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ENT > 2: ENT - Acute Otitis Media, Chronic Otitis Media > Flashcards

2: ENT - Acute Otitis Media, Chronic Otitis Media Flashcards

1
Q

What is otitis media

A

Inflammation of the middle ear

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2
Q

What age group is otitis media more common

A

6-24months

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3
Q

What percentage of children under 2 have had otitis media

A

70%

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4
Q

What is the main cause of otitis media in general

A

Bacterial super-infection following viral URTI

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5
Q

What bacteria most commonly causes otitis media

A

S. pneumonia (35%)

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6
Q

what are 3 other causes of otitis media

A

Haemophillus Influenza
Morexella Catarrhalis
Group A streptococci

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7
Q

Give 5 risk factors for otitis media

A
  • Recent viral URTI
  • Pacifier Use
  • Bottle Feeding
  • Parental smoking
  • Enlarged adenoids
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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
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9
Q

How will older children with otitis media present (4)

A
  • Otalgia
  • Hearing loss
  • Fever
  • Tender mastoid P
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10
Q

When will otalgia cease

A

Rupture of tympanic membrane

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11
Q

What does the eustachian tube connect

A

Ear to nasopharynx

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12
Q

What is the role of the Eustachian tube

A

Contains cilia that waft secretions from middle ear to nasopharynx

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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
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14
Q

What does accumulation of middle ear secretions cause

A

Bacterial superinfection - resulting in collection of pus and bulging of tympanic membrane

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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

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16
Q

What is first line investigation for acute otitis media

A

Otoscopy

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17
Q

What are early signs on otoscope in otitis media

A
  • Loss of light reflex

- Retraction of tympanic membrane

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18
Q

What are three late signs of otitis media on otoscopy

A
  • Cartwheel tympanic membrane
  • Yellow spot on TM
  • Ruptured TM
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19
Q

What is cartwheel TM

A

increase blood vessels around lateral TM

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20
Q

What is the yellow spot on anterior-inferior tympanic membrane in otitis media

A

pars tensa - indicates eminent rupture

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21
Q

How will rupture of the TM present

A

purulent discharge in external auditory canal

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22
Q

What is second-line investigation of otitis media

A

Rinne and Weber’s

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23
Q

What type of hearing loss does otitis media cause

A

Conductive

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24
Q

If there is discharge from ear canal what should be done

A

Send from MC+S

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25
Q

What is first-line management for otitis media

A

Analgesia with paracetamol and ibuprofen

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26
Q

What are 5 indications for antibiotics in otitis media

A
  1. Disease >4d
  2. Bilateral otitis media and <2years
  3. Systemically unwell
  4. Perforated TM
  5. Other co-morbidities that predispose to complications
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27
Q

What is first-line antibiotic in otitis media

A

Amoxicillin TDS

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28
Q

Which children with otitis media should be admitted to hospital

A

<3 months with T > 38

3-6 months with T > 39

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29
Q

What are two surgical options of otitis media

A

Tympanocentesis

Myringotomy

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30
Q

When is tympanocentesis indicated

A

Patients who do not respond to initial treatment

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31
Q

When is myringotomy indicated for otitis media

A

Recurrent otitis media

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32
Q

What is myringotomy

A

Incision into ear drum - then insert tympanostomy tube

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33
Q

What are 4 complications of otitis media

A
  1. Mastoiditis
  2. Labrynthitis
  3. Cranial abscess
  4. Facial. N palsy
  5. Sigmoid sinus thrombosis
  6. Chronic otitis media
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34
Q

What is mastoiditis

A

Inflammation of mastoid air cells

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35
Q

What is labrynthitis

A

Inflammation of labyrinth in inner ear

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36
Q

What is mastoiditis

A

Inflammation of mastoid air cells

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37
Q

When is the peak incidence of mastoiditis

A

6-12m

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38
Q

What causes mastoiditis

A

Otitis media

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39
Q

What are three risk factors for mastoiditis

A
  1. Cholesteatoma
  2. Immunocomprimised
  3. Younger children
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40
Q

How will mastoiditis present

A

Boggy erythematous swelling behind the ear that pushes the pinna forwards

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41
Q

What are mastoid air cells

A

Collection of cells in mastoid process of temporal bone that connect with middle ear using mastoid antrum

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42
Q

Explain pathophysiology of mastoid air cells

A

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
Q

What investigations may be ordered in mastoiditis

A
  • Ear swab

- CT head and mastoid = indicated for all patients

44
Q

What is first-line management for mastoiditis

A

IV ceftriaxone or co-amoxiclav

45
Q

How long should oral antibiotics be continued for in mastoiditis

46
Q

What are surgical options to manage mastoiditis

A

Incision and drainage

Needle aspiration

47
Q

What are surgical indications for mastoiditis

A
  • Fails to improve after 48h
  • Pyrexia
  • Complications
48
Q

What are two intra-cranial complications of mastoiditis

A
  • Infection

- Dural sinus thrombosis

49
Q

What are extra-cranial complications

A
  • Facial N Palsy
  • Hearing Loss
  • Labrynthitis
  • Subperiosteal abscess
  • Cranial osteomyelitis
50
Q

What is otitis media with effusion

A

Accumulation of inflammatory infiltrate in the middle ear causing conductive hearing impairment.

51
Q

What age-group is otitis media with effusion more common

A

Children - eustachian tube can be blocked by recurrent infections causing inflammation

52
Q

What could cause otitis media w/effusion in adults

A

Malignancy

53
Q

Give 4 risk factors for otitis media with effusion

A

Pacifier use
Bottle fed
Parental smoking
Primary ciliary dyskinesia

54
Q

How can otitis media with effusion present clinically

A
  • Conductive hearing loss
  • Sensation of fullness in the ear which may be accompanied by hissing
  • Vertigo
55
Q

What type of hearing defect is present in otitis media with effusion

A

Conductive hearing loss

56
Q

How will otitis media with effusion present on otoscope

A

Loss of light reflex due to fluid

57
Q

How will audiometry present in otitis media with effusion

A

Conductive hearing loss

58
Q

How will tympanometry present in otitis media with effusion

A

Type B: due to reduced membrane compliance

59
Q

If an adult has otitis media with effusion what will be done

A

Full ENT exam including flexible nasoendoscopy

60
Q

If otitis media with effusion does not resolve in three months what is offered

A

Myringotomy and grommet insertion

61
Q

What is the NICE criteria for grommet insertion

A
  • Less than three-years old with bilateral otitis media

- Hearing loss in better ear less than 25-35 decibels

62
Q

What should any child with multiple grommet insertion be considered for

A

Adenoidectomy if enlarged

63
Q

What position are grommets inserted

A

Anterior-Inferior

64
Q

If myringotomy and grommet insertion is not acceptable - what may be offered

A

Hearing aids or Auto-Inflation

65
Q

What is chronic otitis media

A

chronic infection of the middle ear due to an ongoing inflammatory response

66
Q

What are the two types of chronic otitis media

A
  1. Mucosal

2. Squamous

67
Q

What causes mucosal chronic otitis media

A

Perforation of tympanic membrane resulting in chronic inflammation

68
Q

In mucosal chronic otitis media what may be the cause of initial perforation

A

Infection
Trauma
Tumour

69
Q

If there is discharge in chronic otitis media what is it referred to

A

Supprative chronic otitis media

70
Q

What is squamous chronic otitis media

A

Cholesteatoma formation

71
Q

Perforations in which part of the tympanic membrane are associated with higher risk of cholesteatoma

A

Perforation of the posterior-superior tympanic membrane (attico-antral region) have a higher risk of cholesteatoma

72
Q

What is the most common cause of chronic otitis media

A

Recurrent otits media

73
Q

What else may cause chronic otitis media

A

Grommet insertion

74
Q

How will chronic otitis media present clinically

A

Discharge from the ear present for >6W in absence of otalgia or fever

75
Q

What will be seen on otoscope in chronic otitis media

A

Perforation of TM

76
Q

Why must the location of TM perforation on otoscopy be noted

A

As posterior-superior (atticoantral) region has a higher risk of perforation

77
Q

What other investigations are performed in chronic otitis media

A

Audiometry

Tympanometry

78
Q

If suspicious a cholesteatoma has formed what should be ordered

A

CT scan of petrous portion of temporal bone

79
Q

What is first line management for chronic otitis media

A

Aural toileting

Topical antibiotics and steroids

80
Q

When should someone with chronic otitis media be referred to ENT

A

Symptoms have not resolved in 6W

81
Q

What are the two surgical options for managing chronic otitis media

A
  • Myringoplasty

- Tympanoplasty

82
Q

What is a myringoplasty

A

Autologous graft from temporals fascia or tragal cartilage is used to repair defects in pars tensa

83
Q

What is a tympanoplasty

A

Myringoplasty with reconstruction of ossicular chain

84
Q

What is the main complication of chronic otitis media

A

Hearing Loss

85
Q

If a patient has otalgia but tympanic membrane and external membrane appear normal, what is the likely cause

A

Referred Ear Pain

86
Q

What cranial nerve damage can cause referred ear pain

A
  • V (Trigeminal)
  • 7 (Facial)
  • 9 and 10
87
Q

What pathology supplied by cranial nerve 5 can cause otalgia

A
  • Parotid Gland
  • Upper Molar
  • TMJ Joint
88
Q

What pathology innervated by cranial nerve 7 can cause referred otalgia

A
  • Ramsay-Hunt Syndrome
89
Q

What pathology innervated by cranial nerve 9 and 10 can cause otalgia

A
  • Malignancy of posterior third of the tongue, piriform recess or infective causes
90
Q

What is a cholesteatoma

A

Pocket of ectopic epithelium that grows in the attic of the middle ear

91
Q

What causes cholesteatoma

A

Epithelial cells naturally shed in the pocket, but that cannot escape into the middle ear causing a collection to grow

92
Q

Explain cholesteatoma as a cause of chronic otits media

A

Epithelial cells grow from the tympanic membrane. Where they collect and form an inflammatory reaction that can cause necrosis of surrounding structures

93
Q

How can cholesteatomas be divided

A
  • Congenital

- Acquired

94
Q

What is a congenital cholesteatoma

A

Present at birth caused by embryonic nests of epidermal cells in the middle ear

95
Q

How can acquired cholesteatomas be divided

A
  • Primary

- Secondary

96
Q

What is a primary acquired cholesteatoma

A

Eustachian tube dysfunction cases TM to retract inwards due to negative pressure causing a retraction pocket

97
Q

What is a secondary acquired cholesteatoma

A

Epithelium migrates inwards through perforated TM

98
Q

How do cholesteatomas typically present

A

Foul-smelling Otorrhoea

99
Q

What investigations are ordered if suspected cholesteatoma

100
Q

What type of hearing loss is present in cholesteatoma

A

Conductive hearing loss

101
Q

How will cholesteatoma present on otoscopy

A

Primary: brown irregular mass
Secondary: pearly, keratinised mass in attic region

102
Q

How is cholesteatoma managed

A

Surgical removal

103
Q

What are 4 possible complications of cholesteatoma

A

Hearing Loss
Facial palsy
Abscess
Mastoiditis

ENT (16 decks)

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