2 - ear diseases Flashcards
what is otitis externa? what are causes?
= inflammation of skin of ear canal
- bacteria e.g. staph aureus or pseudomonas aeruginosa
- fungal e.g. aspergillus or candida albicans
- inflammation like eczema, seborrheic dermatitis, contact dermatitis
what is acute otitis media?
= inflammation of middle ear, common in kids from upper resp infection etc
- very painful, eardrum can burst
what is management of acute otitis media?
should resolve in 3 days - if lasts longer then antibiotics given (amoxicillin/clarithromycin)
what is otitis media with effusion?
also called glue ear, common in kids
- it’s accumulation of fluid behind tympanic membrane with no symptoms of acute inflammation
= it’s when eustachian tube blocked, pressure goes down & fluid builds up & sits there getting thick & infection
what should you consider as cause if adults with otitis media with effusion?
rhinosinusitis, nasopharyngeal carcinoma or nasopharyngeal lymphoma (tumours blocking eustachian tube)
what is seen on tympanogram and on otoscopy for glue ear?
tympanogram = conductive hearing loss - flat tympanogram
otoscopy = visible fluid & bubbles, sucked in tympanic membrane, altered colour tympanic membrane
what is treatment of otitis media with effusion?
- usually resolve in 3 months but if not then:
grommet = tube that allows air to pass through hole bypassing eustachian tube prevents fluid coming back, lasts about a year
(also do adenoidectomy if needed)
what is cholesteatoma?
sounds like tumour from name but it’s not, it’s when eardrum has sucked in and dead skin builds up inside middle ear, as keratin builds up it erodes any bone it’s touching like ear canal, ossicles, inner ear etc
what is presentation & management of cholesteatoma?
PRESENTS = hearing loss, foul smelling discharge (complications)
MANAGE = needs surgical excision & reconstruction (mastoid)
what are complications of acute otitis media & cholesteatoma? (think of each wall of middle ear and what could go wrong at each location)
- subperiosteal abscess (laterally)
- sensorineural hearing loss or tinnitus or vertigo or facial palsy (medially)
- brain abscess or meningitis (superiorly)
- venous sinus thrombosis (posteriorly)
what is otosclerosis? presentation?
hereditary disorder where bony deposits in stapes/footplate/cochlea making gradual onset conductive hearing loss
PRESENTS - usually under 40s with tinnitus/hearing loss (uni or bilateral), perceive their own voice as loud (more in women - pregnancy)
what is typical audiogram for noise induced hearing loss?
normal apart from dip of both air & bone at 4000 Hz is typical from loud noise hearing loss
what drugs known to cause sensorineural hearing loss?
- gentamicin & aminoglycosides
- chemotherapeutic drugs - cisplatin, vincristine
- aspirin & NSAIDs
what is most common bug to cause otitis media?
streptococcus pneumoniae
what is seen on otoscopy of acute otitis media?
bulging red, inflamed membrane, maybe effusion. opaque tympanic membrane
what is presentation of otitis media with effusion (glue ear)?
- deafness
- poor school performance
- behavioural issues
- speech delay
- NO OTALGIA OR FEVER
what is tinnitus? primary vs secondary?
tinnitus = persistent addition sound not in environment
primary = no known cause (often w sensorineural hearing loss)
secondary = known cause like impacted ear wax, ear infection, meniere’s disease, noise exposure, medicine side effects, acoustic neuromas, multiple sclerosis, truma & depression
what is investigation & management of otosclerosis?
investigation - can do audiometry showing conductive hearing loss and tympanometry (reduced absorption of sound since tympanic membrane stiff & no compliant)
management - either hearing aids or fix stapes footplate
what is presbycusis? presents?
= age related sensorineural hearing loss due to degeneration of cochlea
PRESENTS
- gradual & subtle hearing loss with high pitched lost 1st so loud environment tricky
what is sudden sensorineural hearing loss?
less than 3 days of sensorineural hearing loss - lots of different causes like autoimmune, acoustic neuroma/vestibular schwannoma etc
what investigations done for sudden sensorineural hearing loss?
- rinnes & weber test
- autoantibodies in blood (to exclude autoimmune cause)
- MRI (to exclude acoustic neuroma)
- audiometry graph (shows sensorineural pattern- with drop of 30 decibels in 3 different frequencies)
what is treatment of sudden sensorineural hearing loss?
- give oral steroids
- if not help then intratympanic steroids
