Common Middle Ear Pathologies

Question 1

What are the red flags that require onward referral?

Answer 1

1. Sudden or rapidly deteriorating HL
2. Ear pain
3. Discharge or bleeding
4. Unilateral / asymmetric hearing
5. Unilateral / asymmetric tinnitus
6. Dizziness, vertigo
7. Chronic conductive HL
8. Fluctuating hearing
9. Aural fullness or pressure
10. Facial numbness, tingling or weakness

Question 2

Why is noting pinna deformity important?

Answer 2

Whilst it may not impact audiometry / tymps, it may be associated with other abnormalities of the conductive system.

Question 3

What is perichondritis?

Answer 3

An infection of the cartilage under the skin

Caused by inset bites, ear piercings, injuries or after burns.

Question 4

What is a microtia?

Answer 4

An abnormally small pinna

Question 5

What is agenesis?

Answer 5

Completely absent pinna

Question 6

What are the characteristics of otitis external?

Answer 6

Symptoms:
- Itching
- Pain
- Crusting
- Discharge
- Vomiting, loss of apetite
- May be accompanied by otitis media

Treatment:
- Suction
- Analgesia
- Antibiotics

Impact on clinical diagnosis
- Would expect to see a CHL

Question 7

What are some common causes of ear canal swelling?

Answer 7

Extosis - a bone growth deep in the canal causing skin irritation and interference with skin and wax migration. Common in swimmers and surfers

Osteoma: a non-cancerous tumor

Impact on clinical diagnosis:
May see a CHL depending on size

Question 8

What is TM / ossicular trauma?

Answer 8

• A central perforation
• Diagnosed by tymps, PTA and CT scans

Question 9

What are some characteristics of TM perforation?

Answer 9

• Categorised as central, marginal and attic
• The larger the perforation the larger the CHL
• May be caused by repeated infections as well as trauma.

Question 10

For someone with otitis external, what would we expect to see on the audiogram?

Answer 10

CHL

Question 11

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