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.