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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
What do Acute Otitis Media present with? (3)
- Upper respiratory infection (URI) features Cold symptoms - Local Otalgia, otorrhea, hearing loss, “ear tugging” - Systemic Fever, malaise, irritability
26
What is Ear Tugging?
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)
27
Which bacteria typically cause AOM?
Streptococcus pneumoniae - Left (a frequent cause of OM) Haemophilus influenzae - Middle Moraxella catarrhalis - Right
28
What often precedes Acute Otitis Media?
Viral Infections (Virus) e.g., Rhinovirus RSV Influenza Adenovirus Parainfluenza
29
What is the peak incidence of AOM during a human's year of life?
Peak incidence in first 2-3 years of life; and more males than females
30
What are the multiple factors that cause a peak incidence of OM in the first 2-3 years of life? Give 3
Daycare First nations Winter months Bottle feeding Smoke exposure Lower socioeconomic status
31
What are the physical risk Factors that can cause AOM? (Give 3)
Allergies Craniofacial disorders (including cleft palate) Immune deficiency Reflux disease Nasal obstruction (eg adenoid hypertrophy)
32
Are vaccines effective against AOM?
Yes, very effective against severe infections! Streptococcus pneumoniae is a frequent cause of OM
33
What causes Otitis Media with Effusion?
Fluid in middle ear space No clinical features of acute inflammation/infection
34
Does OME usually present symptoms?
Usually asymptomatic
35
With what sensations OME can be associated with? (3)
- Pressure or fullness sensation, ear popping - CHL - Recurrent AOMs
36
What are the 3 Types of middle ear effusions?
Mucoid (thick, glue-like) Serous (thin, watery, bubbles) Purulent (thick, pus)
37
In which of the 3 types of Otitis media is Purulent Effusion seen? (2)
AOM and CSOM
38
What is the treatment for OME?
Most of the time NO treatment is necessary Often self-limiting
39
How can OME affect children? (3)
It can cause hearing loss in children, possible language delay, and school performance issues
40
What does this graph show?
Most of the time NO treatment is necessary and over time heals itself 90% of the time
41
What are the long-term effects of OME? (2)
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
What is a surgical treatment for OME if needed?
Tympanostomy tubes then follow-up audiograms
43
What is a treatment for not-at-risk children?
- 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
What is the link between Otitis media and the mastoid bone?
* 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
What are the ways to help diagnose OM?
*Clinical history *Otoscopy (pneumatic) *Audiogram -Hearing status (CHL) - Tympanometry -Compliance of tympanic membrane
46
What is pneumatic otoscopy?
* Pneumatic attachment blows air onto TM * Assess color, position and mobility of TM
47
What does this picture show?
It shows TM normal mobility when a puff of air is sent through the ear canal using Pneumatic Otoscopy
48
What does this image show?
Using pneumatic Otoscopy shows a reduced mobility of TM due to AOM.
49
What does this image show?
Using pneumatic Otoscopy shows reduced mobility of TM due to OME.
50
How does Tympanometry work? (3)
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
Why do we use ear tubes? (2)
We do a Myringotomy-incision in the TM to: Pressure equalization Middle ear fluid exit
52
What is the most common surgical procedure in North America?
Ear Tubes surgery
53
What are other names for Ear Tubes? (4)
Tympanostomy tubes Ventilation tubes Pressure equalization tubes Grommets
54
What is occurring in this picture?
Severe TM retraction due to too much negative pressure in the ME
55
What are the complications of Ear Tubes? (Give 3)
- Tympanosclerosis/myringosclerosis - Perforation (after tube falls out) - Tube otorrhea - Tube blockage - Granulation tissue - Cholesteatoma
56
What is occurring in this image?
OM with Ear Tubes
57
What is occurring in the image?
Chronic OM with Ear Tubes/Tube associated granulation tissue (friable, bleeding tissue)
58
What occurs in this image?
Using pneumatic Otoscopy shows absent mobility of TM due to TM perforation or ear tube.
59
What are the intracranial complications of OM? (4)
- Meningitis - Brain abscess (extradural subdural, cerebral) - Sigmoid sinus thrombosis - Otitic hydrocephalus
60
What are the extracranial complications of OM? (Give 3)
Mastoiditis Bezold’s abscess Petrous apicitis Facial Paralysis TM Perforation Hearing loss Labyrinthitis
61
What is Mastoiditis? (2)
- AOM and local inflammatory findings over the mastoid bone
62
What are the symptoms of Mastoiditis? (5)
Pain, erythema, tenderness, swelling/auricular protrusion
63
Into what other complications can mastoiditis develop? (3)
Bezold’s abscess, meningitis, sigmoid sinus thrombosis
64
What are treatments for Mastoiditis? (2)
- IV antibiotics - Tubes +/- mastoidectomy
65
What is Bezold's Abscess?
- Spread of infection from mastoid tip to the upper neck - Presents with AOM and upper neck mass
66
What are treatments for Bezold's Abscess? (3)
- IV antibiotics - Mastoidectomy - Drainage of abscess
67
What is Petrous Apicitis?
Inflammation of the petrous apex portion of the temporal bone
68
What conditions can Petrous Apicitis cause? (4)
- Gradenigo’s triad - Retroorbital pain - Otorrhea - CN6 palsy
69
What are treatments for Petrous Apicitis?
IV antibiotics, Bone drill out
70
What is Facial nerve paralysis? (3)
- Usually seen with AOM in children - Possible dehiscent facial nerve in middle ear space - Good resolution rates
71
What are treatments for AOM of patients with Facial nerve paralysis? (3)
IV antibiotics Ear tube Ototopical drops
72
What is Labyrinthitis?
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
What is a treatment for labyrinthitis?
Treatment is IV antibiotics but function may not recover
73
What is a treatment for labyrinthitis?
Treatment is IV antibiotics but function may not recover
74
What is Meningitis?
* 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
What is a brain abscess?
A localized collection of pus Spread from mastoid/middle ear via venous channels Focal neurologic signs and headaches
76
What is Sigmoid Sinus Thrombosis?
* 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
What is a treatment for Sigmoid Sinus Thrombosis? (3)
IV antibiotics Mastoidectomy Anticoagulation
78
What is Otitic Hydrocephalus?
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
What are the most common bacteria found on hearing aids?
Staphylococcus

CMSD5260 Hearing Disorders (12 decks)

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