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2. Respiratory diseases
Otitis
Acute otitis externa 2
D iffuse inflam m ation of th e external ear canal, d ue to bacterial or fung al infection.
C om m on precipitants of otitis externa are m aceration, traum a of th e ear canal or
presence of a foreig n bod y or d erm atolog ic d iseases (such as eczem a, psoriasis).
Clinical features
– E ar canal pruritus or ear pain, often sev ere and exacerbated by m otion of th e pinna;
feeling of fullness in th e ear; clear or purulent ear d isch arg e or no d isch arg e
– O toscopy:
• d iffuse eryth em a and ed em a, or infected eczem a, of th e ear canal
• look for a foreig n bod y
• if v isible, th e tym panic m em brane is norm al (sw elling , pain or secretions v ery often
prev ent ad equate v isualization of th e tym panic m em brane)
Treatment
– R em ov e a foreig n bod y, if present.
– T reatm ent of pain: paracetam ol and / or ibuprofen P O (pag e 2 9 ).
– L ocal treatm ent (usually 5 to 7 d ays):
R em ov e skin d ebris and secretions from th e aud itory canal by g entle d ry m opping
(use a d ry cotton bud or a sm all piece of d ry cotton w ool). In ad d ition, 0 .5 % g entian
v iolet can be applied once a d ay, using a cotton bud .
C onsid er ear irrig ation (0 .9 % sod ium ch lorid e, using a syring e) only if th e tym panic
m em brane can be fully v isualised and is intact ( no perforation) . O th erw ise, ear
irrig ation is contra-ind icated .
Acute otitis media (AOM)
A cute inflam m ation of th e m id d le ear, d ue to v iral or bacterial infection, v ery com m on
in ch ild ren und er 3 years, but uncom m on in ad ults.
T h e principal causativ e org anism s of bacterial otitis m ed ia are Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis and in old er ch ild ren, Streptococcus pyogenes.
Clinical features
– R apid onset of ear pain ( in infants: crying , irritability, sleeplessness, reluctance to
nurse) and ear d isch arg e (otorrh oea) or fev er.
– O th er sig ns such as rh inorrh oea, coug h , d iarrh oea or v om iting are frequently
associated , and m ay confuse th e d iag nosis, h ence th e necessity of exam ining th e
tym panic m em branes.
57
Otitis
Acute otitis externa 2
D iffuse inflam m ation of th e external ear canal, d ue to bacterial or fung al infection.
C om m on precipitants of otitis externa are m aceration, traum a of th e ear canal or
presence of a foreig n bod y or d erm atolog ic d iseases (such as eczem a, psoriasis).
Clinical features
– E ar canal pruritus or ear pain, often sev ere and exacerbated by m otion of th e pinna;
feeling of fullness in th e ear; clear or purulent ear d isch arg e or no d isch arg e
– O toscopy:
• d iffuse eryth em a and ed em a, or infected eczem a, of th e ear canal
• look for a foreig n bod y
• if v isible, th e tym panic m em brane is norm al (sw elling , pain or secretions v ery often
prev ent ad equate v isualization of th e tym panic m em brane)
Treatment
– R em ov e a foreig n bod y, if present.
– T reatm ent of pain: paracetam ol and / or ibuprofen P O (pag e 2 9 ).
– L ocal treatm ent (usually 5 to 7 d ays):
R em ov e skin d ebris and secretions from th e aud itory canal by g entle d ry m opping
(use a d ry cotton bud or a sm all piece of d ry cotton w ool). In ad d ition, 0 .5 % g entian
v iolet can be applied once a d ay, using a cotton bud .
C onsid er ear irrig ation (0 .9 % sod ium ch lorid e, using a syring e) only if th e tym panic
m em brane can be fully v isualised and is intact ( no perforation) . O th erw ise, ear
irrig ation is contra-ind icated .
Acute otitis media (AOM)
A cute inflam m ation of th e m id d le ear, d ue to v iral or bacterial infection, v ery com m on
in ch ild ren und er 3 years, but uncom m on in ad ults.
T h e principal causativ e org anism s of bacterial otitis m ed ia are Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis and in old er ch ild ren, Streptococcus pyogenes.
Clinical features
– R apid onset of ear pain ( in infants: crying , irritability, sleeplessness, reluctance to
nurse) and ear d isch arg e (otorrh oea) or fev er.
– O th er sig ns such as rh inorrh oea, coug h , d iarrh oea or v om iting are frequently
associated , and m ay confuse th e d iag nosis, h ence th e necessity of exam ining th e
tym panic m em branes.
57
