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ENT > 1: Conditions of the pinna and external auditory canal > Flashcards

1: Conditions of the pinna and external auditory canal Flashcards

1
Q

What is chrondrodermatitis nodular helices

A

Catilaginous lump on helix or anti-helix

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2
Q

What are two risk factors for chondrodermatitis nodular helices

A
  • Usually affects the ear the person sleeps on

- Working outside

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3
Q

What is a pinna haematoma

A

Blunt trauma to the ear

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4
Q

What is auditory exostosis also known as

A

Surfer’s ear

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5
Q

What is auditory exostosis

A

Hypertrophy of multiple bony canals bilaterally

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6
Q

What causes auditory exostosis

A

Cold exposure

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7
Q

How may cerumen impaction present clinically

A

Aural fullness
Conductive hearing loss
Tinnitus

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8
Q

What counts as the outer ear

A

Auricle, external auditory meatus, tympanic membrane

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9
Q

What is basal cell carcinoma

A

Malignant proliferation of basal cells

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10
Q

What is the most common malignant skin cancer

A

BCC

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11
Q

In which population does BCC occur more

A

Males

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12
Q

What are 3 risk factors for BCC

A
  • Skin types 1 and 2
  • Sun exposure
  • Gorlin syndrome
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13
Q

Explain growth of BCC

A

Grows over weeks-months

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14
Q

How do BCC present clinically

A
  • Pearly nodule, with rolled borders
  • Ulcerated centre
  • Telangectasia
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15
Q

How is BCC investigated

A

Exciscional biopsy

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16
Q

How is BCC managed

A

Surgical excision

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17
Q

Explain the prognosis of BCC and why

A

Good prognosis as it is only locally invasive - with a low risk of metastases

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18
Q

what is squamous cell carcinoma

A

malignant proliferation of keratinocytes in stratum spinosum

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19
Q

what is the most common site for SCC to develop

A

ear

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20
Q

what is the second most common skin cancer

A

SCC

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21
Q

in which gender is SCC more common

A

males

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22
Q

how does the incidence of SCC change with age

A

increases with age

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23
Q

what are 4 risk factors for SCC

A
  • Sun exposure
  • Previous skin cancer
  • Chemical exposure
  • Xeroderma pigmentosum
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24
Q

explain presentation of SCC

A
  • Growths weeks - months
  • Presents as a non-healing, bleeding ulcer with everted edges
  • Surrounding skin appears inflamed
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25
Q

what is bowen’s disease

A

Squamous cell-carcinoma in situ

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26
Q

How is SCC diagnosed

A

Punch biopsy

Or, excision biopsy = diagnosis and treatment

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27
Q

How is SCC managed

A

Excision biopsy

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28
Q

If the lesion is less than 20mm, what margins should be used

A

4mm

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29
Q

What % of SCC metastasise

A

2%

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30
Q

When is a foreign body in the ear more common

31
Q

How may foreign body present clinically

A
  • Pain
  • Conductive hearing loss
  • Discharge
  • Bleeding
32
Q

How are insects removed

33
Q

When is syringing used to remove an object

A

If sure there is no damage to tympanic membrane

34
Q

How are soft foreign bodies removed

A

Tilley’s or crocodile forceps

35
Q

How are solid foreign bodies removed

A

Jobson-Horne Probe

36
Q

When should a child be referred to a senior for GA removal of an object

A
  • Un-cooperative
  • Failed attempt
  • Suspect TM rupture
37
Q

Define otitis externa

A

Inflammation of external ear

38
Q

In which patients does otitis externa tend to occur

A

Young female

39
Q

What is the most common causative organism of otitis externa

A

Pseudomonas aeurginosa

40
Q

What is a risk factor for otitis externa

A

Moisture of the ear

41
Q

What are risk factors for otitis externa

A

Moisture:

  • Swimming
  • Frequent hair washing
  • Humid environment

Trauma:

  • Cotton buds
  • Eczema/Psoriasis

Immunocompromised
Ear polyp or foreign body

42
Q

Explain relationship between diabetes and otitis externa

A

Diabetes increases risk of otitis externa and complications of otitis externa

43
Q

How wil otitis externa present

A

Erythematous canal
Progressive ear pain
Purulent discharge

44
Q

If bacteria otitis externa, what colour is the discharge

A

White-Yellow

45
Q

If fungal otitis externa, what colour is the discharge

A

Thick Grey

46
Q

What are two signs of otitis externa

A

Erythematous

Tragus is tender to palpation

47
Q

What is mild otitis externa

A
  • Erythematous
48
Q

What is moderate otitis externa

A
  • Painful
  • Discharge
  • Narrowed external auditory meatus
49
Q

How does severe otitis externa present

A
  • Completely occluded EAM
50
Q

What are 3 differentials of otitis externa

A
  • Furuncle
  • Otitis media with effusion
  • Ramsay Hunt
51
Q

What is a furuncle

A

Painful ear canal due abscess formation from infection of hair follicle

52
Q

How is otitis externa usually diagnosed

53
Q

What is used to grade the severity of otitis externa on otoscopy

A

Brighton-Grading System

54
Q

What is grade I on Brighton grading system

A
  • Erythema
  • Mild pain
  • No hearing loss
  • TM visible
55
Q

What is grade 2 on Brighton grading system

A
  • Erythema
  • Pain
  • Canal slightly obstructed by debris
  • TM obscured
56
Q

What is grade 3 on Brighton grading system

A
  • Erythema
  • Canal closed
  • TM not visible
57
Q

What is grade 4 on Brighton grading system

A
  • Systemic complications
  • Cellulitus
  • Perichondritis
58
Q

When are swabs sent in otitis externa

A

Suspect fungal infection - thick grey discharge

59
Q

Why may a random plasma glucose be ordered in otitis externa

A

Check for diabetes

60
Q

When is high-resolution CT ordered in otitis externa

A

Suspect complications

61
Q

What is the management of mild otitis externa

62
Q

What are three methods of cleaning the ear canal

A
  1. Syringing
  2. Micro-suction
  3. Dry mopping
63
Q

What is indicated for moderate otitis externa

A

Topical antibiotics and topical corticosteroids

64
Q

What is indicated for severe otitis externa

A

Aluminimum acetate wick inserted for several days. Then removed (when canal widened) and micro-suctioned

65
Q

What is a criteria for ear syringing

A

TM must be intact

66
Q

What may resistant to otitis externa treatment indicate

67
Q

How should treatment-resistant otitis externa be investigated and why

A

Punch-out biopsy - due to risk of SCC

68
Q

What is major complication of otitis externa

A

Malignant otitis externa

69
Q

What is malignant otitis externa

A

Extension of otitis externa into mastoid air cells in temporal bone

70
Q

What is a risk factor for malignant otitis externa

A

Diabetic and elderly

71
Q

How may malignant OE present

A

Severe Headache

CN7 Involvement

72
Q

How is malignant OE managed

A

Urgent IV antibiotics and debridement

73
Q

What are 3 complications of malignant OE

A

Mastoiditis
Osteomyelitis
Intra-cranial spread

ENT (16 decks)

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