Otitis Externa (Swimmer's Ear) and Mastoiditis in Children

00:01 For otitis externa, we’re talking now about the ear canal.

00:06 We’re worried about different pathogens and different causes.

00:10 This is classically called swimmer’s ear.

00:13 And it’s from a chronically moist external auditory canal.

00:17 It’s associated with prolonged redness or a foreign body in the ear canal.

00:22 Sometimes kids will put something in there and then forget about it and you can get an infection.

00:26 It’s usually associated with Pseudomonas species.

00:29 But other bacteria are possible such as E. coli or staph aureus.

00:35 So here’s a particularly bad case of otitis externa.

00:38 It should hurt a little bit to wiggle on the outside of the ear because you’re moving that canal.

00:43 And there should be frank purulent drainage or swelling visible directly on otoscopy.

00:50 You don’t need a bulb for this.

00:52 It’s on the ear canal itself.

00:54 So patients typically will have ear pain.

00:57 They’ll have pain with tugging on the outer ear and they there’ll be pus draining from their ear.

01:01 That’s your diagnosis.

01:04 How do we treat it? Topical ciprofloxacin drops are usually the trick.

01:09 They do treat pseudomonas.

01:11 Or you can use polymyxin ear drops which is a bit cheaper.

01:15 If it’s super severe, you can insert a wick into the ear to allow for penetration of the drops into the deeper part of the ear.

01:23 It’s not fun to place a wick and the child is not excited to receive one, but it may help the ear heal up a little bit faster.

01:30 Also, we can provide NSAIDs for pain and irritation.

01:34 So let’s turn now to mastoiditis.

01:37 That’s when ear infections go totally wrong.

01:40 This is basically an infection of the mastoid air cells in the skull behind the ear.

01:46 This usually starts with an acute otitis media or an otitis externa and then it spreads down to those air cells.

01:54 So this is usually caused by otitis media bacteria, although some bacteria are more likely to cause it than others, so the differential of organisms is a little bit different.

02:06 It can be caused by Strep pneumo, by Staph aureus and can also be MRSA and by group A strep and also by Pseudomonas, especially if there’s an otitis externa present.

02:20 So these patients can be fairly sick.

02:23 They may have fever.

02:24 They’re going to have significant ear pain.

02:27 You will notice a proptosis or a pushing forward of the affected ear.

02:32 And they will have palpation and pain to palpation behind their ear.

02:37 So if you press behind a protuberant ear and it hurts, that’s mastoiditis.

02:43 You can get a CT scan like this, which will show a opacification of those air cells in the mastoid area.

02:52 And may also show some bony destruction.

02:55 It’s sort of like an osteomyelitis of this skull as well.

02:59 Patients with mastoiditis, which is a rare complication of otitis media, are often admitted to the hospital for IV antibiotics.

03:08 Usually, we’ll start with something like ampicillin sulbactam unless we suspect a very invasive infection such as MRSA.

03:16 And usually, those look very severe and the patients are exceptionally ill.

03:20 Then we might cover for MRSA with either vancomycin or clindamycin.

03:24 And if there is an otitis externa associated with it, we might cover for pseudomonas with something like ciprofloxacin.

03:33 If there is an otitis media with it, oftentimes ear, nose and throat doctors will prefer to do myringotomy in addition to a surgical drainage of the lesion if surgical drainage is necessary.

03:44 And in those surgical cases as deemed by the ear, nose, and throat doctor, we will usually do either a mastoidectomy or a drain placement.

03:52 They may get an osteitis and then we have to have drainage of the bone in addition.

03:58 And we usually will go to surgery if there’s a case that’s not responding to IV antibiotics, likely we might suspect.

04:07 So that’s my review of all ear infections in kids.

04:11 Hey, thanks for your time.