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Ophthalmology & ENT > Ear > Flashcards

Ear Flashcards

1
Q

Draw the structure of the ear?

Describe how a sound is heard.

A

Find picture on google

  1. Sound waves directed into ear canal by pinna
  2. Sound wave hits eardrum and vibrates it
  3. The eardrum attaches to malleus, which attaches to incus, which attaches to stapes. There is chain reaction of vibration through the bones
  4. The stapes is connected to the cochlea, it has a piston effect which passes on the vibration to the fluid in the cochlea
  5. The fluid vibrating sends a signal to the brain via nerve VIII
  6. Signal is processed by the brain
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2
Q

What are the bones of the ear? Which order are they in?

A

From outside going in:
Malleus
Incus
Stapes

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3
Q

Where are the cut offs between outer, middle and inner ear?

A

Outer: up to eardrum

Middle: inside of eardrum up to cochlea

Inner: the rest!

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4
Q

What is the eustachean tube?

What is its purpose?

A

Tube that goes from the middle ear to nasopharynx

Equalises pressure of middle ear to that of external auditory meatus

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5
Q

How do we balance?

A

The semi-circular canals

They are attached to the cochlea

They contain endolymph. Upon movement of the head the flow changes speed or direction.

Sensory receptors send signals to the brain

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6
Q

Which nerves pass through the inner ear?

A

VIII - vestibulocochlear, which innervates cochlea and vestibular apparatus

VII - facial, does not innervate anything in inner ear

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7
Q

Draw and label the structures of the pinna?

A

http://teachmeanatomy.info/head/organs/ear/external-ear/

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8
Q

What are some causes of a painful ear?

A

50% is referred pain from jaw, throat, teeth

Other causes:
Otitis externa
Otitis media
Furunculosis
Temporomandibular joint dysfunction
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9
Q

What is otitis externa?

Pathophysiology

A

Inflammation of the external ear (external auditory meatus, auditory canal, outer surface of eardrum)

Caused by infection

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10
Q

Causes of otitis externa?

A

Infection: S aureus, P aeruginosa, H zoster

Skin condition: acne, psoriasis, eczema

Irritants: swimming pool water, trauma (foreign body)

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11
Q

Presentation of otitis externa?

A

Erythema, oedema in ear canal

Exudate

Pain moving tragus or auricle

Pre-auricular lymphadenopathy

Hearing loss

Fever

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12
Q

What is the other name for swimmer’s ear?

A

Acute diffuse otitis externa

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13
Q

What is a furuncle?

A

A small localised infection arising from a hair follicle in the canal

S. aureus

Very painful

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14
Q

What is a serious complication of otitis externa?

A

Necrotising (malignant) otitis externa

Extension of infection into the mastoid and temporal bones

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15
Q

Necrotising (malignant) otitis externa.

Pathophysiology
Presentation
Causative bugs
Risk factors

A

Extension of infection from otitis externa into the mastoid and temporal bones resulting in osteomyelitis

S. aureus
P. aeruginosa

Pain
Oedema
Exudate
Facial nerve palsy

Diabetes, immunocompromise

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16
Q

Investigations of otitis externa?

A

Look for exudate in canal

Look for perforated tympanic membrane

Swab

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17
Q

If you can’t see the eardrum how can you tell if its perforated?

A

They can taste medication placed in ear

They can bow air out of ear when nose pinched

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18
Q

Management of acute otitis externa?

A

Topical drops: antibiotic + steroid

Can use wicks

Remove debris

If cellultitis or lymphadenopathy treat with oral abx

If systemically unwell need an ENT review and possible IV abx

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19
Q

In chronic otitis externa, what things could be perpetuating the problem?

A

Scratching ear
Swimming
Poor compliance with treatment
Skin disease

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20
Q

What do the topical drops used to treat otitis externa contain?

A

Antibiotic: gentamicin, ciprofloxacin
Steroid: dexamethasone or hydrocortisone

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21
Q

What are some causes of discharging ear?

A

Otitis media
Otitis externa
Glue ear
Cholesteatoma

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22
Q

What is otitis media?

Types?

A

Inflammation / infection of the middle ear

Types:

  • AOM: acute otitis media
  • OME: otitis media with effusion (glue ear)
  • COM: chronic otitis media
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23
Q

Risk factors for acute otitis media?

A

Younger age: because eustachian tube is at a less acute angle so material is transmitted through it to middle ear easier

Contact with infections (nursery, daycare, school)

Craniofacial abnormalities

Smoking in household

Dummy use

24
Q

Clinical features of acute otitis media?

What would you see OE?

A 
Pain, pulling at ear
Maliase
Irritability crying
Fever
Coryza
Vomiting

Tympanic membrane appears:
Red, yellow or cloudy
Bulging
Air-fluid level

After perforation:
Pain is much less
Discharge in auditory canal

25
Investigations of acute otitis media?
No investigation needed Can do culture of ear discharge Audiometry if there's chronic hearing loss CT or MRI if concerned about complications
26
Management of acute otitis media?
Consider admission if: - systemic unwell - very young - suspected acute complications Treat symptoms: paracetamol, NSAIDs No antibiotics unless systemically unwell
27
What bugs cause otitis media?
H influenzae S pnuemoniae M catarrhalis S pyogenes
28
Complications of acute otitis media?
Progression to chronic suppurative otitis media ``` Labyrinthitis Meningitis Intracranial sepsis Facial palsy Abscess Sepsis ```
29
What is chronic suppurative otitis media? Pathophysiology
Chronic inflammation of middle ear Ongoing cycle of inflammation, ulceration, infection, granulation of middle ear Which over time damages nearby structures
30
Risk factors for chronic suppurative otitis media?
Multiple episodes of acute otitis media Lots of contact with infections: Living in crowded conditions, nursery, daycare Craniofacial abnormalities
31
Clinical features of chronic suppurative otitis media?
Chronically discharging ear (otorrhoea) Conductive hearing loss in affected ear No signs of acute infection Otoscope: - granulation tissue in middle ear space - discharge clear, serous
32
Chronic suppurative otitis media can be safe or unsafe. What does this mean?
Safe: CSOM without cholesteatoma Unsafe: CSOM with cholesteatoma
33
Investigations of chronic suppurative otitis media?
Don't bother with swab Audiology would show conductive hearing loss CT or MRI could show cholesteatoma, malignancy, bone involvement
34
Management of chronic suppurative otitis media?
ENT referral: who can remove discharge and fully view the tympanic membrane Topical antibiotics (but not gentamicin or hydrocortisone) Surgical: repair TM, treat the cholesteatoma
35
In patients with otitis media, what should you not prescribe?
Topical ear drops containing - aminoglycosides (gentamicin) - hydrocortisone Because they're ototoxic, and if the tympanic membrane is perforated the drops will get into middle + inner ear
36
Complications of chronic suppurative otitis media?
Infection spreading to bone Labyrinthitis Facial paralysis Meningitis, intracranial abscess Hearing loss Tympanosclerosis
37
What is the proper name for earwax? | What does it contain?
Cerumen Contains sebum, dead cells, sweat, hair, dust
38
How would you manage impacted cerumen?
Ear drops: sodium bicarbonate, olive oil Irrigation Microsuction
39
Clinical features of impacted cerumen?
``` Hearing loss Blocked ears Tinnitus Itchiness Discomfort ```
40
What are some contra-indications for ear irrigation?
Current infection Perforated TM Grommets Otitis media in last 6 weeks Cleft palate
41
What is ear irrigation?
Using water to flush out ear wax
42
What is cholesteatoma?
A growth of keratinising squamous epithelium in the middle ear It is not cancer but it grows independently so is locally invasive Can erode the ossicles (ear bones), nerves, and sometimes even through base of skull
43
How is cholesteatoma classified? What's the cause of each?
Congenital: occurs during embryogenesis Primary acquired: eustachian tube defect causing negative middle ear pressure Secondary acquired: insult to TM, squamous epithelium gets into middle ear and grows there
44
Presentation of cholesteatoma?
Progressive conductive hearing loss Otorrhoea Signs of infection As lesion grows and erodes surrounding structures - pain - vertigo (erosion into inner ear) - tinnitus - headaches - facial nerve palsy
45
How does the cholesteatoma erode into bones?
It produces osteolytic enzymes which can erode bone
46
Investigations of cholesteatoma?
Otoscopy: can see keratinising lesion, discharge CT: show extent of lesion and look for bony defects
47
Management of cholesteatoma?
Surgical: remove the cholesteatoma Can manage conservatively if the patient is unfit for surgery, but it will grow and erode things
48
What are the complications of cholesteatoma?
Progressive conductive hearing loss Facial nerve palsy Infections leading to abscesses Intracranial complications
49
What types of discharge do these conditions point to? - Otitis externa - Acute otitis media - Chronic otitis media - Cholesteatoma
Externa: scanty discharge, blood, liquid wax (not mucous) Acute Otitis media: mucous discharge Chronic otitis media: Serosanguinous Cholesteatoma: offensive
50
Pathophysiology of acute otitis media?
Infective organisms reach middle ear from nasopharynx via eustachian tube Often follows a URTI
51
What is glue ear? | What causes it?
Another name for otitis media with effusion Collection of fluid in middle ear cleft Chronic (not acute) inflammation Follows acute otitis media Or eustachian tube defect (blocked, so reduced aeration of middle ear)
52
Clinical features of glue ear? | OE?
Hearing loss - poor listening - poor speech - inattention - poor progress at school Often no pain so hard to pick up Otoscopy: retracted or bulging drum, dull, grey, yellow
53
Investigations of otitis media with effusion?
AKA glue ear Otoscopy Audiology Tympanometry: checks mobility of TM
54
Management of otitis media with effusion?
Observation Autoinflation: of the eustachian tube via the nose Grommets (aka tympanostomy) Antibiotics, steroids etc are not recommended
55
What is tympanostomy?
Grommets Tiny tubes that go through the TM to ventilate the middle ear
56
Describe audiometry?
In a soundproof room Headphones play sounds at different frequencies Patient signals / presses button when they hear it Documents lowest and highest freq sounds they can hear Also done with bone conduction
57
What is tympanogram?
Assess tympanic membranes and bones mobility by changing air pressure in ear canal

Ophthalmology & ENT (14 decks)

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