14.2 Ear Disease Flashcards
Label the diagram
Label the diagram
What is this a picture of and explain what the normal signs & abnormal signs are?
Tympanic membrane
- Normal:
- Handle of malleous above cone of light
- Good cone of light reflection
- Abnormal signs:
- Dull & non-reflective cone of light
- Fluid present
- Hole in tympanic membrane
Label the diagram
What things to ask with the ear?
- Otalgia - ear pain
- Otorrhoea -ear discharge
- Hearing Loss
- Tinnitus - sensation of sound in the abscence of external stimulus
- Vertigo - sensation of rotation when not moving (can become nauceus)
What to look at ear?
- External ear (pinna)
- Ear canal (hairs & skin & little wax)
- Tympanic membrane
- Facial nerve
- As runs through temporal bone
- Can get infections here e.g. viral & fractures
- Can be a LMN disorder
What can the following picture be due to?
Herpes zoster virus (can cause facial paralysis) and can be due to reactivation by the Ramsey Hunt Syndrome
What is the following picture an example of?
What can it be caused by?
Tympanic membrane perforation
Causes:
- Trauma e.g. diving
- Infection e.g. otitis media (INCREASE pressure on ear drum)
What is the following condition?
Tympanosclerosis (scarring of the ear drum) - shouldn’t affect function of ear drum
What is the following condition?
Ear effusion
Fluid behind ear drum (common in children)
Buldging and pushed forwards appearance
What are the:
Symptoms
Signs
Treatment
of otitis media with effusion?
Symptoms
- Ear pressure/congestion
- Sometimes otalgia
- ‘Popping’ noises
- Hearing loss [conductive]
- Disequilibrium
- Affects speech development in children
Signs
- TM dull/opaque, fluid level/bubbles
Treatment
- Audiogram, otoscopy, counsel parents
- Watch and wait, f/u in 3 months
- Consider myringotomy/grommets (can equalise air pressures without the function of the Eustachian tube), hearing aid
- In adults with unilateral middle ear effusion - consider nasopharyngeal malignancy
What can cause problems equalising pressures in the ear & retraction of the tympanic membrane?
Swelling/inflammation of the Eustachian tube
What is the following condition?
Acute otitis media
Buldging, dull tympanic membrane, red TM
Who is more susceptible to otitis media infections, symptoms & treatments & red flags?
- Common, esp in under 7’s
-
Symptoms
- Otalgia, no discharge, red & bulging TM
- Acute suppurative otitis media: crescendo pain, then resolution (sometimes with ‘pop’), then discharge and TM perforation
- Associated hearing loss, tinnitus, fever common
- Children: unwell, crying, pulling affected ear
-
Treatment:
- often conservative. amoxicillin in severe cases.
- Red Flags:
- systemic sepsis (give IV antibiotics), CN palsy, meningism, etc.
What is the complication of what infection? (explain)
Mastoiditis complication from otitis media infection
- Usually heal themselves
- Sometimes infection spread to mastoid air cells (fill with pus)
- Can cause intracerebral abscess
-
Symptoms
- Tender, boggy, swollen mastoid process (maybe otalgia & discharge)
-
Treatment
- IV antibiotics (may need mastoidectomy - drill into mastoid)
What is the following condition?
Furoncle
Related to infected hair follicle
Treatment:
- Pop it and give antibiotics
What is the following condition?
Cholesteatoma - collection of keratinising squamous epithelium
e.g. thinning of tegmen due to this can lead to meningitis/intracranial abscess
Treatment:
- Surgically - e.g. mastoidectomy
- Ear drops (antibiotics/steroids)
And has a hole perforation of the tympanic membrane
Acute otitis externa what is it, symptoms, risk factors, signs, management?
Inflammation of outer ear (from auricle → outer surface of TM)
Symptoms
-
Otalgia (± discharge)
- Often after change in environment- humidity/pH or swimming
- Conductive hearing loss, tinnitus, dysequilibrium
Risk Factors
Age, Diabetes, recurrent OE, immunocompromise
Signs
Stenosed ear canal with debris, periauricular/pinna cellulitis, pinna/tragus tender to palpate
Management
Topical Antibiotics (+/- pope wick/regular microsuction), keep ear dry
What is the following condition? & treatment
Pinna Cellulotis (including the lobules)
Treatment:
- Ear drops & antibiotics
What is osteomalitis? (& treatment)
Infection of the ear which causes infection of the bone
Treatment:
- Aggressive IV antibiotics
What is this? How does it work?
Pope wick
Keeps a swollen ear canal patent
Disperses ear drops deep into ear canal
What happens when you give someone antibiotics for an otitis ear infections? (BAD?)
Get rid of GOOD & BAD bacteria thus, INCREASE risk of fungal infection (difficult anti-fungal treatment)
What is the following condition? & causes
Perichondritis (inflammation of the pinna cartilage) - LOBULE spared
Cause:
- Bacterial infections
- High pinna piercing
- Diabetes
- Pseudomonas infection
Symptoms, risk factors, treatment of perichondritis
Symptoms
- Red
- Swollen
- Tender ear
Risk factors
- Piercing
- Lacerations
- Otitis externa
Treatment
- Antibiotics
What is the following condition? Cause? Treatment?
Pinna haematoma
Cause:
- Trauma to ear & collection of blood under perichondrium
- If no blood supply for cartilage it dies = cartilage necrosis
Treatment
- Drain them (needle)
When untreated = cauliflower ear
What condition is this?
Cauliflower ear (associated with pinna haematoma)
How to treat foreign bodies in ear?
Common: bugs & batteries
Bugs
- Drown with olive oil
Batteries
- Remove ASAP as causes errosion e.g. of tegmen, TM, ossicles
Explain the following CT images
LEFT
- Patient fracture through mastoid portion of temporal bone & skull fracture
- Worries about conductive hearing loss (as loss of blood)
RIGHT
- Sensorineural hearing loss (as fracture at optic capsule) - could be DEAD ear
- Check facial nerve & do Rinne’s & Weber’s test
What is the following condition?
Haemotympanum (blood in the tympanic cavity of the middle ear)
What is the following condition?
Battle’s sign
Associated with base skull fracture (blood + bruising under skin of mastoid process)
What is the following condition?
LMN facial nerve palsy (right sided) e.g. due to temporal bone fracture which transected facial nerve
What is this imaging & what is the condition?
Left vestibular Schwannoma
Uncommon benign tumour growing from the vestibular portion of the vestibulocochlear nerve. Can cause unilateral sensorineural hearing loss, unilateral tinnitus, vertigo, facial palsy. Unilateral/asymmetrical hearing loss or tinnitus is investigated with an MRI scan of the internal acoustic meatus where CN VIII passes from the brain out towards the inner ear.
What is this condition?
Asymmetric sensorineural hearing loss (left ear worse than right ear. You can tell this is sensorineural as the bone conduction and air conduction are equally reduced (no air-bone gap)
What is benign Paroxysmal Positional Vertiogo?
Benign Paroxysmal Positional Vertigo - otoconia (small crystals) are dislodged from the otolith organs and can fall into the semicircular canals, causing ROTATORY VERTIGO - sensation of inertia/room feels as though it spins horribly. It is short lasting and episodic, triggered by head movements e.g. turning over in bed / looking up to reach for a high cupboard. Diagnosed using the Dix Hallpike Manoeuvre, treated with Epley’s Manoeuvre (positions that move otoconia back to original positions)
What is vestibular neuronitis?
Vestibular Neuronitis - inflammation of the vestibular nerve (often viral) - produces continuous vertigo (not episodic).
Vertigo can mimic STROKE so get MRI to check and treat immediately
What is labyrinthitis?
Labyrinthitis - inflammation of all of the inner ear structures, causes continuous vertigo AND hearing loss.
