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ENT > Disorders of the Ear > Flashcards

Disorders of the Ear Flashcards

1
Q

Problems of the outer ear (3)

A

pinna haematoma, poor Rx>necrosis>fibrosis
Exostoses: benign bony proliferation in external meatus
wax: don’t remove unless impacted. olive oil 1st line, suction/syringe after warm water/olive oil 2nd line. (may have dizzy spell afterwards).

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2
Q

Causes of otalgia (ear pain) (6)

A

otitis externa

furunculosis

bullous myringitis

barotrauma

TMJ dysfunction

reffered otalgia

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3
Q

Causes of otitis externa (7)

A

acute inflammation of skin in meatus due to:

  • moisture
  • low wax
  • hearing aids
  • contact dermatitis
  • trauma
  • narrow canal
  • infection: staph aureus, pseud aeruginosa
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4
Q

Presentation of otitis externa (4)

A
  • minimal discharge, no mucinous glands at external meatus
  • itching
  • pain
  • tender tragus
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5
Q

common pathogens causing otitis externa (4)

A

pseudomonas aeruginosa

staph aureus

aspergillus niger

candida

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6
Q

Rx of mild and severe otitis externa (4)

A

Aural toilet, clean and suck out debris from external ear

analgesia

insert pope-wick and deliver ear drops

if mild:
-acetic acid drops

if severe (hearing loss, inflamed canal, discharge, fever):
-ciprofloxacin w/o steroids
-topical steroid and Abx combo:
~solfradex (framycetin+dex)
~gent+hydrocortisone
~if proven fungal infection e.g. spores seen then clotrimazole
~betamethasone

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7
Q

Cause and feature of malignant/necrotising otitis externa (5)

A

pseudamonas aeruginosa most common cause

infection of skin and soft tissue surrounding EAM
can>:
-skull base osteomyelitis
-temporal bone destruction
-VI, VII and VIIIth nerve palsies
EMERGENCY
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8
Q

RFs for malignant/necrotising otitis externa (2)

A

DM

immunosuppression

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9
Q

Ix and Rx of malignant/necrotising otitis externa (3)

A

CT head
Rx:
-surgical debridement
-IV Abx

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10
Q

Furunculosis pathology and Rx (2)

A

infection of hair follicle
by staph aureus

Rx w. flucloxacillin if severe.

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11
Q

Features, association and consequence of bullous myringitis (4)

A

painful haemorrhagic blisters deep in meatus or at tympanic membrane

viral otitis media

assoc. w. influenza infection

may lead to sensorineural hearing loss

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12
Q

pathology, Sx and caution with barotrauma/aerotitis (4)

A

damage caused by failure to equalise pressure across Eustachian tube (connects nasopharynx to ear)

Sx:

  • severe pain as drum becomes indrawn
  • in inner ear>vertigo, tinnitus and hearing loss

caution with flying with URTI

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13
Q

Sx, features and associations of TMJ dysfunction (6)

A

Sx:

  • earache
  • facial pain
  • joint clicking
  • bruxism

can become chronic pain syndrome

assoc. w. EDS ad depression.

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14
Q

Sources of referred otalgia (5)

A
  • V: auriculotemporal nerve supplies lateral upper half of pinna, may get referred pain from dental disease and TMJ dysfunction
  • VII: sensory branch refers pain from Ramsay-Hunt
  • IX:primary glossopharyngeal neuralgia induced by talking/swallowing
  • IX and X: tympanic branch of glossopharyngeal and auricular branch of vagus from laryngeal cancer, tonsilitis or post-tonsilectomy.
  • C2/3:refers pain from soft tissue injury of neck and cervical spondylosis
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15
Q

Types of ear discharge (5)

A

thin=outer ear

mucous=middle ear

serosanguinous=chronic otitis media

offensive=cholesteatoma

w. trauma+halo on filter paper=CSF

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16
Q

Causes of ear discharge (3)

A

acute/chronic otitis media

cholesteatoma

glue ear; otitis media+effusion

17
Q

RFs for acute otitis media (8)

A

OFTEN FOLLOWS URTI ASCENDING EUSTACHIAN TUBE

asthma

presence of adenoids

bottle feeding

passive smoking

Down’s syndrome

malformations e.g. cleft palate

GORD/high BMI in adults

18
Q

Presentation of acute otitis media (5)

A

Rapid onset of pain:

  • from bulging tympanic membrane
  • discharge doesn’t occur until membrane bursts
  • children may tug on ear

fever+/-irritability

anorexia/vomitting

conductive hearing loss

handle of malleus can appear horizontally on otoscopy.

19
Q

Organisms causing acute otitis media (4)

A

URTI organisms via eustachian tube:

  • STREP PNEUMONIAE
  • haemophilus
  • moraxella
  • staphs and streps
20
Q

indications for Abx in acute otitis media (4)

A

Sx for =/>4d

<2yrs+bilateral

perforated eardrum

<3mo

21
Q

Mx of acute otitis media (4)

A

Analgesia 1st: paracetemol

Aural toiler to clean debris

Abx if persistent:

  • amoxicillin 1st line
  • co-amoxiclav 2nd
  • erythromycin if pen allergic

recurrent episodes> grommets

22
Q

Complications of acute otitis media (8)

A

MASTOIDITIS

GLUE EAR

petrositits

labyrinthitis

intracranial abscess

meningitis

sensorineural hearing loss from toxins

Facial palsy

23
Q

Presentation, Ix and Mx of mastoiditis (4)

A

painful, swollen mastoid process, pinna displaced laterally and inferiorly w. thick purulent discharge.

do CT head

IV Abx

Myringectomy (remove tympanic membrane)+/- mastoidectomy

24
Q

Symptoms of chronic otitis media (3)

A

discharge which may be bloody

conductive hearing loss

little pain

(may be active or inactive inflammation)

25
Q

Cholesteatoma pathology and aetiology (3)

A

squamous keratinising epithelium (skin) growing into ear instead of out

can become invasive so has to be removed

can be congenital or secondary to tympanic membrane perforation (trauma/surgery/infection)

26
Q

Presentation of cholesteatoma (6)

A

foul smelling discharge (can be like cottage cheese)

pain/headache

vertigo

conductive hearing loss

facial nerve palsy from compression of chordae tympani

cerebellopontine angle syndrome:
-unilateral senorineural hearing loss/tinnitus

27
Q

Complications of cholesteatomas (4)

A

VIIth nerve palsy via chordae tympani compression

meningitis

bony/mastoid invasion

lateral sinus thrombosis

28
Q

Rx of cholesteatomas

A

mastoid exploration/surgery to make dry, safe ear.

29
Q

pathology of glue ear/OME (4)

A

Eustachian tubes blocked by inflamed adenoids

> -ve pressure in middle ear

> fluid drawn into middle ear which can cause an effusion

non-infectious

30
Q

Associations of glue ear/OME (8)

A

Down’s

male

large adenoids

atopy

facial deformity e.g. cleft palate

winter

passive smoking

kartagener’s

31
Q

Presentation of glue ear/OME (3)

A

(most common cause of hearing loss in children)

conductive hearing loss;speech delay

other Sx include balance problems and concentration difficulties.

32
Q

Ix for glue ear/OME (3)

A

Otoscopy:

  • can be normal
  • retracted/bulging drum
  • dull, grey or yello
  • lose cone of light

Audiogram: conductive hearing loss

tympanometry: Flattened curve (stiffened membrane)

33
Q

Mx of glue ear/OME (3)

A

if 1st presentation then observe as most resolve spontaneously by 3mo

surgical options:

  • grommet insertion (can cause tympanosclerosis/infection, advise earplugs when swimming/bathing etc)
  • grommets should fall out after 1yr
  • if multiple grommets needed (problem >1yr) then will need adenoidectomy

(grommets+adenoidectomy works well together)

34
Q

Features of glomus tumour (paraganglioma) (3)

A

benign tumour of middle ear

pulsates

pts. get pulsatile tinnitus

35
Q

Cause, Sx and Mx of perforated tympanic membranes

A

infection most common cause

also trauma/barotrauma

get conductive hearing loss

should resolve spontaneously after 6-8wks (advise to not get wet)

if following otitis media then give co-amoxiclav

36
Q

Inner ear problems presentation and Rx

A

mainly viral infections:
-labarynthitis

present w. sudden onset profound sensorineural hearing loss w. vertigo

Rx w. high dose steroids for 7d e.g. 40mg pred, PO

ENT (11 decks)

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