Disorders of the Ear Flashcards
Problems of the outer ear (3)
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).
Causes of otalgia (ear pain) (6)
otitis externa
furunculosis
bullous myringitis
barotrauma
TMJ dysfunction
reffered otalgia
Causes of otitis externa (7)
acute inflammation of skin in meatus due to:
- moisture
- low wax
- hearing aids
- contact dermatitis
- trauma
- narrow canal
- infection: staph aureus, pseud aeruginosa
Presentation of otitis externa (4)
- minimal discharge, no mucinous glands at external meatus
- itching
- pain
- tender tragus
common pathogens causing otitis externa (4)
pseudomonas aeruginosa
staph aureus
aspergillus niger
candida
Rx of mild and severe otitis externa (4)
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
Cause and feature of malignant/necrotising otitis externa (5)
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
RFs for malignant/necrotising otitis externa (2)
DM
immunosuppression
Ix and Rx of malignant/necrotising otitis externa (3)
CT head
Rx:
-surgical debridement
-IV Abx
Furunculosis pathology and Rx (2)
infection of hair follicle
by staph aureus
Rx w. flucloxacillin if severe.
Features, association and consequence of bullous myringitis (4)
painful haemorrhagic blisters deep in meatus or at tympanic membrane
viral otitis media
assoc. w. influenza infection
may lead to sensorineural hearing loss
pathology, Sx and caution with barotrauma/aerotitis (4)
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
Sx, features and associations of TMJ dysfunction (6)
Sx:
- earache
- facial pain
- joint clicking
- bruxism
can become chronic pain syndrome
assoc. w. EDS ad depression.
Sources of referred otalgia (5)
- 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
Types of ear discharge (5)
thin=outer ear
mucous=middle ear
serosanguinous=chronic otitis media
offensive=cholesteatoma
w. trauma+halo on filter paper=CSF
Causes of ear discharge (3)
acute/chronic otitis media
cholesteatoma
glue ear; otitis media+effusion
RFs for acute otitis media (8)
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
Presentation of acute otitis media (5)
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.
Organisms causing acute otitis media (4)
URTI organisms via eustachian tube:
- STREP PNEUMONIAE
- haemophilus
- moraxella
- staphs and streps
indications for Abx in acute otitis media (4)
Sx for =/>4d
<2yrs+bilateral
perforated eardrum
<3mo
Mx of acute otitis media (4)
Analgesia 1st: paracetemol
Aural toiler to clean debris
Abx if persistent:
- amoxicillin 1st line
- co-amoxiclav 2nd
- erythromycin if pen allergic
recurrent episodes> grommets
Complications of acute otitis media (8)
MASTOIDITIS
GLUE EAR
petrositits
labyrinthitis
intracranial abscess
meningitis
sensorineural hearing loss from toxins
Facial palsy
Presentation, Ix and Mx of mastoiditis (4)
painful, swollen mastoid process, pinna displaced laterally and inferiorly w. thick purulent discharge.
do CT head
IV Abx
Myringectomy (remove tympanic membrane)+/- mastoidectomy
Symptoms of chronic otitis media (3)
discharge which may be bloody
conductive hearing loss
little pain
(may be active or inactive inflammation)
Cholesteatoma pathology and aetiology (3)
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)
Presentation of cholesteatoma (6)
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
Complications of cholesteatomas (4)
VIIth nerve palsy via chordae tympani compression
meningitis
bony/mastoid invasion
lateral sinus thrombosis
Rx of cholesteatomas
mastoid exploration/surgery to make dry, safe ear.
pathology of glue ear/OME (4)
Eustachian tubes blocked by inflamed adenoids
> -ve pressure in middle ear
> fluid drawn into middle ear which can cause an effusion
non-infectious
Associations of glue ear/OME (8)
Down’s
male
large adenoids
atopy
facial deformity e.g. cleft palate
winter
passive smoking
kartagener’s
Presentation of glue ear/OME (3)
(most common cause of hearing loss in children)
conductive hearing loss;speech delay
other Sx include balance problems and concentration difficulties.
Ix for glue ear/OME (3)
Otoscopy:
- can be normal
- retracted/bulging drum
- dull, grey or yello
- lose cone of light
Audiogram: conductive hearing loss
tympanometry: Flattened curve (stiffened membrane)
Mx of glue ear/OME (3)
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)
Features of glomus tumour (paraganglioma) (3)
benign tumour of middle ear
pulsates
pts. get pulsatile tinnitus
Cause, Sx and Mx of perforated tympanic membranes
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
Inner ear problems presentation and Rx
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
