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CMSD5260 Hearing Disorders > Disorders of the ME: ET, Otitis Media and Infection Control > Flashcards

Disorders of the ME: ET, Otitis Media and Infection Control Flashcards

1
Q

What is Otitis media?

A

Infection/inflammation of the middle ear

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2
Q

What are the 3 MOSTS of OM?

A
  • Most common infection in childhood
  • Most common reason for pediatrician visits
  • Most common reason for antibiotic use
    Responsible for development of antibiotic-resistant bacteria
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3
Q

What is the peak incidence of OM between 6-18 months old? (2)

A
  • 50% of children by age of 1 yr
  • By 3 yrs >85% of children have had 1 episode
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4
Q

What is AOM?

A

Acute (Severe) otitis media

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5
Q

What is OME? (2)

A
  • Otitis media with effusion (fluid)
  • Chronic (persistent) OME
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6
Q

What is CSOM?

A

Chronic suppurative otitis media

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7
Q

Describe Acute Otitis Media.

A

Infected middle ear fluid and inflammation of the mucosa lining the middle ear space (fever, pain, red and bulging TM)

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8
Q

Describe Otitis Media with Effusion: (2)

A
  • Middle ear effusion without symptoms and signs of inflammation
  • Equivalent terms: secretory OM, chronic serous OM, glue ear
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9
Q

Describe Chronic Suppurative Otitis Media:

A

Chronic purulent otorrhea through a permanent TM perforation or due to cholesteatoma (covered later)

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10
Q

What is the time frame for otitis to be considered Acute?

A

< 3 weeks

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11
Q

What is the time frame for otitis to be considered Subacute?

A
  • 3 weeks to 3 months
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12
Q

What is the time frame for otitis to be considered Chronic?

A

> 3 months

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13
Q

What is the Eustachian Tube? (3)

A
  • Connects middle ear to nasopharynx
  • Bony and cartilaginous portions
  • Ciliated respiratory epithelium (like nasal cavity)
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14
Q

What are the muscles important for the proper functioning of the Eustachian tube (3)

A

-Levator veli palatini
- Tensor veli palatini (dilator tubae)
- (Salpingopharyngeus)

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15
Q

What mouth condition disrupts the functioning of the muscles of the ET?

A

Cleft palate disrupts functioning of these muscles

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16
Q

Is the ET most of the time open or closed?

A

Usually closed

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17
Q

When does the Et open?

A

During swallowing and yawning

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18
Q

Which portions involved in the opening of the ET?

A

The opening involves cartilaginous portion and normal palatal muscle function

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19
Q

What are the functions of the ET? (3)

A

1) Pressure regulation of middle ear
Due to intermittent opening

2) Protection from nasopharyngeal sounds and secretions

3) Clearance of middle ear secretions
Mucociliary lining

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20
Q

What are the 5 pathophysiologies complications OM?

A

1) Upper respiratory infection

2) Inflammation of nose and eustachian tube

3) Eustachian tube dysfunction/obstruction

4) Negative middle ear pressure

5) Middle ear secretions

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21
Q

What do the ET children look like? (4)

A

1) Longer bony portion, shorter cartilaginous portion
2) 10 degree angle from horizontal
3) Small nasopharyngeal orifice in infants (4-5 mm)
4) Less mature muscles

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22
Q

What do the ET Adults look like? (4)

A

1) Anterior 2/3 cartilage, posterior 1/3 bony
2) 45 degree angle from horizontal
3) Large nasopharyngeal orifice (8-9 mm)
4) More mature muscles

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23
Q

What could occur if ET does not open normally? (2)

A

Eustachian tube dysfunction (ETD)
Otitis media

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24
Q

What could occur if ET opens too easily?

A

Patulous Eustachian tube: a disorder of the valve of the Eustachian tube that causes it to remain open.

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25
Q

What do Acute Otitis Media present with? (3)

A
  • Upper respiratory infection (URI) features
    Cold symptoms
  • Local
    Otalgia, otorrhea, hearing loss, “ear tugging”
  • Systemic
    Fever, malaise, irritability
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26
Q

What is Ear Tugging?

A

Child pulls on their ear

Primary sign of Acute Otitis Media
0% had OM (study with hundreds of children)
With fever
15% had OM (similar study)

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27
Q

Which bacteria typically cause AOM?

A

Streptococcus pneumoniae - Left (a frequent cause of OM)
Haemophilus influenzae - Middle
Moraxella catarrhalis - Right

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28
Q

What often precedes Acute Otitis Media?

A

Viral Infections (Virus)

e.g.,
Rhinovirus
RSV
Influenza
Adenovirus
Parainfluenza

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29
Q

What is the peak incidence of AOM during a human’s year of life?

A

Peak incidence in first 2-3 years of life; and more males than females

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30
Q

What are the multiple factors that cause a peak incidence of OM in the first 2-3 years of life? Give 3

A

Daycare
First nations
Winter months
Bottle feeding
Smoke exposure
Lower socioeconomic status

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31
Q

What are the physical risk Factors that can cause AOM? (Give 3)

A

Allergies
Craniofacial disorders (including cleft palate)
Immune deficiency
Reflux disease
Nasal obstruction (eg adenoid hypertrophy)

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32
Q

Are vaccines effective against AOM?

A

Yes, very effective against severe infections!

Streptococcus pneumoniae is a frequent cause of OM

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33
Q

What causes Otitis Media with Effusion?

A

Fluid in middle ear space
No clinical features of acute inflammation/infection

34
Q

Does OME usually present symptoms?

A

Usually asymptomatic

35
Q

With what sensations OME can be associated with? (3)

A
  • Pressure or fullness sensation, ear popping
  • CHL
  • Recurrent AOMs
36
Q

What are the 3 Types of middle ear effusions?

A

Mucoid (thick, glue-like)
Serous (thin, watery, bubbles)
Purulent (thick, pus)

37
Q

In which of the 3 types of Otitis media is Purulent Effusion seen? (2)

A

AOM and CSOM

38
Q

What is the treatment for OME?

A

Most of the time NO treatment is necessary
Often self-limiting

39
Q

How can OME affect children? (3)

A

It can cause hearing loss in children, possible language delay, and school performance issues

40
Q

What does this graph show?

A

Most of the time NO treatment is necessary and over time heals itself 90% of the time

41
Q

What are the long-term effects of OME? (2)

A

Mixed results on the development of cognitive, linguistic, auditive, and communicative skills

Severe hearing loss can produce severe impairments, however less agreement that mild hearing loss produces impairments

42
Q

What is a surgical treatment for OME if needed?

A

Tympanostomy tubes then follow-up audiograms

43
Q

What is a treatment for not-at-risk children?

A
  • Watchful waiting for 3 months of onset (if known) or 3 months from diagnosis
  • Hearing test if persistent for 3 months or if significant hearing loss, language delay, or learning problems
    Re-examine every 3-6 months
44
Q

What is the link between Otitis media and the mastoid bone?

A
  • The middle ear is connected to the mastoid bone
  • Fluid in middle ear space -> fluid in mastoid
  • On the CT scan, it shows opacification of ME and Mastoid
45
Q

What are the ways to help diagnose OM?

A

*Clinical history
*Otoscopy (pneumatic)
*Audiogram
-Hearing status (CHL)
- Tympanometry
-Compliance of tympanic membrane

46
Q

What is pneumatic otoscopy?

A
  • Pneumatic attachment blows air onto TM
  • Assess color, position and mobility of TM
47
Q

What does this picture show?

A

It shows TM normal mobility when a puff of air is sent through the ear canal using Pneumatic Otoscopy

48
Q

What does this image show?

A

Using pneumatic Otoscopy shows a reduced mobility of TM due to AOM.

49
Q

What does this image show?

A

Using pneumatic Otoscopy shows reduced mobility of TM due to OME.

50
Q

How does Tympanometry work? (3)

A

3 parts of the probe
- Manometer (pump) varies air pressure against TM and changes ear canal pressure and measures it

  • Speaker produces a 220Hz probe pure tone
  • Microphone measures loudness of sound in ear canal which depends on how much is reflected back
51
Q

Why do we use ear tubes? (2)

A

We do a Myringotomy-incision in the TM to:
Pressure equalization
Middle ear fluid exit

52
Q

What is the most common surgical procedure in North America?

A

Ear Tubes surgery

53
Q

What are other names for Ear Tubes? (4)

A

Tympanostomy tubes
Ventilation tubes
Pressure equalization tubes
Grommets

54
Q

What is occurring in this picture?

A

Severe TM retraction due to too much negative pressure in the ME

55
Q

What are the complications of Ear Tubes? (Give 3)

A
  • Tympanosclerosis/myringosclerosis
  • Perforation (after tube falls out)
  • Tube otorrhea
  • Tube blockage
  • Granulation tissue
  • Cholesteatoma
56
Q

What is occurring in this image?

A

OM with Ear Tubes

57
Q

What is occurring in the image?

A

Chronic OM with Ear Tubes/Tube associated granulation tissue (friable, bleeding tissue)

58
Q

What occurs in this image?

A

Using pneumatic Otoscopy shows absent mobility of TM due to TM perforation or ear tube.

59
Q

What are the intracranial complications of OM? (4)

A
  • Meningitis
  • Brain abscess (extradural subdural, cerebral)
  • Sigmoid sinus thrombosis
  • Otitic hydrocephalus
60
Q

What are the extracranial complications of OM? (Give 3)

A

Mastoiditis
Bezold’s abscess
Petrous apicitis
Facial Paralysis
TM Perforation
Hearing loss
Labyrinthitis

61
Q

What is Mastoiditis? (2)

A
  • AOM and local inflammatory findings over the mastoid bone
62
Q

What are the symptoms of Mastoiditis? (5)

A

Pain, erythema, tenderness, swelling/auricular protrusion

63
Q

Into what other complications can mastoiditis develop? (3)

A

Bezold’s abscess, meningitis, sigmoid sinus thrombosis

64
Q

What are treatments for Mastoiditis? (2)

A
  • IV antibiotics
  • Tubes +/- mastoidectomy
65
Q

What is Bezold’s Abscess?

A
  • Spread of infection from mastoid tip to the upper neck
  • Presents with AOM and upper neck mass
66
Q

What are treatments for Bezold’s Abscess? (3)

A
  • IV antibiotics
  • Mastoidectomy
  • Drainage of abscess
67
Q

What is Petrous Apicitis?

A

Inflammation of the petrous apex portion of the temporal bone

68
Q

What conditions can Petrous Apicitis cause? (4)

A
  • Gradenigo’s triad
  • Retroorbital pain
  • Otorrhea
  • CN6 palsy
69
Q

What are treatments for Petrous Apicitis?

A

IV antibiotics,
Bone drill out

70
Q

What is Facial nerve paralysis? (3)

A
  • Usually seen with AOM in children
  • Possible dehiscent facial nerve in middle ear space
  • Good resolution rates
71
Q

What are treatments for AOM of patients with Facial nerve paralysis? (3)

A

IV antibiotics
Ear tube
Ototopical drops

72
Q

What is Labyrinthitis?

A

Inflammation of labyrinth
AOM spreads through weak or dehiscent oval window
Severe auditory and vestibular loss occurs
Nystagmus, tinnitus, hearing loss and vertigo all appear promptly

73
Q

What is a treatment for labyrinthitis?

A

Treatment is IV antibiotics but function may not recover

73
Q

What is a treatment for labyrinthitis?

A

Treatment is IV antibiotics but function may not recover

74
Q

What is Meningitis?

A
  • Inflammation of the meninges (lining of the brain)
    • Dramatically reduced due to vaccination
    • Headache, photophobia, fever, decreased level of consciousness, neck rigidity
    • Diagnosis: CT and LP
    • Management: IV antibiotics (+/- tubes)
  • Follow-up audio crucial (late-onset SNHL)
75
Q

What is a brain abscess?

A

A localized collection of pus
Spread from mastoid/middle ear via venous channels
Focal neurologic signs and headaches

76
Q

What is Sigmoid Sinus Thrombosis?

A
  • The sigmoid sinus (large draining vein) is located just posterior to mastoid
  • Thrombosis = stationary blood clot but can spread to other areas
  • Signs of mastoiditis, severe headaches septicemia, picket-fence spiking fevers
77
Q

What is a treatment for Sigmoid Sinus Thrombosis? (3)

A

IV antibiotics
Mastoidectomy
Anticoagulation

78
Q

What is Otitic Hydrocephalus?

A

Too much CSF
Increased intracranial pressure (ICP)
Results from AOM and thrombosis
Progressive headache
If collateral drainage inadequate, can progress to coma, death
Treatment: reduce ICP (neurosurgery)

79
Q

What are the most common bacteria found on hearing aids?

A

Staphylococcus

CMSD5260 Hearing Disorders (12 decks)

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