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外耳炎 External otitis / Otitis externa
游泳耳 Swimmer's ear
耳痛
外耳道腫脹
耳分泌物
傳導性聽力障礙
甚至張開嘴巴就會疼痛 Pain when mastication
- 黴菌感染症狀：難治療的耳道癢, 耳道充塞感
* 學齡兒童盛行率最高, 夏天
危險因子 :
游泳
洗頭髮
Trauma - 過度清潔
助聽器, 耳機
過敏性或接觸性皮膚炎 (化妝品, 耳環過敏)
Noninfectious causes include contact dermatitis from topical medications or resins in hearing aids,
seborrhea, and psoriasis.
Pseudomonas
Staphylococcus aureus, Staphylococcus epidermidis, and Enterobacteriaceae.
Otomycosis (Fungal otitis externa)
- Candida : 白色類皮脂腺樣耳垢
- Aspergillus : 細小黑色耳垢
輕度外耳炎：外耳搔癢, 有時合併輕微疼痛
中度外耳炎：外耳搔癢合併中等程度疼痛, 加上部分耳道阻塞
重度外耳炎：外耳道完全阻塞劇烈疼痛, 耳殼周圍紅腫 (periauricular erythema)
頸部淋巴結腫大, 發燒
PE : 拉耳殼 (auricle) 會產生疼痛, 外耳道紅腫
* 耳鏡檢查是否合併中耳炎(耳膜有 air-fluid level), 耳膜穿孔
Nonototoxic ototopical antibiotics are first-line therapy
Oral antibiotics are reserved for febrile patients and those with periauricular extension
If fungal infection is suspected, topical clotrimazole 1% solution can be used
Alternatively, systemic treatment with an antifungal agent such as fluconazole can be used.
* Complication :
耳殼蜂窩性組織炎 (Auricular cellulitis)
耳殼周圍紅腫熱輕微疼痛
治療一般以口服抗生素為主
耳殼軟骨膜炎 (Auricular perichondritis)
不會 involve 到耳垂
惡性外耳炎 (Malignant external otitis)
外耳炎侵犯 "顱底" (包括軟組織、軟骨、顳骨) 造成組織壞死
故又稱為壞死性外耳炎(necrotizing external otitis)
Potentially life-threatening infection of the external auditory canal
involving the pinna and soft tissues with variable extension to the skull base.
耳劇痛, 發燒, 外耳道皮膚壞死, 外耳道狹窄, 臉部痲痺等
Severe otalgia + Otorrhea
惡性外耳炎大部分因綠膿桿菌感染引起
好發於免疫不全患者
初期症狀緩和易被誤診為一般外耳炎
P. aeruginosa, but MRSA now accounts for 15% of cases
Fungal disease occurs in diabetics and patients with immunocompromise
若侵犯顳骨, 顱底造成骨髓炎與多發性顱神經病變, 死亡率為 67%
若向顱內進展為 腦膜炎, 顱內膿瘍, 敗血性血栓靜脈炎, 死亡率則高達80%
Severe complication : Lateral or sigmoid sinus thrombosis and meningitis
Cranial nerve involvement is a serious sign.
The 7th cranial nerve is usually the first nerve affected by cranial extension,
and the presence of dysfunction of the 9, 10, 11 cranial nerve
implies even more extensive disease.
抗生素要 cover 綠膿桿菌 → Ciprofloxacin；三代 cephalosporin
Severe case : IV Antibiotics to cover MRSA + P. aeruginosa
療程 : 至少 6 星期
同時給局部的外耳道滴劑
嚴重者甚至需要做外科手術的清創
外耳炎之診斷與治療
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