1-Ears (Infection and tumours) Flashcards
types of ear infections
otitis externa
malignant otitis externa
acute otitis media
chronic supprative otitis media
Otitis media with effusion
Mastoiditis
types of ear tumours
acoustic neuroma
Otitis externa
Background
- Is an inflammatory condition of the outer ear that can affect the auricle, external auditory canal and external surface of the tympanic membrane.
- Can be acute <3 weeks or chronic
- Sometimes known as swimmers ear
otitis externa causes
Bacterial infection- most commonly
- Pseudomonas aeruginosa
- Staph aureus
Others
- Fungal infections
- Eczema
- Contact dermatitis
- Antibiotics for non bacterial infection -> fungal infections more likely
otitis media presentation
Presentation
- Ear pain
- Discharge
- Itchiness
- Conductive hearing loss
- Examination
o Erythema and swelling
o Lymphadenopathy
Investigations otitis externa
- Otoscopy
management of mild otitis externa
- Acetic acid – antifungal and antibacterial effects
- Ensure that the patient is advised to keep the ear dry for the next 7-10 days.
manageemnt of moderative otitis externa
- Topical antibiotic and steroid e.g. neomycin, dexamethasone and acetic acid -> Otomize ear spray
- Beware of aminoglycosides (gentamicin)-> ototoxic, esp if undiagnosed perforation
management of severe otitis externa
- Oral antibiotics e.g. fluclox or clarithromycin
- Ear wick
Indication for oral abx
Cellulitis extending beyond the external ear canal
When the ear canal is occluded by swelling and debris, and a wick cannot be inserted
People with diabetes or compromised immunity, and severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa
ear wick
Where the meatus is completely occluded and there is significant swelling of the external meatus may be treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration.
fungal otitis externa management
clotrimazole ear drops
malignant otitis externa background
- Osteomyelitis of temporal bone
- Severe and life-threatening form of otitis externa
- Infection spreads to bones surrounding ear canal and skull
Risk factors for
- DM
- Immunosuppression
- HIV
Presentation of malignant otitis externa
- Symptoms more severe than normal otitis external
- Persistent headache
- Severe pain and fever
examination findings for malignant otitis externa
granulation tissue a the junction between the bone and cartilage in the ear canal (halfway along) – key finding
management of malignant otitis externa
Management
- Admission
- IV antibiotics
- Imaging (CT or MRI)
Complications of malignant otitis externa
- Facial nerve damage and palsy
- Meningitis
- Intracranial thrombosis
- Death
What is the difference between otitis media with effusion and acute otitis media?
Otitis media with effusion (OME) and acute otitis media (AOM) are two main types of otitis media (OM).
- Otitis Media with Effusion describes the symptoms of middle ear effusion (MEE) without infection
- Acute Otitis Media is an acute infection of the middle ear and caused by bacteria in about 70% of cases
Acute otitis media
Background
- Infection of the middle ear (where cochlea, vestibular apparatus and nerves are found)
- Bacteria enter via eustachian tube
- Often viral URTI precedes bacterial infection of the middle ear
causes of AOM
Causes viruses and bacteria.
- Streptococcus pneumonia
- Haemophilus influenzae
Presentation of AOM
- Ear pain
- Reduced hearing
- General malaise
- Coryzal symptoms and sore throat
- Can cause balance issues if affects vestibular system
examination findings for AOM
- Otoscopic exam: **bulging red, yellow or cloudy tympanic membrane **
- There may also be discharge in the auditory canal if the tympanic membrane has perforated.
investigations for AOM
otoscopy
management of AOM
- Most resolve without Abx in 3 days
- Simple analgesia
- Consider delayed antibiotics prescription
- When immediate antibiotics:
- co-morbidities
- systemically unwell
- immunocompromised
Which antibitoics
- Amoxicillin for 5- 7 days
- Clarithromycin if penicillin allergic
Chronic suppurative otitis media
Background
- a complication of otitis media - chronic inflammation of the middle ear and mastoid cavity, leading to tympanic perforation
Chronic suppurative otitis media Presentation
- Most common in childhood
- Recurrent ear discharge (otorrhoea) through without pain or fever >6 weeks
- History of ear problems
- Conductive hearing loss
- Occasional otalgia or true vertigo
Otoscopic findings Chronic suppurative otitis media
- Painless examination
- Evidence of tympanic membrane perforation
- Inflammation with otorrhea
Management Chronic suppurative otitis media
- Topical antibiotics with or without steroids, aural toileting (antiseptic ear cleaning)
Otitis media with effusion background
- ‘Glue ear’, is a condition characterized by a collection of fluid within the middle ear space without signs of acute infection- like hearing under water
Pathophysiology
- Due to blockage of the eustachian tube- air pressure cannot equilibrate and mucus cannot drain
- Fluid reabsorption and no air equilibration by ET -> negative pressure in middle ear
- Decreases mobility of TM and ossicles -> affecting hearing (underwater hearing)
causes and risk factors for otitis media with effusion
- More common in children
- Acute otitis media
- Eustachian tube dysfunction
- Low grade viral or bacterial infection
Otitis media with effusion Presentation
- Hearing loss
- Intermittent ear pain with fullness
- Aural discharge
- Recurrent ear infections
Otitis media with effusion examination findings
- Otoscope- usually no signs of inflammation or discharge on examination
- Retracted
- Straw coloured TM
- Loss of light reflex
- Opacification of drum
- Fluid level (makes ossicles move less easily- like hearing under water
management otitis media with effusion
Management
- Watch and wait
- Hearing tests
- Auto inflation -> nasal balloon -> ventilating middle ear two to three times a day
- Hearing aids
- Grommets
Mastoiditis
Background
- Infection of the mastoid bone of the skull
- Middle ear cavity communicates via mastoid antrum with mastoid air cells
- Provides a potential route for middle ear infections to spread into the mastoid bone (mastoid air cells)
- Osteomyelitis
mastoiditis causes
Causes
- Complication of unresolved otitis media- bacterial infection
mastoiditis presentation
Presentation
- Fever, irrationality
- Swelling of the ear lobe
- Redness and tenderness behind the ear
- Drainage of the ear
- Bulging and drooping of the ear.
investigations for mastoiditis
- Otoscope
- Ear culture
- Blood test
- CT scan
Management of mastoiditis
- IV antibiotics
- Mastoidectomy if abx don’t work
- Myringotomy- drain middle ear
Complications of mastoiditis
- Destruction of mastoid bone
- Epidural abscess
- Facial paralysis
- Meningitis
- Hearing loss
Acoustic neuroma
Background
Benign tumour of Schwann cells surrounding auditory nerve (vestibulocochlear nerve) that innervates the inner ear
- Also known as vestibular schwannomas
- usually unilateral
bilateral acoutstic neuromas asscoiated with
neurofibromatosis type II
Pathophysiology of acoustic neuroma
- Schwann cells are found around PNS and provide myeline sheath around neurones
- Occur at the cerebellopontine angle -> sometimes called cerebellopontine angle tumours
Presentation of acoustic neuroma
- 40-60 yo
- Gradual onset
- Unilateral sensorineural hearing loss
- Unilateral tinnitus
- Dizziness or imbalance
- Sensation of fullness in the ear
- Facial nerve palsy if tumour grows large enough
investigations for acoustic neuroma
Investigations
- Audiometry- sensorineural hearing loss
- Brain imaging (MRI or CT)
Management of acoustic neuroma
- Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate
- Surgery to remove the tumour (partial or total removal)
- Radiotherapy to reduce the growth
Notable risks associated with treatment of acoustic neuroma
x
Notable risks associated with treatment are:
* Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
* Facial nerve injury, with facial weakness
