Otitis externa

Otitis externa

Q. 1

A 40-year-old South Indian woman with well-controlled diabetes comes to your clinic complaining of ear pain and low-grade fever for the past five weeks. She reports that there has also been copious greenish drainage on her pillow each morning. Her pain has been worsening, which brought her to the clinic. On examination, she is exquisitely tender when her external ear is manipulated. A limited examination of the ear canal shows red, inflamed skin with copious greenish exudate. There is no tenderness over the mastoid process. Which of the following is the most likely diagnosis?

 A

Acute otitis media

 B

Chronic otitis media

 C

Mastoiditis

 D

Otitis externa

Q. 1

A 40-year-old South Indian woman with well-controlled diabetes comes to your clinic complaining of ear pain and low-grade fever for the past five weeks. She reports that there has also been copious greenish drainage on her pillow each morning. Her pain has been worsening, which brought her to the clinic. On examination, she is exquisitely tender when her external ear is manipulated. A limited examination of the ear canal shows red, inflamed skin with copious greenish exudate. There is no tenderness over the mastoid process. Which of the following is the most likely diagnosis?

 A

Acute otitis media

 B

Chronic otitis media

 C

Mastoiditis

 D

Otitis externa

Ans. D

Explanation:

Patients with diabetes, or patients who sustain damage to the external ear canal (usually with swabs) are susceptible to otitis externa. This patient has many of the findings: ear pain, pruritus, and discharge. On examination, the ear canal is erythematous and edematous. Tenderness to manipulation of the external ear is also indicative of otitis externa, and is not seen in otitis media.

Acute otitis media presents with fever and ear pain. The external ear canal is unaffected in otitis media, and there is no pain with manipulation of the external ear.
 
Chronic otitis media is inflammation of the middle ear and/or the mastoid. It may present with otorrhea, but inflammation of the ear canal and tenderness to manipulation of the external ear canal are not seen. Thus, otitis externa is a better diagnosis.
 
Mastoiditis is characterized by swelling, erythema and tenderness over the mastoid. Diagnosis is confirmed by cloudiness and loss of margins of the mastoid on radiograph. None of these findings are present here.

Q. 2

A 40 year old woman presents with a three day history of irritation, pain, and watery discharge of her left ear. She has just returned from holiday, where she admits to using her towel, artificial nails, and ear buds to try to alleviate itching in her ear. What is the likely diagnosis?

 A

Mastoiditis

 B

Otitis Externa

 C

ASOM

 D

Trigeminal Neuralgia

Q. 2

A 40 year old woman presents with a three day history of irritation, pain, and watery discharge of her left ear. She has just returned from holiday, where she admits to using her towel, artificial nails, and ear buds to try to alleviate itching in her ear. What is the likely diagnosis?

 A

Mastoiditis

 B

Otitis Externa

 C

ASOM

 D

Trigeminal Neuralgia

Ans. B

Explanation:

Inflammation of the ear canal with or without infection is the charecteristic of acute otitis externa.  

If symptoms are recurrent or if they last longer than three months, the condition is classed as chronic otitis externa.

Acute otitis externa can also be classified according to its cause.

These are split into three main groups:

  • Infective (bacterial, fungal, and viral), 
  • Non-infective dermatitis (allergic, eczematous, and irritant), and 
  • Mixed infective and non-infective

Exacerbating factors include: Warm humid climates, swimming, frequent hair washing (especially if in the bath), and insertion of foreign bodies can introduce bacterial infection and cause local trauma to the ear canal, making infection more likely. Prolonged use of hearing aids may also predispose to infection.


Q. 3

Most common cause of otitis externa is:

 A

Pseudomonas aeruginosa

 B

Proteus species

 C

Staphylococcus epidermidis

 D

Diphtheroids

Q. 3

Most common cause of otitis externa is:

 A

Pseudomonas aeruginosa

 B

Proteus species

 C

Staphylococcus epidermidis

 D

Diphtheroids

Ans. A

Explanation:

Otitis externa is an inflammatory and infectious process of the EAC.

Pseudomonas aeruginosa and Staphylococcus aureus are the most commonly isolated organisms.

Less commonly isolated organisms include Proteus species, Staphylococcus epidermidis, diphtheroids, and Escherichia coli.


Q. 4

Otomycosis is most commonly caused by:

 A

Aspergillus

 B

Rhizopus

 C

Candida

 D

Penicillium

Q. 4

Otomycosis is most commonly caused by:

 A

Aspergillus

 B

Rhizopus

 C

Candida

 D

Penicillium

Ans. A

Explanation:

Otomycosis is an inflammatory process of the external ear canal due to infection with fungi and is responsible for more than 9% of the diagnoses of otitis externa.

In 80% of cases, the etiologic agent is Aspergillus, whereas Candida is the next most frequently isolated fungus.

Other more rare fungal pathogens include Phycomycetes, Rhizopus, Actinomyces, and Penicillium.


Q. 5

The most common causative organism for external otitis in adults is:

 A

Streptococcus viridans

 B

Staphylococcus epidermidis

 C

Pseudomonas aeruginosa

 D

E. coli

Q. 5

The most common causative organism for external otitis in adults is:

 A

Streptococcus viridans

 B

Staphylococcus epidermidis

 C

Pseudomonas aeruginosa

 D

E. coli

Ans. C

Explanation:

Otitis externa is an inflammatory and infectious process of the external auditory canal.

Pseudomonas aeruginosa and Staphylococcus aureus are the most commonly isolated organisms.

Less commonly isolated organisms include Proteus species, Staphylococcus epidermidis, diphtheroids, and Escherichia coli.
 

Q. 6

Aspergillus causes all except ‑

 A

Bronchopulmonary allergy

 B

Otomycosis

 C

Dermatophytosis

 D

 Allergic sinusitis

Q. 6

Aspergillus causes all except ‑

 A

Bronchopulmonary allergy

 B

Otomycosis

 C

Dermatophytosis

 D

 Allergic sinusitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Dermatophytosis


Q. 7

Common causes of otitis externa:

 A

Aspergillus

 B

Mucor

 C

Candida

 D

a and c

Q. 7

Common causes of otitis externa:

 A

Aspergillus

 B

Mucor

 C

Candida

 D

a and c

Ans. D

Explanation:

 

  • Otitis externa is an inflammatory and infectious process of the external auditory canal which is seen in all ages and both sexes.
  • M/C organism causing otitis externa are

Pseudomonas aeruginosa

Staphylococcus aureus

  • Less commonly isolated organisms are ‑
  1. Proteus species
  2. Staphylococcus epidermidis
  3. Diphtheroids
  4. E. coli

Fungal Otitis Externa/Otomycosis

  • In 80% of cases organism is aspergillus
  • 2nd M/C organism is candida

Other more rare fungal pathogens include

  • Phycomycetes
  • Rhizopus
  • Actinomyces
  • Penicillium



Q. 8

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Q. 8

External otitis is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonists ear

 D

ASOM

Ans. C

Explanation:

Humidity and hot climate are one of the predisposing factors for otitis externa. Hence – otitis externa is also k/a Singapore ear (where climate is hot & humid) or Telephonist ear as talking on phone causes humidity around ear) or Swimmers ear.

 


Pseudomonas aeruginosa is a normal inhibitant of external ear. Its numbers are kept in balance by the normal acidity of EAC. Prolonged swimming or abusive use of cotton typed ear buds can alter the pH, producing a more basic environment in which pseudomonas grows rapidly.



Q. 9

Causes of Otomycosis:

 A

Candida

 B

Aspergillus

 C

Thermophilus

 D

a and b

Q. 9

Causes of Otomycosis:

 A

Candida

 B

Aspergillus

 C

Thermophilus

 D

a and b

Ans. D

Explanation:

Q. 10

Fungus causing otomycosis most commonly is:

 A

Aspergillus fumigatus

 B

Candida

 C

Mucor

 D

Penicillin

Q. 10

Fungus causing otomycosis most commonly is:

 A

Aspergillus fumigatus

 B

Candida

 C

Mucor

 D

Penicillin

Ans. A

Explanation:

Q. 11

Chalky white tympanic membrane is seen in: 

 A

ASOM

 B

Otosclerosis

 C

Tympanosclerosis

 D

Cholesteatoma

Q. 11

Chalky white tympanic membrane is seen in: 

 A

ASOM

 B

Otosclerosis

 C

Tympanosclerosis

 D

Cholesteatoma

Ans. C

Explanation:

 

Keratosis Obturans (Primary canal cholesteatoma)

  • It is accumulation of a large plug of desquamated keratin in the external auditory meatus
  • Seen between 5 and 20 yrs of age (i.e. younger age as compared to cholestealoma which is seen in middle age)
  • May be U/L or Bilateral (occasionally)
  • It may be associated with bronchiectasis and chronic sinusitis.

Clinical Features

  • Pain in the ear (severe olatagia)
  • Hearing loss (of conductive type)
  • Tinnitus
  • Ear discharge – sometimes
  • Pearly white mass of keratin is visible in the ear canal
  • Tympanic membrane is thickened and chalky white in appearance
  • Ear canal is ballooned

Treatment

  • Removal by syringing / Instrumentation
  • Periodic checkup should be done to see reaccumulation
  • If it recurs – keratolytic agent – 2% salicylic acid in alcohol can be tried.

Q. 12

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Q. 12

Diffuse otitis externa is also known as:

 A

Glue ear

 B

Malignant otitis externa

 C

Telephonist’s ear

 D

ASOM

Ans. C

Explanation:

Q. 13

Otitis externa Haemorragica is caused by:

 A

Influenza

 B

Proteus

 C

Staph

 D

Streptococcus

Q. 13

Otitis externa Haemorragica is caused by:

 A

Influenza

 B

Proteus

 C

Staph

 D

Streptococcus

Ans. A

Explanation:

 

Otitis externa haemorrhagica is most commonly caused by influenza virus and is characterised by formation of haemorrhagic bullae on the tympanic membrane.



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