Ear Flashcards
How do you treat meatal swelling?
Ribbon gauze soaked in magnesium sulphate
or pope wick changed daily then gentamicin or neomycin
What causes mastoiditis?
Breakdown of bony partitions (trabeculae) between mastoid air cells
When should mastoiditis be suspected?
Continuous discharge for >10 days
If systemically unwell
Causes of ear pain
Referred pain from CN9 (tonsillitis) CN10 - carcinoma of pyriform fossa CN5 mandibular division (upper molars or TMJ) C2/C3 pain due to posture Mastoiditis OM
Causes of otorrhea
Acute = OM or OE
Chronic inflammatory disease
In acute, pain is dominant before discharge
What is subacute suppurative OM?
Continuous discharge from ear >3 weeks after OM
Due to mucosal infection or infection of nasopharynx
What is safe chronic suppurative OM?
Active mucosal chronic OM
Perforation is central so there is always a rim of ear drum
Involves pars tensa
Discharge arises from secreting mucosa
What is unsafe chronic suppurative OM?
Active chronic with cholesteatoma May spread intra cranially due to erosion of bone Atticantral Discharge is foul smelling May need radical mastoidectomy
Causes of conductive hearing loss
Obstruction due to wax, foreign body, debris
Perforation causing reduction in SA of TM - also allows incident sound pressure which causes distortion of sound waves
Discontinuity of ossicular chain - usually due to infection (particularly of long process of incus)
Fixation of ossicular chain due to otosclerosis which immobilises foot of stapes
Eustachian tube blockage (glue ear) - progressive deafness due to accumulation of viscous material
MUST EXCLUDE CARCINOMA OF NP as this can present as conductive hearing loss
Causes of sensorineural hearing loss
Bilateral progressive = age, noise damage, drug ototoxicity
Unilateral progressive = meniere’s or acoustic neuroma
Sudden loss = mumps, measles, chicken pox, trauma
Meniere’s
Fluctuating hearing levels and recurrent episodes of vertigo
Complications of otitis media
Mastoiditis TM perforation Labrynthitis Meningitis Intracranial abscess Hearing loss Sinus thrombosis Damage to facial nerve
Management for otitis media
Can resolve spontaneously
Amoxicillin 5-7 days for:
high risk/ systemically unwell pts
Clarithromycin 2nd line
RF for OM
Children <4
Passive smoking
Formula fed
Craniofacial abnormalities
S+S of OM
Ear pain, tugging of ear
fever, poor feeding, crying, rhinorrhea
What is chronic suppurative OM?
Chronic inflammation of middle ear with otorrhoea through perforated TM
Causes ear discharge, hearing loss, hx of OM
What may cause persistent OME?
Impaired eustachian tube function
Low grade infection
Persistent local inflammatory reaction
Adenoidal infection or hypertrophy
RF for OME
Kids with Downs, cleft palate, CF, PCD, allergic rhinitis
Management of OME
Active observation - resolves in 6-12 weeks
What are the types of otitis externa?
Diffuse = involves skin + subdermis of ear canal Localised = infection of hair follicle Malignant = spread into bone
Bacteria causing OE
Pseudomonas aerigenosa or staph aureus
Complications of OE
Abscess, inflamed TM, malignant OE
Management of OE
Symptomatic relief
Topical tx for infection
What is ear wax made of?
Dead flattened cells, cerumen, sebum + foreign substances
RF for impacted ear wax
Narrow or deformed ear canals Numerous hairs in ear canals Benign bony growths in canal Dermatological disease on scalp/ ear Elderly Hx of OE Downs
S+S of impacted ear wax
Conductive hearing loss Blocked ears Ear ache Tinnitus Itchiness Vertigo
Management of impacted ear wax
Ear drops for 3-5 days (Sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil drops)
2nd line: ear irrigation
Referral to ENT
What is a cholesteatoma?
Abnormal sac of keratinising squamous epithelium + accumulation of keratin within middle ear
S+S of cholesteatoma
Foul smelling discharge
Conductive hearing loss
What images of TM would indicate cholesteatoma?
Evidence of discharge
Presence of deep retraction pocket
Crust or keratin in upper part of TM
Perforated TM
Management of cholesteatoma
Otomicroscope + micro-suctioning
dB threshold for deafness
0-20
What are typical dB levels for a whisper, average home noise + conversational speech?
30 = whisper 50 = noise 60 = speech
Gradings of hearing loss
25-40 = mild, cannot hear whispers 40-70 = moderate, cannot hear speech 70-90 = severe, cannot hear shouting >95 = profound, cannot hear noises that would be painful
Causes of hearing loss in children
Conductive = glue ear Sensorineural = genetics, intrauterine infection/ drugs, prematurity, infections
RF for hearing loss in children
Fam hx Infection (rubella, mumps, meningitis) Ototoxic meds Prematurity/ low birth weight Craniofacial abnormalities Klinefelters/ Turners Severe hyperbilirubinemia Head injury Neurodegenerative disorders
Screening for deafness in children
Automated otoacoustic emissions test (AOAE)
then Automated auditory brainstem response test (AABR) if this is positive
Pure tone sweep test upon school entry
Management of deafness in children
Communication support - hearing aids, radio aids, cochlear implants, lip reading, BSL
Management of conductive hearing loss
Grommets
Auto-inflation
Types of hearing aid
External
Cochlear implants
Bone anchored hearing aids
What is presbyacusis?
Hearing loss in older people as they age
Usually bilateral, high pitched sounds most affected
RF for presbyacusis
Arteriosclerosis
Exposure to loud noise, chemicals or meds
Smoking
Management of presbyacusis
Hearing aids Lip reading Hearing assistive devices Cochlear implants Active middle ear implant
Difference between vestibular neuritis + labyrinthitis
VN = only vestibular nerve L = VN + labyrinth
Causes of labyrinthitis
URTI - viral Bacterial Vertebrobasilar ischemia Meningitis Meniere's Ototoxic meds
S+S of labyrinthitis
Sudden, spontaneous + severe vertigo Not triggered but exacerbated by movement N+V Hearing loss Tinnitus URTI symptoms
What drugs can cause vertigo?
Aminoglycosides Anti-HTN (amlodipine) Anti-depressants Benzos Anti-epileptics
Investigations for ?labyrinthitis
Pts fall towards affected side when walking HINTS: Head impulse test Nystagmus check Skew deviation (cover/ uncover test)
What HINTS results suggest labyrinthitis + ischemic stroke?
labyrinthitis = abnormal head impulse, unidirectional nystagmus + no vertical skew stroke = normal head impulse, bidirectional nystagmus + vertical skew
Management of labyrinthitis
Prochlorperazine or antihistamines
Myringotomy + evacuation of effusion if needed
Complications of labyrinthitis
Falls
Unilateral hearing loss
BPPV
Pathology of acoustic neuroma
Tumours of vestibulocochlear nerve arising from Schwann cells of nerve sheath
Usually benign + slow growing
Cause symptoms through mass effect + pressure
Difference between CPA tumours + internal auditory canal tumours?
CPA can grow without affecting function
Internal canal tumours cause hearing loss or vestibular disturbance early
RF for acoustic neuroma
Neurofibromatosis
High dose ionising radiation
S+S of acoustic neuroma
Unilateral/ asymmetrical hearing loss or tinnitus
Impaired facial sensation
Balance problems
Investigations for ?acoustic neuroma
Audiology
MRI
Management of acoustic neuroma
Microsurgery
Stereotactic radiosurgery
Observation
What features should you examine in nasal trauma/ FB?
Epistaxis or rhinorrhea Septal haematoma Septal deviation Lacerations, ecchymoses, swelling Crepitus Facial/ mandibular fracture Ophthalmoplegia Facial anesthesia
Management of nasal trauma
Ice + analgesia
Refer to ENT if deviation present
Closed reduction
Presentation + common FB in nose
Nasal obstruction/ persistent offensive discharge from 1 nostril
Beads, buttons, sweets, nuts, seeds, peas
When to refer to ENT for FB in nose?
Hx of prolonged nasal discharge
FB is in posterior position
Pt is unco-operative
Management of nasal FB
Use topical anesthetics + vasoconstrictor spray
Blow positive pressure through nose (parents blowing in pts mouth while obstructing unaffected nostril)
Use nasal speculum + hook/ forceps
Use suction
Use Fogarty balloon catheter
Presentation of septal perforation
Nasal whistling sound Discharge from nose Nasal congestion Infection Epistaxis
Pathology of nasal polyps
Lesions arising from nasal mucosa
Frequently in clefts of middle meatus
Part of spectrum of chronic rhinosinusitis
What are nasal polyps associated with?
Asthma
Aspirin sensitivity
Cystic fibrosis
Churg Strauss syndrome
S+S of nasal polyps
Nasal airway obstruction Discharge Dull headaches Snoring Reduced smell
Investigations + management of polyps
Flexible endoscopy (rhinoscopy) Topical corticosteroids Endoscopic sinus surgery 2nd line
Complications of nasal polyps
Acute bacterial sinusitis
Sleep disruption
Can lead to craniofacial abnormalities
