Ear Flashcards
what is AOM (Acute Ottitis Media)?
An upper respiratory infection involving the middle ear by extension of infection up the eustachian tube
Predominantly disease of infants and children
Present with earache
what are the most common infections of the middle ear?
viral
secondary bacterial from viral infection
Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes.
how do you diagnose AOM?
send sample of pus if eardrum perforates and pus leaks
how do you treat middle ear infection?
if viral resolves spontaneously in 4 days
if bacterial, bilateral, under 2 years or with otorrhoea - ABX: Amoxicillin for 5 days or Clarithromycin 5 days if penicillin allergic
how do you treat recurrent AOM?
ie more than 3 episodes in 6 months or 5 in 12 months
refer to ENT specialist & consider amoxicillin OD or BD
what is acute sinusitis?
Mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with upper respiratory viral infections.
However, severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
how do you treat acute sinusitis?
In uncomplicated avoid antibiotics as most cases resolve in 14 days without antibiotics.
Where indicated
1ST LINE penicillin V
2ND LINE doxycycline –NOT IN CHILDREN!!!
what is ottitis externa (OME)?
inflammation of outer ear canal
Redness and swelling of the skin of the ear canal.
It may be itchy (especially in the early stages).
Can become sore and painful.
There may be a discharge, or increased amounts of ear wax.
If the canal becomes blocked by swelling or secretions, hearing can be affected.
bacterial causes of ottitis externa (aka glue ear)?
staph aureus
proteus spp
pseudomonas aeruginosa
fungal causes of OME?
aspergillus niger
candida albicans
management of OME?
topical aural toilet (syringe it)
Swab reserved for unresponsive cases
Then treat depending on culture results
Acetic acid ear drops for 7 days (mild)
Gentisone, Locortem, Otomize or Sorfradex (moderate)
Topical gentamicin or ciprofloxacin (severe) include corticosteroid for ear canal oedema
For fungal infection clotrimoxazole solution 2-3 times daily until 14 days after cure.
Abx required if cellulitis or extends outside ear canal
antibiotics for OME?
Topical clotrimazole (trade name canesten) for Aspergillus niger, along with thorough aural toilet
what are the 5 Ds?
Deafness Discomfort Discharge Dizziness Din Din -Destruction by disease -Defective movement of face
Types of hearing loss?
Senorineural (cochlear)
Conductive (middle or external ear)
Mixed
Central
which cranial nerves are involved in earache?
V VII IX X C2 C3
which conditions have ottorhoea (discharge) present?
AOM
COM
CSF
what is the cause of facial palsy?
lower motor neurone disease
what is cholesteatoma?
cells in the ear change to squamous (SKIN) where they shouldn’t be that kind of cell. increased cell turnover.
inflammation, keratin production.
common at any age (congenital/acquired)
found in superior posterior middle ear/petrous apex.
can be caused by chronic OME and perforated eardrum
what is glue ear?
OME with effusion:
Otitis media with effusion (OME) is inflammation of the middle ear, accompanied by the accumulation of fluid in the middle-ear cleft, without the symptoms and signs of acute inflammation.
can cause (temporary) sensorineural hearing loss
what is chronic OME?
RAOM (recurrent acute otitis media) can cause complications due to the environment suitable for proliferation of bacteria
causes of conductive hearing loss?
Fluid – effusion, blood, CSF
TM perforation - traumatic or chronic
Ossicular problem
Stapes Fixation - Otosclerosis
management of conductive hearing loss?
Often delayed as polytrauma May need facial nerve decompression If no recovery and EMG studies May need to manage CSF leak Most settle but may need repair May need hearing restoration Either hearing aid or ossiculoplasty
structures of external ear?
Tympanic membrane:- 3 layers – outer epithelial layer, middle fibrous layer, inner mucosal layer of respiratory epithelium
structures of middle ear?
ossicles (stapes malleus and incus) intra-ossicular synovial joints fibrous joint at oval window with stapes stapedius tensor tympani mucoid glands Eustachian tube
structures of internal ear?
labyrinth
vestibulocochlear nerve
semicircular canals
cochlea
what is Costen’s syndrome?
TMJ dysfunction - joint lesions
pathology of CNVII?
geniculate herpes / Ramsay Hunt syndrome
Bell’s Palsy
Sphenoid or ethmoidal sinus pathology – infection, neoplasm
Nasal pathology - including foreign bodies – (see local causes…)!
types of hearing aid?
BTE (behind the ear)
ITE (in the ear)
ITC (in the canal)
what is telecoil?
hearing aid induction loop system in public places
indication for hearing aids?
hearing loss only
what is a vibrant soundbridge?
new implantable hearing aid device which directly stimulates middle ear structures (ossicles or round window)
consists of implanted device (FMT floating mass transducer) and magnetic external sound processor
how do cochlear implants work and what are their indications?
electrical stimulation of neural structures in cochlea, transmitted to brain and perceived as sound
indicated in severe to profound sensorineural hearing loss
