CSIM 1.56: ENT Infections Flashcards
Problems with which structures cause issues with balance?
- Eyes
- Proprioception
- Vestibular system
- Cerebellum/brain
Why do you look behind the ear when doing an ear exam?
To look for a post-auricular incision scar, indicative of previous ear surgery
Which incisions are possible in ear surgery?
- Post-auricular incision
- Endaural incision
IMG 126
How do you hold an otoscope (OSCE)?
What do you do with the other hand?
Like a pen IMG 127
Pull the ear upwards, outwards and backwards
What conditions or abnormal features of the outer ear canal can be visible with otoscopic examination?
- Otitis externa
- Mastoid cavity (removed mastoid air cells causing a completely different appearance inside, NB: this is not pathological)
What condition or abnormal features of the tympanic membrane can be seen?
• Perforations (central or marginal)
What are the tuning fork tests?
Which frequency of tuning fork is used
Rinne’s test:
• Positive Rinne is good. This means that the sound is heard better in front of the ear than on the mastoid process
Weber’s test:
• Place fork in midline of head and see if the patient can hear it in the middle
512Hz
How do you activate a tuning fork?
Hit it onto a bony prominence (not a hard surface)
Describe interpretation of abnormal Weber’s tests
Normal/central
• Normal hearing
• OR: equal hearing loss on both sides
To one side:
• Conductive loss - tone is louder on the affected side because sensorineural hearing is more sensitive
• Sensorineural loss - tone louder on the contralateral side
How is otitis externa treated?
- Reassurance
- Microsuction
- Analgesia
- Ear drops
When do you refer someone with otitis externa?
When the canal is completely closed with discharge/debris/swelling
If malignant:
• Emergency referral for surgery
• Antibiotics
What is malignant/necrotic otitis externa?
An aggressive infection with extreme pain (not related to cancer) seen in immunocompromised patients which causes cranial nerve palsies
What are the types of otitis media?
- Acute otitis media
- Acute suppurative otitis media
- Chronic suppurative otitis media
- Otitis media with effusion
Describe acute/chronic suppurative otitis media.
Drainage of the middle ear is compromised due to some kind of blockage in the eustachian tube. This causes a negative middle ear pressure, causing effusion of fluid into middle ear
What is otitis media with effusion more commonly referred to as?
Glue ear
What is the treatment for acute otitis media?
- Analgesia of paracetamol + NSAID
* NOT antibiotics, as AOM is usually viral
What is the treatment for acute suppurative otitis media?
- Analgesics
* Antibiotics - as in this case, ASOM usually is bacterial
What are the potential complications of acute suppurative otitis media?
Intracranial
• Meningitis
• Intracranial abscess
• Sinus thromboses
Extracranial • Mastoiditis (mastoid air cells, expands, erodes the bone) • Facial nerve palsy • Labyrinthitis • Sensorineural hearing loss
Describe the features of mastoiditis
How is this dealt with?
- Protruding ear due to red swelling behind ear (IMG 128)
- Fever
- Associated with Acute suppurative otitis media and deafness
Immediately referred to ENT (life-threatening)
Is glue ear an emergency? Is it infective? Does it need antibiotics
No, no and no.
What is cholesteatoma
Congenital trapped keratinising squamous epithelium which is found in the MIDDLE EAR:
• Usually skin migrates from the umbo outwards as it grows, creating a ‘conveyer belt’ which carries out dead cells
• This doesnt happen, so they accumulate
How is glue ear treated?
- Hearing aids
* Ventilation tubes (grommets)
What is chronic suppurative otitis media? What is seen on examination
Condition which follows ASOM which is slow-to-heal
• Perforated eardrum
• Discharge in ear
Describe the clinical features of rhinosinusitis
- Nasal discharge
- Tender over cheeks
- No nasal airflow
