Applied Anatomy common Ear Conditions Flashcards
What is Acute Otitis Media ?
Risk factors ?
What are the clinical presentations?
What would you see on otoscopic examination ?
How would you treat.
Inflammation of the middle ear is associated with infection.
Risk factors:
Paediatric age group, smoking (passive) exposure, lack of immunization, prematurity, recurrent URTI, immunodeficiency
Clinical Presentation:
Hearing loss, otalgia, fever, malaise, coryza/rhinorrhoea
Non-specific symptoms in children: irritability, crying, poor feeding, restlessness, vomiting
Pain resolved by perforation of tympanic membrane- greenish discharge may be seen
On otoscopic examination:
Tympanic membrane may be inflamed or cloudy; bulging with an air-fluid level, may even be perforated
Management
- Supportive treatment
- antibiotics if systemically unwell or have a high risk of complications.
- Refer is people are at risk of complications or Children younger than 3 months of age with a temperature of 38°C or more.
What is Otis media with effusion?
What are the clinical presentations ?
What is the management ?
Middle ear is filled with fluid that lessens the vibrations of the eardrum and tiny bones (ossicles). decreased/loss of hearing. Common in children who have just suffered from otitis media.
Clinical presentation:
Hearing loss, mild, intermittent ear pain
May have balance problems
Often have recurrent URTI in the past
Management:
For children without hearing loss - reassurance
If hearing loss is clinically suspected, consider referral for formal assessment with tympanometry and hearing testing.
Surgical management (grommets) is advised if persistent (>3mo) and bilateral or significant hearing loss or social, developmental , educational difficulty
Adults should be investigated for underlying causes
What is ear wax impaction?
What causes it?
What are risk factors?
What is the clinical presentation?
How do you manage?
An accumulation of earwax that causes symptoms.
Causes:
Over production of cerumen, anatomical variations of the canal, cerumen gland atrophy (drier cerumen).
Risk factors:
Elderly, male, narrow ear canals, psoriasis, use of cotton buds, insertion of hearing aids
Presentation:
Hearing loss (most common symptom).
A sensation of blocked ears/discomfort, earache, ringing noises (tinnitus).
Examination:
Otoscopy confirms if there is ear wax and if it is impacted.
Can remove ear wax by:
First line: ear drops to soften wax and aid removal (olive oil or almond oil, sodium bicarbonate 5% & NaCl 0.9%)
Ear irrigation microsuction
**Contraindicated in perforated tympanic membrane
Explain otitis externa ?
Clinical Presentation ?
On examination what would you see ?
Diffuse inflammation of the external ear canal (auditory canal); may also involve the pinna or ear drum.
Aka ‘swimmer’s ear’ or ‘tropical ear’
Acute otitis externa:
Ear pain and tenderness of the tragus and/or pinna (often severe)
Ear discharge
Hearing loss due to ear canal occlusion
On examination:
Tenderness of the tragus and/or pinna
Red and oedematous ear canal
Erythema of the tympanic membrane
Cellulitis of the pinna and adjacent skin
Hearing loss & lymphadenitis
Management
Analgesics for the pain
Aural toilet
Topical acetic acid
Topical antibiotics (+/- steroids)
If patient is systemically unwell admit to hospital (start on IV antibiotics)
Others:
Keep ears dry
Manage risk factors
Safety netting
What would you likely to see with chronic otitis media ?
What causes it ?
Chronic otitis media:
Constant ear itch
Scaly ear canal partial stenosis conductive hearing loss
Fungal infection: cotton-like debris, hyphae, or dots of black debris may be seen in the ear canal
What would you see with malignant otitis media ?
What would course it ?
Malignant otitis media
Constant disproportionate ear pain, headache, purulent otorrhoea, fever, or malaise, vertigo.
Profound conductive hearing loss
Patients appear very unwell, facial nerve paralysis.
Explain Tympanic Membrane Perforation.
How do you check for a tympanic perforations?
Where is it safe for perforation, and there isn’t?
Presence of a hole/tear in the tympanic membrane.
Can lead to decreased/loss of hearing
Greater risk of developing an ear infection.
Causes:
Infection, barotrauma, sudden loud noises, foreign objects.
Clinical presentation
Changes in hearing, ringing noises, ear pain, ear discharge, fever, and feeling of air coming out of the ear when the nose is blown.
Need to do an otoscopic examination.
Unsafe perforations are suggestive of cholesteatoma and are found in the:
Attic
Posterior region
Involving the TM margin
Safe perforations are anywhere else:
Anterior portion
Inferior portion
AND not involving the tympanic membrane margin
What is cholesteatoma ?
What symptoms ?
What investigations ?
What treatment ?
Accumulation of squamous epithelium trapped within the middle ear - erodes/destroy structures within the temporal bone.
Symptom include painless otorrhea, either unremitting or frequently recurrent, conductive hearing loss and dizziness (uncommon)
Investigations: audiogram; CT/MRI scans
Treatment includes surgical excision/removal of the cholesteatoma
Of these perforations which are safe and which are unsafe?
A - Unsafe
B - Safe
C - unsafe
How do you treat a tympanic membrane performation ?
Management:
Conservative- eardrum will usually heal by itself within 6-8 weeks (best to avoid water getting into the ear whilst it is healing)
Medical- antibiotics in cases where the perforation is due to a bacterial infection
Surgery- in cases where perforated ear drum does not heal by itself.
