Otitis Externa

Descripción General

Definición

La otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa es una infección del conducto auditivo externo.

Epidemiología

• Incidencia: 4 de 1000 personas al AL Amyloidosis año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos
• Aproximadamente el 10% de las personas desarrollan una otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa a lo largo de su vida.
• Edad:
  • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria grupos de edad
  • Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños
• Es más probable que ocurra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el verano debido a:
  • Humedad
  • Participación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum actividades acuáticas

Etiología

• Infección bacteriana (la mayoría de los LOS Neisseria casos):
  • Pseudomonas aeruginosa Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas
  • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess
  • Staphylococcus epidermidis Staphylococcus epidermidis A species of staphylococcus that is a spherical, non-motile, gram-positive, chemoorganotrophic, facultative anaerobe. Mainly found on the skin and mucous membrane of warm-blooded animals, it can be primary pathogen or secondary invader. Staphylococcus
  • Proteus vulgaris Proteus vulgaris A species of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in soil, fecal matter, and sewage. It is an opportunistic pathogen and causes cystitis and pyelonephritis. Proteus
  • Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli
• Infección por hongos (poco frecuente):
  • Candida albicans Candida albicans A unicellular budding fungus which is the principal pathogenic species causing candidiasis (moniliasis). Candida/Candidiasis
  • Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins niger

Factores de riesgo

• Natación u otra exposición al AL Amyloidosis agua
• Clima caluroso y húmedo
• Traumatismos (incluida la limpieza con bastoncillos de algodón)
• Oclusión del canal auditivo:
  • Cerumen Cerumen The yellow or brown waxy secretions produced by vestigial apocrine sweat glands in the external ear canal. Otitis Externa
  • Cuerpo extraño
  • Auxiliares auditivos
  • Auriculares
• Condiciones dermatológicas:
  • Eczema Eczema Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema)
  • Dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) de contacto
  • Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis
• Radioterapia
• Inmunosupresión:
  • VIH/SIDA
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Quimioterapia

Fisiopatología

Mecanismos de defensa del oído

• El trago y el cartílago conchal → impiden la entrada de cuerpos extraños
• Los LOS Neisseria folículos pilosos y el estrechamiento del istmo → impiden la entrada de contaminantes
• Cerumen Cerumen The yellow or brown waxy secretions produced by vestigial apocrine sweat glands in the external ear canal. Otitis Externa → crea un entorno ácido → inhibe el crecimiento de bacterias y hongos

Patogénesis de la otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa

• La ruptura de la barrera piel-cerumen es causada por:
  • Daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el epitelio
  • ↓ Cantidad y calidad del cerumen Cerumen The yellow or brown waxy secretions produced by vestigial apocrine sweat glands in the external ear canal. Otitis Externa
  • Acumulación de humedad
  • Obstrucción del canal auditivo
• ↑ pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance del conducto auditivo → el conducto auditivo se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un caldo de cultivo óptimo para los LOS Neisseria organismos microscópicos → infección
• Inflamación y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema de la piel → exudado purulento

Presentación Clínica y Diagnóstico

Síntomas

• Dolor Dolor Inflammation de oído
• Prurito
• Plenitud
• Secreción (otorrea)
• Pérdida de audición

Examen físico

• Sensibilidad a la presión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el trago
• Dolor Dolor Inflammation a la manipulación del pabellón auricular
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema y eritema del canal auditivo
• Restos purulentos amarillos, blancos, grises o marrones
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la otoscopia neumática, la membrana timpánica es móvil.

Diagnóstico

El diagnóstico de la otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria antecedentes y el examen físico. Cultivo del canal auditivo o de la secreción está indicado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos graves, recurrentes o crónicos.

Tratamiento

Tratamiento

• Eliminar el cerumen Cerumen The yellow or brown waxy secretions produced by vestigial apocrine sweat glands in the external ear canal. Otitis Externa, la piel descamada y el material purulento.
• Proteger el oído del agua.
• Alivio del dolor Dolor Inflammation:
  • AINEs
  • Acetaminofén
  • Opiáceos para el dolor Dolor Inflammation intenso
• Gotas óticas antibióticas tópicas:
  • Polimixina B más neomicina
  • Ofloxacina
  • Ciprofloxacina
  • Los LOS Neisseria preparados combinados con esteroides tópicos pueden ayudar con el prurito y la inflamación.
• Se puede colocar una mecha en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el oído para facilitar la administración de la medicación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con un edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema importante del conducto auditivo.
• La otomicosis es una infección fúngica del conducto auditivo externo:
  • Puede desarrollarse con la infección bacteriana, o puede ser el resultado de una terapia con antibióticos
  • Se trata con antifúngicos tópicos (e.g., solución de clotrimazol)

Pronóstico

• La mejora de los LOS Neisseria síntomas comienza unas 36–48 horas después del inicio del tratamiento.
• Se resuelve completamente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum unos 7 a 10 días

Complicaciones

Celulitis periauricular

• Se produce eritema, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema y calor Calor Inflammation alrededor del pabellón auricular.
• El dolor Dolor Inflammation es leve.
• Los LOS Neisseria síntomas sistémicos están ausentes.

Otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa maligna

También conocida como otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa necrotizante, se trata de una infección invasiva y potencialmente mortal del conducto auditivo externo y la base del cráneo.

Etiología:

• Casi siempre es causada por Pseudomonas aeruginosa Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas
• Factores de riesgo:
  • Ancianos
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus
  • VIH
• Junto con los LOS Neisseria factores de riesgo mencionados, la afección se observa con mayor frecuencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con antecedentes de irrigación del oído.

Presentación clínica:

• Otalgia Otalgia Acute Otitis Media extrema (desproporcionada para los LOS Neisseria hallazgos) y otorrea abundante
• El tejido de granulación puede ser visible en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la porción inferior del canal auditivo externo.
• Puede provocar parálisis de los LOS Neisseria nervios craneales si la enfermedad evoluciona hacia una osteomielitis de la base del cráneo y de la articulación temporomandibular

Diagnóstico:

• Cultivos del drenaje del canal auditivo
• TC:
  • Erosión ósea
  • Radio lucidez del oído medio
• Biopsia para descartar malignidad

Tratamiento:

• Terapia antibiótica intravenosa:
  • Ciprofloxacina
  • Piperacilina-tazobactam
  • Cefepima o ceftazidima
  • Meropenem Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than imipenem, but does not need to be given with an enzyme inhibitor such as cilastatin. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. Carbapenems and Aztreonam
• El desbridamiento quirúrgico rara vez es necesario en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de infección extensa.

Complicaciones:

• Parálisis de los LOS Neisseria nervios craneales
• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis
• Absceso cerebral
• Tromboflebitis del seno dural

Diagnóstico Diferencial

• Dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) por contacto: edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema y el eritema persistentes del conducto auditivo y del pabellón auricular a pesar del tratamiento adecuado de la otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa pueden indicar una reacción alérgica. Esta reacción puede ser causada por medicamentos ototópicos, cosméticos o champús. El prurito y el eritema son los LOS Neisseria síntomas principales y pueden observarse vesículas, generalmente debidas a la fricción y a la comezón El diagnóstico se realiza clínicamente. El tratamiento implica el cese de la sustancia causante.
• Otitis media supurativa crónica: una complicación de la otitis media aguda persistente con perforación. Los LOS Neisseria síntomas incluyen otorrea, otalgia Otalgia Acute Otitis Media, pérdida de audición, tinnitus Tinnitus A nonspecific symptom of hearing disorder characterized by the sensation of buzzing, ringing, clicking, pulsations, and other noises in the ear. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. Cranial Nerve Palsies o vértigo. El diagnóstico se realiza clínicamente. La membrana timpánica suele ser parcialmente visible y no se puede mover mediante insuflación neumática. También puede verse una perforación de la membrana timpánica o bolsas de retracción. El tratamiento consiste principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum fluoroquinolonas tópicas.
• Carcinoma del canal auditivo: una enfermedad rara que se debe considerar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de un crecimiento anormal o de falta de respuesta al AL Amyloidosis tratamiento habitual. Los LOS Neisseria síntomas comunes de carcinoma del canal auditivo incluyen dolor Dolor Inflammation leve y otorrea con sangre. Puede observarse una lesión friable purulenta circundante en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen otoscópico. La pérdida de audición y la parálisis facial son signos tardíos. El diagnóstico se hace HACE Altitude Sickness clínicamente y se confirma con una biopsia.
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis: es una enfermedad inflamatoria de la piel que suele afectar al AL Amyloidosis conducto auditivo externo y provoca un enrojecimiento y descamación que a menudo se extiende a la concha y el pabellón auricular: El aspecto clínico de la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el conducto auditivo externo varía según el subtipo. El diagnóstico se realiza clínicamente. El tratamiento puede incluir esteroides y retinoides. Los LOS Neisseria casos más graves pueden requerir dosis elevadas de esteroides, fototerapia o medicamentos biológicos.