ENT Referral Guidelines For The Ear | Otitis Externa

Otitis Externa

Otitis externa is extremely common according to ENT Consultant in Lahore. Predisposing factors are scratching of the external canal with cotton buds or other implements and narrow external auditory canals. A particularly important factor is wet ears (humid climates, swimming, syringing without drying the canal, frequent hair washing or lying in the bath to wash the hair).
Symptoms and signs: Whatever the predisposing factor, the skin of the external auditory canal becomes oedematous. Otalgia, otorrhoea and a blocked sensation in the ears with a mild hearing loss are common in the acute stage. In the chronic form itching is a frequent complaint. my site
Treatment: It is essential that debris in the ear canal is removed so that the ear drops are absorbed effectively. If the practice nurse is not trained in the aural toilet, this may require the patient to be referred for suction clearance. Systemic antibiotics are not usually required unless there are signs of associated lymphadenitis, perichondritis or cellulitis. Advise the patient to keep the ears dry and not to insert implements.
The first line of treatment is a combination of steroid and antibiotic (eg. neomycin) drop or spray. If the patient does not respond to this within a few days, take a swab, change to an alternative antibiotic/steroid combination and repeat the aural toilet. Consider fungal infections.
When to refer: If the patient does not respond to the second line treatment, refer to the emergency ENT Surgeon in Lahore clinic. Refer if there is persistent discharge or pain, diagnostic doubt about the condition of the tympanic membrane or if the patient is immuno-compromised or a poorly controlled diabetic as there is a risk of “malignant “otitis externa (temporal bone osteomyelitis). If the skin of the external canal is so swollen that drops will patently not enter the canal, then a dressing or wick may need to be inserted.

Recurrent Acute Otitis Media (Raom)

Approximately 40% of children will suffer one or more episodes before the age of 7 years. At least 85% will resolve within 72 hours without treatment and it is uncommon in adults.  A significant proportion of children with RAOM failing medical management appear to have a partial maturational IgA deficiency. Children with RAOM may require long-term low-dose antibiotic treatment or grommet insertion until they grow out of the condition. Grommet surgery in children with RAOM can prevent infection, pain and the need for antibiotics.
Symptoms and signs: Earache, hearing loss and a red bulging drum prior to tympanic membrane rupture. The child may be irritable with a fever and sickness. After rupture, there will be relief of pain and a purulent discharge.
Treatment: In view of ENT Specialist in Lahore Analgesia such as a combination of ibuprofen and paracetamol. If unresolved after three days prescribe amoxicillin or erythromycin. If antibiotics are prescribed the length of the course should be reviewed after three days. Encourage nose blowing.
If treatment fails with the first line antibiotics, prescribe co-amoxiclav or clarithromycin.
When to refer: Refer to a routine ENT clinic if:
  1. there is a failure of the infection to resolve despite the above treatment.
  2. there is a persistent perforation.
  3. there are more than 6 attacks in one year for a period of more than one year.
Published By: ENT Doctor in Lahore

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