00:01
For otitis externa, we’re talking
now about the ear canal.
00:06
We’re worried about different
pathogens and different causes.
00:10
This is classically called swimmer’s ear.
00:13
And it’s from a chronically
moist external auditory canal.
00:17
It’s associated with prolonged redness
or a foreign body in the ear canal.
00:22
Sometimes kids will put something
in there and then forget about it
and you can get an infection.
00:26
It’s usually associated
with Pseudomonas species.
00:29
But other bacteria are possible such as E.
coli or staph aureus.
00:35
So here’s a particularly bad
case of otitis externa.
00:38
It should hurt a little bit to
wiggle on the outside of the ear
because you’re
moving that canal.
00:43
And there should be frank purulent drainage
or swelling visible directly on otoscopy.
00:50
You don’t need a bulb for this.
00:52
It’s on the ear canal itself.
00:54
So patients typically
will have ear pain.
00:57
They’ll have pain with
tugging on the outer ear
and they there’ll be pus
draining from their ear.
01:01
That’s your diagnosis.
01:04
How do we treat it?
Topical ciprofloxacin drops
are usually the trick.
01:09
They do treat pseudomonas.
01:11
Or you can use polymyxin ear
drops which is a bit cheaper.
01:15
If it’s super severe, you can
insert a wick into the ear
to allow for penetration of the drops
into the deeper part of the ear.
01:23
It’s not fun to place a wick and the
child is not excited to receive one,
but it may help the ear heal
up a little bit faster.
01:30
Also, we can provide NSAIDs
for pain and irritation.
01:34
So let’s turn now to mastoiditis.
01:37
That’s when ear infections
go totally wrong.
01:40
This is basically an infection of the mastoid
air cells in the skull behind the ear.
01:46
This usually starts with an acute
otitis media or an otitis externa
and then it spreads down
to those air cells.
01:54
So this is usually caused
by otitis media bacteria,
although some bacteria are more
likely to cause it than others,
so the differential of organisms
is a little bit different.
02:06
It can be caused by Strep pneumo, by
Staph aureus and can also be MRSA
and by group A strep and
also by Pseudomonas,
especially if there’s an
otitis externa present.
02:20
So these patients can be fairly sick.
02:23
They may have fever.
02:24
They’re going to have significant ear pain.
02:27
You will notice a proptosis or a
pushing forward of the affected ear.
02:32
And they will have palpation and
pain to palpation behind their ear.
02:37
So if you press behind a
protuberant ear and it hurts,
that’s mastoiditis.
02:43
You can get a CT scan like this,
which will show a opacification of
those air cells in the mastoid area.
02:52
And may also show some
bony destruction.
02:55
It’s sort of like an osteomyelitis
of this skull as well.
02:59
Patients with mastoiditis, which is a
rare complication of otitis media,
are often admitted to the
hospital for IV antibiotics.
03:08
Usually, we’ll start with something
like ampicillin sulbactam
unless we suspect a very
invasive infection such as MRSA.
03:16
And usually, those look very severe and
the patients are exceptionally ill.
03:20
Then we might cover for MRSA with
either vancomycin or clindamycin.
03:24
And if there is an otitis
externa associated with it,
we might cover for pseudomonas with
something like ciprofloxacin.
03:33
If there is an otitis media with it,
oftentimes ear, nose and throat
doctors will prefer to do myringotomy
in addition to a surgical drainage of the
lesion if surgical drainage is necessary.
03:44
And in those surgical cases as deemed
by the ear, nose, and throat doctor,
we will usually do either a
mastoidectomy or a drain placement.
03:52
They may get an osteitis and then we have
to have drainage of the bone in addition.
03:58
And we usually will go to
surgery if there’s a case
that’s not responding to IV
antibiotics, likely we might suspect.
04:07
So that’s my review of all
ear infections in kids.
04:11
Hey, thanks for your time.