Discharging ears and otitis media Flashcards
What are causes of discharge in the external ear? what is the appearance of the discharge?
OE - scanty (sparse) watery discharge
Trauma - blood
Liquid wax
What is the external ear comprised of?
- Auricle (pinna)
2. External acoustic meatus - ends at the tympanic membrane (ear drum)
What are causes of middle ear discharge? what is the appearance?
i. Middle ear disease - mucous discharge
ii. Chronic otitis media - serosanginous (blood + serous fluid)
iii. cholesteatoma - offensive
What causes CSF otorrhoea? What would u see on filter paper?
CSF leakage into middle ear 1. Trauma 2. Halo sign on filter paper or glucose is ↑, or beta 2 (tau) transferrin is present.
What is the middle ear comprised of?
Tympanic cavity containing the bones (ossicles) - malleus, incus and stapes
Epitympanic recess - superior to tympanic cavity next to mastoid air cells
How does acute OM present?
Rapid onset of pain Fever (+/- irritability) Anorexia Vomiting Often after viral URTI Conductive hearing loss
What are the common causative organisms of acute OM?
Strep pneumoniae
H influenzae
Moraxella catarrhalis
What is a sign of a perforated eardrum in acute OM?
Purulent discharge
What is rx of acute om?
Analgesia
Amoxicillin for 7 or less days
what are complications of acute OM?
mastoiditis petrositis labyrinthitis facial palsy meningitis intracranial abscesses
What is chronic otitis media?
chronic inflammation of the middle ear and mastoid cavity that is characterised by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks.
What causes chronic otitis media?
following an upper respiratory tract infection that has led to acute otitis media
How does chronic OM present?
discharge
reduced hearing
little pain
what are the types of chronic om?
mucosal
squamous
each may be inactive or w active inflammation
What is a complication of chronic OM?
cholesteatoma as secretions cannot drain and it differentiates into squamous epithelium
What is a cholesteatoma? How does it occur?
Abnormal sac of keratinising squamous epithelium + accumulation of keratin in the middle are or mastoid air cells spaces that can become infected and erode neighbouring air spaces
- chronic middle ear pressure causes a weak area in the upper TM to be sucked inwards and form a retraction pocket, this has a large pouch w a narrow neck which traps desquamating surface epithelium, becomes filled w keratin debris
Outermost layer is metabolically active and produces proteolytic enzymes, they’re locally destructive and erodes adjacent bones
What age does cholesteatoma commonly affect?
5-15yrs
How does cholesteatoma present? What features indicate impending CNS complications?
- Foul discharge +/- deafness (conductive)
- Indication of impending CNS complications:
Headache
Pain
Facial paralysis
Vertigo
What is the treatment of cholesteatoma?
mastoid surgery
What is the treatment of cholesteatoma when the TM can’t be clearly seen due to purulent discharge
Treat for presumed infection + bring the person back for re-examination after rx has completed
What are complications of cholesteatoma?
- Meningitis
- Cerebral abscess
- Hearing loss
- Mastoiditis
- Facial nerve dysfunction
What is mastoiditis?
bacterial infection of the mastoid air cells surrounding the inner and middle ear
What can mastoiditis progress to?
Destruction of air cells in the mastoid bone +/- abscess
intracranial extension
What is an RF of mastoiditis?
Withholding abx in OM
What are signs of mastoiditis?
- Raised temperature
- Tender mastoid
- Protruding auricle
What is the treatment of mastoiditis?
- Hospital
- IV abx
- Myringotomy +/- definitive mastoidectomy
what is a myringotomy?
incision in eardrum to relieve pressure
How does acute otitis media appear on otoscopy?
bulging red tympanic membrane with red vessels
