from previous page swelling. Tony does not have any systemic signs of illness and his cranial nerve examination is normal. |
Aural toilet is performed to remove debris from his external auditory canal, where a wick is then inserted. Tony is started |
on ciprofloxacin ear drops with close follow-up in the upcoming week. Tony is also advised to keep his ears as dry as possible in the |
upcoming fortnight. His symptoms gradually improve over the next two weeks and his medications are ceased. |
Summary
• The external ear is composed of the pinna( also known as the auricle) and the external auditory canal. Conditions affecting the external ear are common presentations in general practice.
• Acute otitis externa is common among Australians, especially during summer when people are more likely to swim. Topical antimicrobial agents are initial therapy for uncomplicated acute otitis externa, with systemic therapy in complicated cases.
• Skull base osteomyelitis is a rare but life-threatening condition that should be excluded in patients with severe symptoms or risk factors such as diabetes and immunosuppression.
• Cerumen should be only be removed when symptomatic or when it is preventing necessary assessment of the tympanic membrane.
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1. Which TWO statements regarding the anatomy and physiology of the external ear are correct? a) The external ear is composed of the auricle and the external auditory canal. b) The skin covering the pinna is tightly bound to the posteromedial surface and loosely bound to the anterolateral aspect. c) The junction of the cartilaginous and bony external ear canal, the isthmus, is usually the narrowest part of the canal. d) Cerumen protects the epithelium of the external auditory canal from breakdown; it has antimicrobial lysozymes and contributes to the normally alkaline pH of the ear canal.
2. Which THREE are correct regarding conditions of the pinna? a) An auricular haematoma occurs when there is blunt trauma with shearing force to the pinna, resulting in the disruption of tissue layers. b) Perichondritis has not been linked to ear piercing. c) Because of its increased UV exposure, the skin over the pinna is at risk of developing pre-cancerous and cancerous lesions. d) Congenital ear malformations can be associated with renal tract abnormalities.
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3. Which TWO are risk factors for otitis externa? a) Ear piercing. b) Cold weather, where people wear head coverings. c) Anatomical factors. d) Underlying skin disorder affecting the ear canal.
4. Which THREE statements regarding acute bacterial otitis externa are correct? a) The typical presentation of acute bacterial otitis externa begins with diminished hearing in the affected ear. b) Patients with otitis externa complain of severe pain on manipulation of the tragus or pinna. c) It can be difficult or impossible to visualise the tympanic membrane in severe cases of canal swelling. d) Treatment consists of symptomatic relief, removal of the debris and optimisation of drug delivery via topical antimicrobial agents.
5. Which TWO modalities are recommended for the initial treatment of uncomplicated acute otitis externa? a) Topical antimicrobial agents. b) Ear syringing to remove debris.
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c) Systemic antibiotics. d) Combination antimicrobial and steroid drops.
6. Which THREE statements are correct? a) Furuncles present with a diffuse swelling of the ear canal. b) A furuncle is a localised collection of pus in the external auditory canal, arising from the hair follicles in the outer third of the external auditory canal. c) The treatment of fungal otitis externa consists of aural toilet followed by the application of topical anti-fungal ear drops. d) Fungal otitis externa has the potential to cause skull base osteomyelitis in individuals who are immunocompromised.
7. Which TWO statements are correct? a) Herpes zoster infection, of the geniculate ganglion of the facial nerve results in Ramsay Hunt syndrome. b) The prognosis of facial nerve recovery in Ramsay Hunt syndrome is as good as that of Bell’ s palsy. c) Skull base osteomyelitis is a progressive infection of the external auditory canal that invades the skull base. d) Approximately 90 % of skull base osteomyelitis
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is caused by S. aureus.
8. Which THREE primary dermatological conditions may mimic otitis externa? a) Eczema b) Acne c) Psoriasis d) Seborrhoeic dermatitis
9. Which TWO statements are correct? a) Exostoses and osteomas are interchangeable terms for the same condition. b) Exostoses occur in 70-80 % of surfers and the degree of obstruction increases with the frequency and duration of surfing. c) Cerumen is produced in the outer third of the ear canal and naturally migrates out of the canal. d) Even if patients do not complain of symptoms and there is no need to assess the auditory system, excess cerumen always requires removal.
10. Which THREE are contraindications to ear irrigation? a) Active otitis externa. b) Hearing loss. c) A non-intact tympanic membrane. d) Prior ear surgery.
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CPD POINTS |