Ear

Question 1

Otitis Externa

Answer 1

Infection of outer ear
SX
Pain - especially on traction of pinna + tragus
Itching
May Ottorrhea - foul smelling
Conductive hearing loss if canal become swollen

Otoscopic Exam
Painful
Red Canal
May see exudate (fungal or bacterial origin); black/grey if fungus is A. niger
Furuncles may be present - will see localized nodule/pustule.
Post/Pre auricular +cervical lymphadenopathy

Pseudomonas Aeruginosa: bacterial inf often resistant to antibiotics; may become necrotizing. May lead to osteomyelitis

Question 2

Otitis Media

Answer 2

Infection of Middle Ear

Sx
Otalgia
conductive hearing loss
Fever, nausea, vomitting (bacterial)
Spontaneous perforation of TM allowing exudate to leak

Sequelae: mastoiditis, meningitis, cholesteatoma

Otoscopic Exam: 
indistinct landmarks + displaced cone of light
bulging red TM
Fluid (may be purulent) behind TM
Poor mobility of TM
May see vesicles present

Risk Factors:
Bottle fed, smoking, allergies, food sensitivities, poor development of skull bones, immunosuppression.

MOST cases begin as viral and secondarily become bacterial –> S.pneumoniae, Haemophilus influenza B or Eustachian Tube Blockage (serous OM)

Question 3

Serous OM

Answer 3

Secretory otitis media is an effusion in the middle ear resulting from incomplete resolution of acute otitis media or obstruction of the eustachian tube without infection. Symptoms include hearing loss and a sense of fullness or pressure in the ear.

Otoscopy
Retraction of TM
Air bubbles/clear fluid
May be discolouration of TM

Question 4

Mastoiditis

Answer 4

Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. Symptoms include redness, tenderness, swelling, and fluctuation over the mastoid process, with displacement of the pinna, fever, purulent ottorrhea and may cause facial paralysis (CN 5,7,9).

Question 5

Cholesteatoma

Answer 5

Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process.
LIFE THREATENING

Sequelae of OM with TM perforation
Conductive hearing loss –> sensorineural loss
Tumour usually in the upper quadrant - pars flaccida.
Foul smelling discharge is common

Question 6

Tympanosclerosis

Answer 6

Deposition of hyaline material within layers of TM
Chalky white patches with irregular margins
Follows severe OM

Question 7

Otosclerosis

Answer 7

Uncoupling of bone formation vs resorption.
Foot of stapes + oval window fuse so sound waves do not travel properly.
Autosomal dominant
F>M
Pulsatile Tinnitius - hear your own pulse
Weber - wont show bc tends to be bilateral
Rhine - BC>AC

Question 8

Meniere’s Dx

Answer 8

Tinnitus, Vertigo, Unilateral Deafness (TRIAD)
Episodic
Due to the excess endolymph in semilunar canals that causes vestibular membrane to bulge into vestibular cavity; distorts sound transmission. Affects CN8 transmission of sound.
May be viral or autoimmune - unknown cause
SENSORINEURAL LOSS

Question 9

Schwannoma (Acoustic Neuroma)

Answer 9

A Schwann cell–derived tumor of the 8th cranial nerve usually btwn pons + medulla.
Causes Macrophage mediated degenerative changes.
Sx - d/t pressure on CN8
-tinnitus
-hearing loss - sensorineural

Genetic
Benign - non-invasive
MRI/CT scan needed for diagnosis

Question 10

Benign Paroxysmal Positional Vertigo

Answer 10

Changes in head position induces vertigo due to dislodged otolith crystals - sending false message to brain about movement.
Sx
Rotary Nystagmus - only happens when vertigo is occurring.
When at rest, no sx
Dix-Hallpike maneuvre = assessment
Epley maneuvre = used to reposition otolith crystals