this condition as an external otitis diagnostic on physical examination. People may also have earwax and itching. When enough swelling and discharge in the ear canal is present to block the opening, external otitis may cause temporary conductive hearing loss.
Because external otitis symptoms cause many people to try to clear the ear canal (or scratch it) with a sleek tool, general self-cleaning causes additional trauma to the injured skin, so that worsening conditions are common.
Maps Otitis externa
Cause
Two factors necessary for external otitis to develop are (1) the presence of germs that can infect the skin and (2) a disturbance in the integrity of the skin of the ear canal that allows infection to occur. If the skin is healthy and unharmed, exposed only to high concentrations of pathogens, such as soaking in ponds contaminated with feces, will likely trigger an episode. However, if there are chronic skin conditions affecting the skin of the ear canal, such as atopic dermatitis, seborrhoeic dermatitis, psoriasis or keratin production abnormalities, or if there has been damage to the skin due to trauma, even normal bacteria found in the ear canal may cause infections and symptoms external otitis.
Ear fungal infection of the fungus, also known as otomycosis, ranges from non-essential to very severe. The fungus can be a saprophyte, where there are no symptoms and the fungus only lives together in the ear canal in a harmless parasite relationship with the host, where the only physical finding is the presence of a fungus. If the fungus begins to actively reproduce, the ear canal fills with solid fungus feces, causing increasing pressure and pain unceasingly until mold is removed from the channel and anti-fungal drugs are used. Most antibacterial ear drops also contain steroids to accelerate the resolution of canal edema and pain. Unfortunately, such drops make the fungus infection worse. Long-term use of them increases the growth of fungus in the ear canal. Antibacterial ear drops should be used a maximum of one week, but 5 days is usually enough. Otomycosis responds to more than 95% of the time to three days of the same over-the-counter anti-fungal solution used for athlete's feet.
Swimming
Swimming in contaminated water is a common way to contract the swimmer's ears, but it is also possible to contract the swimmer's ear from water trapped in the ear canal after bathing, especially in humid climates. The constriction of the ear canal from bone growth (the Surfer's ear) can trap the dirt that causes the infection. Divers Saturation has reported otitis externa during occupational exposure.
Object in ear
Even without exposure to water, the use of objects such as cotton or other small objects to clean the ear canal is enough to cause damage to the skin, and allow the condition to develop. Once the skin of the ear canal is inflamed, external otitis can be drastically increased by scratching the ear canal with an object, or by letting the water remain in the ear canal for a long time.
Infection
Most cases are caused by Pseudomonas aeruginosa and Staphylococcus aureus , followed by a large number of other gram-positive and gram-negative species. Candida albicans and Aspergillus species are the most common fungal pathogens responsible for this condition.
Diagnosis
When the ear is examined, the canal appears red and swollen in a well-developed case. The ear canal may also look like eczema, with scaly scaly skin. Touching or moving the outer ear increases the pain, and this maneuver on physical examination is important in establishing a clinical diagnosis. It may be difficult to see the eardrum with an otoscope on initial examination due to constriction of the ear canal from inflammation and the presence of drainage and debris. Sometimes the diagnosis of external otitis is a conjecture and a return visit is required to fully check the ear. A drainage culture can identify bacteria or fungi that cause infection, but is not part of routine diagnostic evaluation. In the case of severe external otitis, there may be swelling of the lymph node (s) directly below the ear.
Diagnosis may be missed in most cases early because of ear examination, with the exception of pain with manipulation, almost normal. In some early cases, the most striking visual invention was the lack of ear wax. As a moderate or severe case of external otitis, it may take several weeks before the ear canal returns a normal amount.
Classification
In contrast to chronic external otitis, acute otitis externa (AOE) is largely a bacterial infection, occurs suddenly, rapidly worsens, and becomes painful. The ear canal has an abundant supply of nerves, so the pain is often severe enough to interfere with sleep. Wax in the ear can be combined with swelling of duct related skin and pus to block the channel and dampen hearing, creating temporary conductive hearing loss. In more severe or untreated cases, the infection may spread to the soft tissues of the face surrounding the adjacent parotid glands and the jaw joint, making chews ache. In its mildest form, otitis externa is so common that some nose and throat doctors have suggested that most people will have at least a brief episode at some point in life. While a minority of people seem to have an innate tendency toward chronic otitis externa, most people can avoid external otitis altogether once they understand the complicated mechanisms of disease.
The bone ear canal skin is unique, as it can not be moved but is firmly attached to the bone, and is almost paper thin. For these reasons, he is easily scratched or torn by even minimal physical strength. Inflammation of the ear canal skin usually begins with physical humiliation, most often from injuries caused by self-cleaning or scratching with cotton, pen caps, nails, hair pins, keys, or other small tools. Another contributing factor for acute infection is prolonged water exposure in the form of swimming or exposure to extreme humidity, which can harm the protective function of the canal skin, allowing bacteria to thrive, hence the name "swimmer's ear".
Prevention
Strategies to prevent acute external otitis are similar to those for treatment.
- Avoid putting any into the ear canal: the use of cotton buds or swabs is the most common event that causes acute external otitis.
- Most normal ear canals have their own self-cleaning and drying mechanisms, the latter with simple evaporation.
- After a long swim, a person susceptible to external otitis may dry his ears with a small battery-powered ear dryer, available at many retailers, especially stores that serve water sports enthusiasts. Alternatively, drops containing dilute acetic acid (vinegar diluted 3: 1) or Burow solution may be used. It is very important not to ears the instrument when the skin is saturated with water, as it is very susceptible to injury, which can cause external otitis.
- Avoid swimming in polluted water.
- Avoid washing your hair or swimming if very mild acute external acute otitis symptoms begin
- Although the use of earplugs while swimming and shampooing can help prevent external otitis, there are important details in the use of plugs. A hard and fitting ear plug can scratch the skin of the ear canal and trigger the episode. When earplugs are used during acute episodes, either disposable plugs are recommended, or the plugs used should be cleaned and dried properly to avoid contamination of the infected ear canal with infected whiteness.
Treatment
Drugs
Effective solutions for ear canal include acidification and drying agents, whether used singly or in combination. When the skin of the ear canal is inflamed from acute external otitis, the use of dilute acetic acid may be painful.
Burow Solutions is a very effective drug against external otitis both bacteria and fungi. It is a mixture of buffered aluminum sulfate and acetic acid, and is available without a prescription in the United States.
Ear drops are a mainstay of care for external otitis. Some contain antibiotics, either antibacterial or antifungal, and others are only designed to slightly acidify the ear canal environment to prevent bacterial growth. Some prescription drops also contain anti-inflammatory steroids, which help to overcome swelling and itching. Although there is evidence that steroids are effective in reducing the length of time needed, otitis externa fungi (also called otomycosis) can be caused or compounded by prolonged use of steroids.
Oral antibiotics should not be used to treat uncomplicated acute external otitis. Oral antibiotics do not respond adequately to the bacteria that cause this condition and have significant side effects including an increased risk of opportunistic infections. Conversely, topical products can treat this condition. Oral anti-pseudomonal antibiotics can be used in cases of severe soft tissue swelling that extends to the face and neck and can speed recovery.
Although acute external otitis generally disappears within a few days with topical leaching and antibiotics, complete refund of the hearing and cerumen function may take several days to complete. After fully healed, the ear canal again cleans away. Until it recovers fully, it may be more prone to repeat the infection from further physical or chemical insults.
Effective drugs include ear drops containing antibiotics to fight infections, and corticosteroids to reduce itching and inflammation. In the case of painful topical antibiotic solutions such as aminoglycosides, polymyxin or fluoroquinolone are usually prescribed. Antifungal solution is used in cases of fungal infections. External otitis is almost always dominated by bacteria or especially fungi, so only one type of medication is needed and indicated.
Clean
Removing the remnants of dirt (wax, dead skin, and pus) from the ear canal increases direct contact of the medication prescribed with the infected skin and shortens the recovery time. When the swelling of the canal has progressed to the point where the ear canal is blocked, the topical drops may not penetrate far enough into the ear canal to be effective. The physician may need to carefully insert a cotton axis or other commercially available absorbent material, called the ear wick and then saturate it with the drug. The axis remains saturated with the drug until the channel is open enough so that the drops will pass through the channel without it. Axis removal does not require health professionals. Antibiotic ear drops should be administered in an amount that allows coating of most of the ear canal and is used for no more than 4 to 7 days. The ears should be left open. It is essential that visualization of intact tympanic membrane (eardrum) is recorded. The use of certain drugs with a ruptured tympanic membrane can cause tinnitus, vertigo, dizziness and hearing loss in some cases.
Prognosis
External otitis responds well to treatment, but complications can occur if left untreated. Individuals with underlying diabetes, immune system disorders, or history of radiation therapy to the skull base are more likely to develop complications, including otitis externa maligna. In these individuals, rapid examination by otolaryngologist doctors (ear, nose, and throat) is very important.
- Chronic otitis externa
- Spread of infection to other areas of the body
- Necrotizing external otitis
- Otitis externa haemorhagica
Necrotizing external otitis
External necrotizing otitis (otitis externa maligna) is a rare form of rare external otitis that occurs primarily in elderly diabetics, becoming somewhat more likely and more severe when diabetes is not well controlled. Even less commonly, it can develop because the immune system is severely impaired. Beginning as an external ear canal infection, there is prolongation of infection into the bone ear canal and soft tissues deep into the bone canal. Unknown and untreated, can cause death. The hallmark otitis externa maligna (MOE) is the unrelenting pain that interferes with sleep and continues even after swelling of the external ear canal has been overcome with topical antibiotics. It may also cause skull base osteomyelitis (SBO), manifested by some cranial nerve palsies, described below under the heading "Treatment".
Natural history
MOE follows a much more chronic and sluggish course than ordinary acute otitis externa. There may be granulation involving the floor of the external ear canal, most often at the junction of the cartilage. Paradoxically, the physical findings of MOE, at least in the early stages, are often much more dramatic than ordinary acute otitis externa. At a later stage, there may be soft tissue swelling around the ear, even without significant swelling of the channel. While fevers and leukocytosis may be expected in response to bacterial infections that attack the skull region, the MOE does not cause fever or increased white blood counts.
MOE Treatment
Unlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for healing. Pseudomonas is the most common offending pathogen. Diabetic control is also an important part of treatment. When the MOE is unrecognized and untreated, the infection continues to burn and for several weeks or months it can spread deeper into the head and involves the bone from the base of the skull, which is the base of the osteomyelitis (SBO) skull. Some cranial nerve palsies may occur, including the facial nerve (causing the false face), recurrent laryngeal nerve (causing vocal cord paralysis), and cochlear nerve (causing deafness). The infecting organism is almost always pseudomonas aeruginosa, but it can also be fungi (aspergillus or mucosa). MOE and SBO disagree for operations, but exploratory operations may facilitate the culture of unusual organisms (s) that do not respond to antibiotics that are used empirically (ciprofloxacin being the drug of choice). Ordinary surgical findings are diffuse cellulitis without the formation of local abscesses. SBO may extend to the petrous peak from the temporal or more inferior bone to the opposite side of the skull base.
The use of hyperbaric oxygen therapy in addition to antibiotic therapy is controversial.
Complications
When the base of the skull is involved progressively, adjacent cranial nerves and their branches, especially the facial and vagal nerves, may be affected, resulting in facial paralysis and hoarseness, respectively. If both laryngeal nerves repeatedly paralyzed, shortness of breath may develop and require tracheostomy. Severe deafness may occur, usually later in the course of the disease because of the relative resistance of the inner ear structure. Gallium scans are sometimes used to document infection rates but are not essential for disease management. The skull base of osteomyelitis is a chronic disease that can take many months of IV antibiotic treatment, tends to recur, and has a significant mortality rate.
Epidemiology
High incidence of otitis externa. In the Netherlands, it has been estimated at 12-14 per 1,000 population per year, and has been shown to affect more than 1% of the sample population in the UK over a 12 month period.
History
During the Tektite Project in 1969 there were many otitis externa. Dive Medical Officers found prophylaxis which came to be known as, "Tektite Solution", equal parts of 15% tannic acid, 15% acetic acid and 50% isopropanol or ethanol. As long as Tektite ethanol is used it is therefore available in the lab for preservative specimens.
Other animals
References
External links
- Liquids in the Middle E: Guide for Parents, Good Medicine Institute at Pennsylvania Medical Society
- What to do if your child has swimmer's ear from Seattle Children's Hospital
- DRTBALU.com Otolaryngology online
Source of the article : Wikipedia
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