external and middle ear infections


External otitis

I- Definition :

L & rsquo; otitis externa is an acute dermo-epidermidis that develops at d & rsquo; damaged skin (after extraction & rsquo; a plug of earwax, washing d & rsquo; s ear,…) or d & rsquo; a skin having altered physicochemical properties (baths in the pool or river ; know, essences and detergents that destroy I greasy coating and the surface stratum corneum ; d & rsquo; chronic otorrhea ; after radiotherapy,…) Contributing factors are numerous : hot and humid climate

II- Anatomy and Physiology & rsquo; external ear :

The conduit is made of two parts : bone leads inwards, fibrocartiiagineux the conduit outside. The boundary between the pipe and fibrocartiiagineux Pavilion is frank without demarcation. The outer ear:
– Pavilion
– conduit fibrocartilaginous
– bone leads

  • Peau du conduit fibrocartiiagineux: the epidermis and dermis : hair system + ceruminous glands
  • Skin bone leads : Very slim, little & rsquo; Appendices.
  • Commensalism the external auditory meatus :

*Micromycètes commensaux : the kind micromycètes filamentous (aspergillus), the kind of yeast-like

*commensal bacteria : staphylococci, aerobic diphtheroids, anaerobic diphtheroids, Escherichia coli, Proteus and Pseudomonas aeruginosa are found sporadically in the healthy ear canal.

III- Bacterial infections :

1- Otitis externa diffuse :

A violent pain, s & rsquo; d & rsquo sometimes accompanying; radiation to the mandible and temporal regions. The pain is exacerbated by & rsquo; touch the tragus and mobilization flag.

L & rsquo; otoscopy is difficult, both the pain by narrowing of the duct. L & rsquo; otoscopic appearance varies according to the & rsquo; importance of & rsquo; affection. The injuries range from simple skin hyperemia to stenosis almost complete d & rsquo; a conduit, leaving welling of serous secretion

  • Treatment: essentially local, active against Gram negative organisms most frequently involved, an antibiotic and a corticosteroid usually associated,Among the antibiotics, it is classic d & rsquo; use neomycin and framycetin (Corticétine*, Antibiosynalar*, In notile *, Polydexa ), fluoroquinolone (oflocet)

2- Boil :

C & rsquo; is a staphylococcal skin centered on pilosebaceous follicle, The pain is in the foreground and often the only sign. She is very keen, localized, exacerbated by mastication. It evolves in paroxysms. L & rsquo; examination revealed a swelling congestive, localized, on top of which one can see a yellowish white point

3- impetigo :

Linked to superinfection by staphylococcus or streptococcus after scraping or cleaning a soiled object, or in connection with chronic otorrhea. It s & rsquo; observed most often in the & rsquo; child.

4- erysipelas :

L & rsquo; erysipelas is an acute streptococcal cellulitis

clinically, it is manifested by inflammatory infiltration flag, overflowing into the neighboring region, déjetant lobule. It s & rsquo; & rsquo accompanied, high fever, chills, Treatment is based on the & rsquo; antibiotic penicillin parenterally in high doses

5- Malignant external otitis necrotizing :

Concerns mainly but not exclusively the elderly since the & rsquo; average age goes 60 at 75 years. Diabetes is found in the majority of cases. The quality of diabetes control does not seem to play a role in triggering the disease. Diabetes can be found in & rsquo; occasion of the disease. L & rsquo; malignant otitis externa can also move on any terrain immunodeficient

Pseudomonas aeruginosa as SVT involved, characterized otorrhea, very violent pain insomniantes, and & rsquo; & rsquo absence; improvement from the usual treatments. L & rsquo; otoscopic examination shows a polypoid or necrotic area to the floor of the conduit,

  • Treatment: based on a business emergency antibiotics after a levy for the & rsquo; bacteriology, targeted against Pseudomonas aeruginosa, essentially fluoroquinolone and third generation cephalosporins.

6- acute Myringites :

7- Périchondrites flag :

Formidable by their morphological potential complications, that occur when processing n & rsquo; is undertaken at an early stage

IV- Viral infections :

1- Zone :

It can be presented as a condition flag or conduit. L & rsquo; combination of the two locations is highly suggestive. L & rsquo; eruption responds to the sensitive area of ​​the facial nerve (intermediate VII) : conch, tragus, anthélix, rear and bottom of the duct and of the tympanic membrane. This area known as "Zone Ramsay Hunt" can n & rsquo; be partially achieved. Skin lesions are that & rsquo; an element of atrial shingles, next to paralysis

facial, s & rsquo; cochlear damage and the & rsquo; vestibular. Treatment is primarily based on the & rsquo; acyclovir

2- Herpes :

It is characterized by vesicles grouped bouquet polycyclic outline based on an edematous base.

V- fungal infections :

the otomycosis

Acute otitis media

I- Definition :

L & rsquo; acute otitis media (OMA) is a major reason for prescribing & rsquo; antibiotics in the & rsquo; child. It s & rsquo; d & rsquo acts; bacterial infection. Most of the time, it is opened by a viral nasopharyngitis which disrupts the functioning auditory tubes. The diagnosis is made before the & rsquo; d & rsquo association effusion in & rsquo; middle ear and acute inflammatory signs. L & rsquo; otoscopy found a bulging eardrum by a retro tympanic effusion purulent, or a consecutive purulent otorrhea at a localized perforation of the eardrum pressure.

II- pathogenesis :

L & rsquo; Otitis media is an infectious disease. It results & rsquo; interference between microbial load (viral and bacterial) and an immune reaction. All factors favoring the & rsquo; otitis media are related to this interference : factors related to the & rsquo; host (age, genetic predisposition, atopy) potentiate the & rsquo; impaired immune systems, while environmental factors (children & rsquo; siblings, Children raised in nursery, automno-winter season) interfere with the microbial load). The trunk d & rsquo; Eustache also plays a key role in this infection.

III- The causative :

Bacteriological dgc based on paracentesis or spontaneous flow

  • H influenzae, Strp pneumoniae M .catarrhalis
  • Strp B-hemolytic grp A is exceptionally isolated
  • Anaerobic have a minimal role
  • Enterobacteriaceae (Proteus aeruginosa, E, coli, klebsielles et enterobacter) : 20% the issues – from 03 month

IV- Diagnostic :

The diagnosis of & rsquo; OMA clinic :

  • earache d & rsquo; sudden onset or equivalent (friction or traction flag, irritability and sleep disturbances with unusual crying)
  • Purulent otorrhea, linked to a tympanic break under the pressure of the & rsquo; effusion, spontaneously give the & rsquo; earache
  • Before 2 years, l & rsquo; earache may miss. Abdominal symptoms (diarrhea, vomiting) may be the indirect sign of & rsquo; infection.
  • An infectious syndrome is present : ° F in 40

Otoscopie : The normal eardrum is gray and translucent, l & rsquo; otoscopy classifies the & rsquo; OMA stages:

The stadium congestive :
– Expansion Vx peri-malléaires
– decreased tympanic transparency
– disappearance of the light cone

The collected stage :
– diffuse inflammation of the eardrum
– thickening of the eardrum: opacity, loss of ossicular reliefs
– bomb meant you tympan

The perforated stage :
– perforation du tympan point
– purulent otorrhea

V- Complications :

1- Complications locorégionales :

  • mastoïdite
  • facial palsy octogen device
  • labyrinthite

2- Complications endocrâniennes :

  • purulent meningitis
  • empyème extradural
  • intracerebral abscesses
  • lateral sinus thrombophlebitis

WE- Treatment :

1- ATB systemically : amoxicillin, amoxicillin-clavulanic acid, cephalosporins, macrolides, cotrimoxazole

Antibiotic recommended probabilistic :

  • younger than 2 years
  • age greater than or equal to 2 years and specific risks of infection (immunodépression, malformation of the face, history of mastoiditis)
  • age greater than or equal to 2 years and noisy manifestations suggestive of infection by the pneumococcus (high fever, acute earache)

Antibiotic therapy is not recommended but revaluation 2-3 days if symptoms persist :

  • age greater than or equal to 2 years without noisy demonstrations
  • OMA congestive

2- the paracentèse :
the issues – 03month, the rebel trt, otitis complicated, terrain immunodéprimé

3- Adjuvant therapies :

  • Analgesics and antipyretics
  • Decongestants and disinfectants nasopharyngeal
  • ear drops

L & rsquo; Otitis media chronic simple

I- Definition :

L & rsquo; Chronic otitis media is an inflammation of the lining of the & rsquo; middle ear, c & rsquo; t mean to the eardrum, Annexes cavities and the PT, extended beyond 03 month

II- pathogenesis :

To convey the best sound vibration to the & rsquo; inner ear, l & rsquo; middle ear must be ventilated and drained, c’t 02 conditions are ensured by ventilation, the PT and clearance muco- ciliary

III- Clinique :

  • "Wet mouth"
  • deafness d & rsquo; varying importance
  • otorrhée minimum racy here Devient purulent suites at poussée de réchauffement (infection rhiosinusienne)
  • to & rsquo; otoscopy : the perforation is not marginal, either anterior or central sup and kidney-shaped revealing an edematous mucosa pink shiny
  • L & rsquo; ENT examination centered on the sinuses and nasopharynx is crucial
  • An allergy investigation is needed
  • L’audiométrie : deafness transmission
  • Radiology : (Schuller/TDM) blur the mastoid region

IV- The evolution :

  • warming episodes at the mercy of nasopharyngeal infections and climatic influences
  • L & rsquo; osteitis
  • Can progress to otitis sequelae : Dry open ear

V- Treatment :

1- Medical treatment:

  • treating deficiency states of the mucosa ORL: The vit, sulfur, Spa treatment
  • ATB systemically and topically
  • corticosteroids
  • micro-aspirations, local care

2- surgical treatment :

Dr Henider's course – Faculty of Constantine