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ENT > 1-Ears (Infection and tumours) > Flashcards

1-Ears (Infection and tumours) Flashcards

1
Q

types of ear infections

A

otitis externa
malignant otitis externa
acute otitis media
chronic supprative otitis media
Otitis media with effusion
Mastoiditis

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2
Q

types of ear tumours

A

acoustic neuroma

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3
Q

Otitis externa
Background

A
  • 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
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4
Q

otitis externa causes

A

Bacterial infection- most commonly
- Pseudomonas aeruginosa
- Staph aureus

Others
- Fungal infections
- Eczema
- Contact dermatitis
- Antibiotics for non bacterial infection -> fungal infections more likely

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5
Q

otitis media presentation

A

Presentation
- Ear pain
- Discharge
- Itchiness
- Conductive hearing loss
- Examination
o Erythema and swelling
o Lymphadenopathy

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6
Q

Investigations otitis externa

A
  • Otoscopy
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7
Q

management of mild otitis externa

A
  • Acetic acid – antifungal and antibacterial effects
  • Ensure that the patient is advised to keep the ear dry for the next 7-10 days.
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8
Q

manageemnt of moderative otitis externa

A
  • Topical antibiotic and steroid e.g. neomycin, dexamethasone and acetic acid -> Otomize ear spray
  • Beware of aminoglycosides (gentamicin)-> ototoxic, esp if undiagnosed perforation
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9
Q

management of severe otitis externa

A
  • 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

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10
Q

ear wick

A

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.

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11
Q

fungal otitis externa management

A

clotrimazole ear drops

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12
Q

malignant otitis externa background

A
  • Osteomyelitis of temporal bone
  • Severe and life-threatening form of otitis externa
  • Infection spreads to bones surrounding ear canal and skull
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13
Q

Risk factors for

A
  • DM
  • Immunosuppression
  • HIV
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14
Q

Presentation of malignant otitis externa

A
  • Symptoms more severe than normal otitis external
  • Persistent headache
  • Severe pain and fever
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15
Q

examination findings for malignant otitis externa

A

granulation tissue a the junction between the bone and cartilage in the ear canal (halfway along) – key finding

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16
Q

management of malignant otitis externa

A

Management
- Admission
- IV antibiotics
- Imaging (CT or MRI)

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17
Q

Complications of malignant otitis externa

A
  • Facial nerve damage and palsy
  • Meningitis
  • Intracranial thrombosis
  • Death
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18
Q

What is the difference between otitis media with effusion and acute otitis media?

A

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

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19
Q

Acute otitis media

Background

A
  • 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
20
Q

causes of AOM

A

Causes viruses and bacteria.
- Streptococcus pneumonia
- Haemophilus influenzae

21
Q

Presentation of AOM

A
  • Ear pain
  • Reduced hearing
  • General malaise
  • Coryzal symptoms and sore throat
  • Can cause balance issues if affects vestibular system
22
Q

examination findings for AOM

A
  • Otoscopic exam: **bulging red, yellow or cloudy tympanic membrane **
  • There may also be discharge in the auditory canal if the tympanic membrane has perforated.
23
Q

investigations for AOM

A

otoscopy

24
Q

management of AOM

A
  • 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

25
Q

Chronic suppurative otitis media
Background

A
  • a complication of otitis media - chronic inflammation of the middle ear and mastoid cavity, leading to tympanic perforation
26
Q

Chronic suppurative otitis media Presentation

A
  • 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
27
Q

Otoscopic findings Chronic suppurative otitis media

A
  • Painless examination
  • Evidence of tympanic membrane perforation
  • Inflammation with otorrhea
28
Q

Management Chronic suppurative otitis media

A
  • Topical antibiotics with or without steroids, aural toileting (antiseptic ear cleaning)
29
Q

Otitis media with effusion background

A
  • ‘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)

30
Q

causes and risk factors for otitis media with effusion

A
  • More common in children
  • Acute otitis media
  • Eustachian tube dysfunction
  • Low grade viral or bacterial infection
31
Q

Otitis media with effusion Presentation

A
  • Hearing loss
  • Intermittent ear pain with fullness
  • Aural discharge
  • Recurrent ear infections
32
Q

Otitis media with effusion examination findings

A
  • 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
33
Q

management otitis media with effusion

A

Management
- Watch and wait
- Hearing tests
- Auto inflation -> nasal balloon -> ventilating middle ear two to three times a day
- Hearing aids
- Grommets

34
Q

Mastoiditis
Background

A
  • 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
35
Q

mastoiditis causes

A

Causes
- Complication of unresolved otitis media- bacterial infection

36
Q

mastoiditis presentation

A

Presentation
- Fever, irrationality
- Swelling of the ear lobe
- Redness and tenderness behind the ear
- Drainage of the ear
- Bulging and drooping of the ear.

37
Q

investigations for mastoiditis

A
  • Otoscope
  • Ear culture
  • Blood test
  • CT scan
38
Q

Management of mastoiditis

A
  • IV antibiotics
  • Mastoidectomy if abx don’t work
  • Myringotomy- drain middle ear
39
Q

Complications of mastoiditis

A
  • Destruction of mastoid bone
  • Epidural abscess
  • Facial paralysis
  • Meningitis
  • Hearing loss
40
Q

Acoustic neuroma
Background

A

Benign tumour of Schwann cells surrounding auditory nerve (vestibulocochlear nerve) that innervates the inner ear
- Also known as vestibular schwannomas
- usually unilateral

41
Q

bilateral acoutstic neuromas asscoiated with

A

neurofibromatosis type II

42
Q

Pathophysiology of acoustic neuroma

A
  • Schwann cells are found around PNS and provide myeline sheath around neurones
  • Occur at the cerebellopontine angle -> sometimes called cerebellopontine angle tumours
43
Q

Presentation of acoustic neuroma

A
  • 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
44
Q

investigations for acoustic neuroma

A

Investigations
- Audiometry- sensorineural hearing loss
- Brain imaging (MRI or CT)

45
Q

Management of acoustic neuroma

A
  • 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
46
Q

Notable risks associated with treatment of acoustic neuroma
x

A

Notable risks associated with treatment are:
* Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
* Facial nerve injury, with facial weakness

ENT (17 decks)

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