2: ENT - Acute Otitis Media, Chronic Otitis Media Flashcards
1
Q
What is otitis media
A
Inflammation of the middle ear
2
Q
What age group is otitis media more common
A
6-24months
3
Q
What percentage of children under 2 have had otitis media
A
70%
4
Q
What is the main cause of otitis media in general
A
Bacterial super-infection following viral URTI
5
Q
What bacteria most commonly causes otitis media
A
S. pneumonia (35%)
6
Q
what are 3 other causes of otitis media
A
Haemophillus Influenza
Morexella Catarrhalis
Group A streptococci
7
Q
Give 5 risk factors for otitis media
A
- Recent viral URTI
- Pacifier Use
- Bottle Feeding
- Parental smoking
- Enlarged adenoids
8
Q
How will infants with otitis media present clinically (6)
A
- Irritable
- Tugging at the affected ear
- Fever
- Febrile convulsions
- Poor Feeding
- Tender mastoid process
- Crying
9
Q
How will older children with otitis media present (4)
A
- Otalgia
- Hearing loss
- Fever
- Tender mastoid P
10
Q
When will otalgia cease
A
Rupture of tympanic membrane
11
Q
What does the eustachian tube connect
A
Ear to nasopharynx
12
Q
What is the role of the Eustachian tube
A
Contains cilia that waft secretions from middle ear to nasopharynx
13
Q
Explain pathophysiology of otitis media
A
- Obstruction ET causes poor drainage and ventilation of middle ear.
- Reabsorption air causes negative middle ear pressure
- This causes retraction of tympanic membrane - otalgia and conductive hearing loss
14
Q
What does accumulation of middle ear secretions cause
A
Bacterial superinfection - resulting in collection of pus and bulging of tympanic membrane
15
Q
Why does obstruction of ET occur
A
Inflammation of mucosa caused by viral infection or allergic rhinitis. Or mechanical obstruction due to large adenoids or nasal polyps
16
Q
What is first line investigation for acute otitis media
A
Otoscopy
17
Q
What are early signs on otoscope in otitis media
A
- Loss of light reflex
- Retraction of tympanic membrane
18
Q
What are three late signs of otitis media on otoscopy
A
- Cartwheel tympanic membrane
- Yellow spot on TM
- Ruptured TM
19
Q
What is cartwheel TM
A
increase blood vessels around lateral TM
20
Q
What is the yellow spot on anterior-inferior tympanic membrane in otitis media
A
pars tensa - indicates eminent rupture
21
Q
How will rupture of the TM present
A
purulent discharge in external auditory canal
22
Q
What is second-line investigation of otitis media
A
Rinne and Weber’s
23
Q
What type of hearing loss does otitis media cause
A
Conductive
24
Q
If there is discharge from ear canal what should be done
A
Send from MC+S
25
What is first-line management for otitis media
Analgesia with paracetamol and ibuprofen
26
What are 5 indications for antibiotics in otitis media
1. Disease >4d
2. Bilateral otitis media and <2years
3. Systemically unwell
4. Perforated TM
5. Other co-morbidities that predispose to complications
27
What is first-line antibiotic in otitis media
Amoxicillin TDS
28
Which children with otitis media should be admitted to hospital
<3 months with T > 38
| 3-6 months with T > 39
29
What are two surgical options of otitis media
Tympanocentesis
| Myringotomy
30
When is tympanocentesis indicated
Patients who do not respond to initial treatment
31
When is myringotomy indicated for otitis media
Recurrent otitis media
32
What is myringotomy
Incision into ear drum - then insert tympanostomy tube
33
What are 4 complications of otitis media
1. Mastoiditis
2. Labrynthitis
3. Cranial abscess
4. Facial. N palsy
5. Sigmoid sinus thrombosis
6. Chronic otitis media
34
What is mastoiditis
Inflammation of mastoid air cells
35
What is labrynthitis
Inflammation of labyrinth in inner ear
36
What is mastoiditis
Inflammation of mastoid air cells
37
When is the peak incidence of mastoiditis
6-12m
38
What causes mastoiditis
Otitis media
39
What are three risk factors for mastoiditis
1. Cholesteatoma
2. Immunocomprimised
3. Younger children
40
How will mastoiditis present
Boggy erythematous swelling behind the ear that pushes the pinna forwards
41
What are mastoid air cells
Collection of cells in mastoid process of temporal bone that connect with middle ear using mastoid antrum
42
Explain pathophysiology of mastoid air cells
Infection can spread to mastoid air cells via antrum. It causes break-down in trabecular resulting in pus accumulation which increases pressure to cause necrosis.
43
What investigations may be ordered in mastoiditis
- Ear swab
| - CT head and mastoid = indicated for all patients
44
What is first-line management for mastoiditis
IV ceftriaxone or co-amoxiclav
45
How long should oral antibiotics be continued for in mastoiditis
14 days
46
What are surgical options to manage mastoiditis
Incision and drainage
| Needle aspiration
47
What are surgical indications for mastoiditis
- Fails to improve after 48h
- Pyrexia
- Complications
48
What are two intra-cranial complications of mastoiditis
- Infection
| - Dural sinus thrombosis
49
What are extra-cranial complications
- Facial N Palsy
- Hearing Loss
- Labrynthitis
- Subperiosteal abscess
- Cranial osteomyelitis
50
What is otitis media with effusion
Accumulation of inflammatory infiltrate in the middle ear causing conductive hearing impairment.
51
What age-group is otitis media with effusion more common
Children - eustachian tube can be blocked by recurrent infections causing inflammation
52
What could cause otitis media w/effusion in adults
Malignancy
53
Give 4 risk factors for otitis media with effusion
Pacifier use
Bottle fed
Parental smoking
Primary ciliary dyskinesia
54
How can otitis media with effusion present clinically
- Conductive hearing loss
- Sensation of fullness in the ear which may be accompanied by hissing
- Vertigo
55
What type of hearing defect is present in otitis media with effusion
Conductive hearing loss
56
How will otitis media with effusion present on otoscope
Loss of light reflex due to fluid
57
How will audiometry present in otitis media with effusion
Conductive hearing loss
58
How will tympanometry present in otitis media with effusion
Type B: due to reduced membrane compliance
59
If an adult has otitis media with effusion what will be done
Full ENT exam including flexible nasoendoscopy
60
If otitis media with effusion does not resolve in three months what is offered
Myringotomy and grommet insertion
61
What is the NICE criteria for grommet insertion
- Less than three-years old with bilateral otitis media
| - Hearing loss in better ear less than 25-35 decibels
62
What should any child with multiple grommet insertion be considered for
Adenoidectomy if enlarged
63
What position are grommets inserted
Anterior-Inferior
64
If myringotomy and grommet insertion is not acceptable - what may be offered
Hearing aids or Auto-Inflation
65
What is chronic otitis media
chronic infection of the middle ear due to an ongoing inflammatory response
66
What are the two types of chronic otitis media
1. Mucosal
| 2. Squamous
67
What causes mucosal chronic otitis media
Perforation of tympanic membrane resulting in chronic inflammation
68
In mucosal chronic otitis media what may be the cause of initial perforation
Infection
Trauma
Tumour
69
If there is discharge in chronic otitis media what is it referred to
Supprative chronic otitis media
70
What is squamous chronic otitis media
Cholesteatoma formation
71
Perforations in which part of the tympanic membrane are associated with higher risk of cholesteatoma
Perforation of the posterior-superior tympanic membrane (attico-antral region) have a higher risk of cholesteatoma
72
What is the most common cause of chronic otitis media
Recurrent otits media
73
What else may cause chronic otitis media
Grommet insertion
74
How will chronic otitis media present clinically
Discharge from the ear present for >6W in absence of otalgia or fever
75
What will be seen on otoscope in chronic otitis media
Perforation of TM
76
Why must the location of TM perforation on otoscopy be noted
As posterior-superior (atticoantral) region has a higher risk of perforation
77
What other investigations are performed in chronic otitis media
Audiometry
| Tympanometry
78
If suspicious a cholesteatoma has formed what should be ordered
CT scan of petrous portion of temporal bone
79
What is first line management for chronic otitis media
Aural toileting
| Topical antibiotics and steroids
80
When should someone with chronic otitis media be referred to ENT
Symptoms have not resolved in 6W
81
What are the two surgical options for managing chronic otitis media
- Myringoplasty
| - Tympanoplasty
82
What is a myringoplasty
Autologous graft from temporals fascia or tragal cartilage is used to repair defects in pars tensa
83
What is a tympanoplasty
Myringoplasty with reconstruction of ossicular chain
84
What is the main complication of chronic otitis media
Hearing Loss
85
If a patient has otalgia but tympanic membrane and external membrane appear normal, what is the likely cause
Referred Ear Pain
86
What cranial nerve damage can cause referred ear pain
- V (Trigeminal)
- 7 (Facial)
- 9 and 10
87
What pathology supplied by cranial nerve 5 can cause otalgia
- Parotid Gland
- Upper Molar
- TMJ Joint
88
What pathology innervated by cranial nerve 7 can cause referred otalgia
- Ramsay-Hunt Syndrome
89
What pathology innervated by cranial nerve 9 and 10 can cause otalgia
- Malignancy of posterior third of the tongue, piriform recess or infective causes
90
What is a cholesteatoma
Pocket of ectopic epithelium that grows in the attic of the middle ear
91
What causes cholesteatoma
Epithelial cells naturally shed in the pocket, but that cannot escape into the middle ear causing a collection to grow
92
Explain cholesteatoma as a cause of chronic otits media
Epithelial cells grow from the tympanic membrane. Where they collect and form an inflammatory reaction that can cause necrosis of surrounding structures
93
How can cholesteatomas be divided
- Congenital
| - Acquired
94
What is a congenital cholesteatoma
Present at birth caused by embryonic nests of epidermal cells in the middle ear
95
How can acquired cholesteatomas be divided
- Primary
| - Secondary
96
What is a primary acquired cholesteatoma
Eustachian tube dysfunction cases TM to retract inwards due to negative pressure causing a retraction pocket
97
What is a secondary acquired cholesteatoma
Epithelium migrates inwards through perforated TM
98
How do cholesteatomas typically present
Foul-smelling Otorrhoea
99
What investigations are ordered if suspected cholesteatoma
CT Scan
100
What type of hearing loss is present in cholesteatoma
Conductive hearing loss
101
How will cholesteatoma present on otoscopy
Primary: brown irregular mass
Secondary: pearly, keratinised mass in attic region
102
How is cholesteatoma managed
Surgical removal
103
What are 4 possible complications of cholesteatoma
Hearing Loss
Facial palsy
Abscess
Mastoiditis
