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Acute Otitis Externa Left Orl HNS Rotation
Acute Otitis Externa Left Orl HNS Rotation
ORL-HNS
PALTEP,RASHELL ANNE C.
QUILANG, SHEILA AYRA F.
GENERAL DATA
Name: D. C.
Age: 56 y.o.
Gender: Female
DOB: Sept. 25,
1962
Address: Taytay,
Rizal
CHIEF COMPLAINT
EAR PAIN, LEFT
HISTORY OF PRESENT ILLNESS
5 days PTC Interim
sweets.
Review of Systems
General: (-)Weight Loss, (-)Weight gain
HEENT: (-) Blurring of vision, (+) Tinnitus, (+) decrease hearing on left ear, (+)
ear pain left ear, (+) itchiness on left ear, (-) epistaxis, (-) dry mouth,
(-)palpable lymph nodes, (-) hoarseness of voice
No Facial asymmetry
Salient Features
• 56 years old/female Decrease hearing
• Otalgia left ear sensation on left ear
Tinnitus on left ear
• Yellowish, watery,
nonfoul-smelling
ear discharge, left
ear
• Tragal tenderness,
left ear
• Intact TM, both ears
Differentials
Otitis media with/without perforation of the
TM
Furunculosis
Mastoiditis
Contact dermatitis of the ear canal
Assessment
ACUTE OTITIS EXTERNA, LEFT
Plan
DIAGNOSTICS
Weber test- localized on the side of infection
Rinne test- bone conduction greater than air
conduction
Plan
THERAPEUTICS
Polymyxin + Neomycin + Dexamethasone
for pain
DISCUSSION
Anatomy
Anatomy
Pinna: Single piece of
yellow elastic cartilage
covered with
Perichondrium and
skin(except lobule and
outer part of external
auditory canal)
External Auditory Canal
Cartilaginous: Bony:
Outer 1/3rd & 8mm Inner 2/3rd & 16mm
Skin lining the bony
canal
Continuation of canal in thin &
cartilage which forms continuous over the
the frame work of tympanic membrane
Devoid of skin
pinna
Fissures of Santorini appendages(Hair and
through them parotid
ceremonious Glands)
About 6mm lateral to
or superficial mastoid
tympanic membrane ,
infection can appear in
bony meatus presents
the canal or vice versa
as narrowing called
ISTHMUS
Anatomy
Innervation: cranial nerves V, VII, IX, X and
greater auricular nerve
Arterial supply: superficial temporal,
Fungal (<2%)
Aspergillus
Candida
PATHOPHYSIOLOGY
3 clinical stages
1. PREINFLAMMATORY STAGE
-consists of edema of the skin of the EAC and obstruction
of glands induce by local trauma or moisture
2. ACUTE INFLAMMATORY
• MILD- characterize by erythe and edematous EAC with
clear, odorless secretions
• MODERATE- increasing edema and pain and
mucopurulent secretions
• SEVERE- the EAC becomes obstructed with debris and
secretions, is intense painful often associated with
periauricular edema and adenopathy
PATHOPHYSIOLOGY
3. CHRONIC INFLAMMATION
-is a single episode lasting more than 4
weeks or 4 or more episodes within one ear
TREATMENT
1st line: prevention
Occlusive earplugs when water exposure is