E N T 1 Flashcards
describe anatomy of the ear
describe the anatomy of the tympanic membrane
what are the two functions of the ear
hearing - auditory
balance - vestibular
describe the pathophysiology of hearing
sound signal from environment
collected by pinna and passed to external auditory meatus
sound strikes the tympanic membrane
transmitted to stapes footplate through chain of ossicles
movement of stapes footplate causes pressure changes in labryinthine fluids = movement of basilar membrane
stimulates hair cells of organ of Corti
act as transducers and convert mechanical energy into electrical impulses
electrical impulse travels along cochlear nerve to auditory cortex
what sx can pt get from problems in the ear
hearing loss oltalgia otorrhea tinnitus vertigo
what examination techniques are used to examine the ear
inspection for asymmetry, cauliflower ear, top, sebaceous cysts, scars, discharge
palpation of pinna - tenderness
post auricular region, mastoid, tragus (ask pt to open and close mouth)
otoscope - external and middle ear = external auditory canal and tympanic membrane
Rinne and Weber’s test in hearing loss
what are the two types of hearing loss
conductive
and sensorineural
what is the difference between sensorineural and conductive hearing loss
conductive hearing loss - problem with conduction of sound in external or middle ear or both = outer and middle ear pathology
sensorineural hearing loss = problem with cochlear or transmission of signals to auditory cortex = inner ear pathology
how do you perform Weber’s Test
strike tuning fork on your elbow
and place in midline of forehead of pt
ask pt if they hear sound louder in one ear or another
or ask if they hear it everywhere
describe interpretation of weber’s test
normal = sound heard at midline, same in both ears
conductive hearing loss = sound heard louder in affected ear
sensorineural hearing loss = sound hear louder in normal or unaffected ear
in bilateral symmetrical hearing loss = Weber’s test is normal
how to perform Rinne’s test
Rinne’s test compares air conduction with bone conduction
strike running fork against elbow or knee
place on mastoid of pt 2-3s
lift fork off mastoid and place vibrating ti[s 1cm from external auditory meatus leave for a few s before taking tuning fork away
ask to which positions they’re able to hear sound loudest
what is a positive vs negative Rinne’s test
positive = loudest when fork 1cm from external auditory meatus
if loudest when hear against mastoid = negative Rinne’s test
how is Rinne’s test interpreted
no significant conductive hearing loss = if air conduction better than bone (positive RInne’s)
in sensorineural hearing loss on the right, for example, Rinne’s test should be positive on the right
conductive hearing loss = bone conduction better than air conduction (negative Rinne’s)
what is the eustachian tube
tube that connects the middle ear to the post nasal space
lining of middle ear = mucosal = mucus producing
when does the Eustachian tube open and what does this allow for
Eustachian tube normally closed
opens regularly - in swallowing or chewing
allows mucus in middle ear space to drain
allow air to move between the post nasal space (atmospheric pressure) and pressure in middle ear = allows for equilibration of air pressure
why is the eustachian tube blocked or locks completely in children
common in children - smaller diameter tube, different orientation, more coughs and colds so nasal lining gets more inflamed
large adenoids in post nasal space which can block tube
why does blockage of eustachian tube cause sx
air in middle ear can not equilibrate with atmospheric pressure in post nasal space
mucus in middle ear accumulates and cannot drain
glue ear on otoscope due to
no equilibrating between atm pressure and middle ear
air reabsorbed leading to negative air pressure in middle air leaving fluid produced by middle ear mucosa
leads to pulling in of tympanic membrane, becomes more concave
why is acute otitis media do pt get a bulging tympanic membrane
bulging tympanic membrane
due to inflammatory exudate by middle ear mucosa
increasing middle ear pressure, pushing tympanic membrane outwards
describe the management of eustachian tube blockage
use of grommets = provide an alternative opening to middle ear
allow air to equilibrate despite closed eustachian tube
otoscopic views
impacted wax - normal and healthy - only needs treatment if causing conductive hearing loss
foreign body
otitis externa = trying to look into ear canal, notice walls of ear canal are oedematous and inflammed + redness of canal wall with discharge (obstruct tympanic view)
can get fungal otitis externa - fungi hyphi not common
what are the infections of the middle ear
- infective otitis media
2. mastoiditis
what are the types of infective otitis media
acute otitis media without perforation
acute otitis media with perforation
chronic suppurative otitis media
mastoiditis, presentation and management
affects children
spread of infection in middle ear into mastoid air cells
paeds emergency which required admission for IV abx
examine outside of ear in children = inflammation behind the ear + mastoid tenderness
what are tympanic membrane pathologies
- perforations = wet (discharge) , dry (no discharge from ear), central/peripheral/attic
wet perforation = chronic supporative otitis media
- cholesteatoma
- tympanosclerosis
which perforation is safer attic vs peripheral
attic = pars flaccid = more dangerous as less tension - associated with more complications
peripheral = pars tense
central
what is a cholesteotoma
retraction pocket in pars flaccid
which fills with keratin, which leads to build up = enlarging cholesteotoma
which can erode middle ear contents
foul smelling, blood stained persistent discharge = consider cholesteotoma
pearly white apperance
refer to specialist assessment
chalky white deposits on tympanic membrane is..
tympanicsclerosis
not serious
sign of previous ear infections, calcification from healing
no sx from it
what are other disease of the middle ear
- otitis media with effusion (glue ear)
- eustachian tube dysfunction + grometts
- otosclerosis
what is the typical apperance of glue ear on otoscope
dark apperance of tympanic membrane = fluid/ mucus
honey comb appearance of fluid
air pockets within the tympanic membrane
otitis media with effusion
what is the treatment for acute otitis media with effusion
grommet insertion in tympanic membrane
allows for air to equilibrate with atmospheric pressure
provides outlet in blocked eustachian tube
how is dx of cholesteatoma made
recurrent purulent, foul smelling discharge
hearing loss
deep retraction pocket in tympanic membrane + granulation tissue and skin debris
tympanic membrane may be perforated
management of cholesteatoma
arrange semi urgent referral ENT specialist or urgent if signs of complication - facial nerve palsy or vertigo
how is earwax managed
if pt symptomatic treat
3-5 days of ear drops to soften wax
ear irrigation
what are the rx to acute otitis externa
foreign body, trauma to ear canal, contact dermatitis, acute otitis media, skin conditions like eczema, water exposure
how does acute otitis externa present, what is seen OE
itch of ear canal - rapid onset
ear pain tenderness of tragic our pinna
discharge
hearing loss (less common)
O/E = oedema and erythema or ear canal, tenderness of tragic or pinn, cellulitis
what questions should be asked to patient with suspected otitis externa
onset, nature, and severity of symptoms, such as:
Pain or tenderness on moving the ear (tragus or pinna) or jaw.
Ear discharge.
Itch in the ear canal.
Fever.
Hearing loss (conductive). Impact on daily functioning and quality of life.
Any possible causes or risk factors, including recent ear trauma, use of hearing aids or ear plugs, history of head or neck radiotherapy
ear surgery or perforation
Any history of allergic or irritant contact dermatitis.
O/E of ear look for
red, erythematous ear canal
ear discharge
signs of fungal infection = candida white strands
regional lymphadenopathy
cellulitis being ear
management of acute otitis externa
- advice on routes of information and support - NHS patient leaflet
- selfcare measures = keep ears clean and dry, avoid swimming and water sports for 7-10days
- analgesia = paracetamol or ibuprofen
what is the presentation of AOM
earache.
In younger children —
holding, tugging, or rubbing of the ear, or non-specific symptoms such as fever, crying, poor feeding, restlessness, behavioural changes, cough, or rhinorrhoea.
management of AOM
analgesia = regular paracetamol or ibuprofen
prescribe 5-7 amoxicillin or erythromycin if pen allergy
refer for admission/ specialist if severe systemic infection, meningitis, mastoiditis, children younger than 3 months with temp 38 or more
management of OME
watchful waiting bro 3 months - spontaneous resolution
grommets insertion
otitis media chronic suppurative infection management
refer for ENT assessment
management of perforated tympanic membrane
self limiting within 3 months
abx if discharge or systemic features
does not heal by itself a myringoplasty may be performed
most common cause of bacterial otitis media
Haemophilus influenzae is a common cause of bacterial otitis media
