Ear Flashcards
Which group of people are more at risk of otitis media and why?
Children
- more narrow, horizontal and short eustachian tube
What causes otitis media?
Often viral
Bacterial - S. pneumonia and H. influenzae
Often preceded by URTI
What are some complications of otitis media?
mastoiditis
meningitis
facial palsy
brain abscess
How would you categorise otitis media?
acute OM: increasing otalgia, no discharge, bulging red eardrum
acute suppurative OM: increasing otalgia, watery discharge (pop), perforation of eardrum
How would you treat otitis media?
oral antx are contrary to evidence (do decrease pain in children) - amoxicillin / erythromycin
analgesia
perforated eardrum give steroid and antx drops (gentisoneHC)
What would you see in otitis media on otoscopy?
bulging eardrum, redding or dull appearance, prominent blood vessels
+/- perforated eardrum
What are some symptoms of otitis media?
ear ache, nausea, vomiting, cough, runny nose, fever, conductive hearing loss
How would you treat otitis externa?
gentisoneHC or flucloxicillin / erythromycin
What are 5 causes of vertigo and how they are different?
Labrynthitis - constant
BPPV
Migrane - episodic, aura, headache, photophobia
Meniere’s disease - hours, unilateral hearing loss, tinnitus, aural pressure
Acoustic neuroma
What is benign paroxysmal postional vertigo?
loose otoliths in semicircular canals cause abnormal movement of endolymph within canal causing vertigo
(crystals which should be at the bottom move to the middle of the canals
What are some symptoms of benign paroxysmal postional vertigo?
vertigo participated by head movements, sudden and disturbing onset (secs-mins), becomes less severe on repeated movements
How do you test for BPPV?
Dix-hall pike maneuver
Will show rotational nystagmus
How do you treat BPPV?
Epley maneuver
Brandt-Daroff exercise for maintainence
What are some causes of referred otalgia?
dental problems, TMJ dysfunction, osteoarthritis of cervical spine, malignant pharynx and larynx, infection of pharynx, degenerative neck pain, throat infection
What are the 4 main causes of otalgia?
Acute otitis media, ottits externa, furuncule, necrotising otitis externa
What are some pathogenic causes of otitis media?
VIRAL - RSV, rhinovirus, parainfluenza
BACTERIAL - strep pneumo, haem influenza, moraxella catarrhalis
How would you treat otitis media?
antibiotics do not benefit children (unless severe)
so give reassurance
What are some complications of otitis media?
mastoiditis, tympanic membrane perforation
Intracranial - meningitis, abscess, lateral thrombosis
Extracranial - petrositis, LMN VII palsy, labyrinthitis, hearing loss, TM perforation
What is otitis externa? What are some predisposing factors?
painful, discharging ear caused by pseudomonas or fungal infection
eczema or dermatitis is predisposing
How would you treat and prevent otitis media?
TREAT - microsuction, pope wick, topical antibiotics, water precautions, clotrimazole for fungal
PREVENT - hands out, ear dry, treat skin disease, acetic acid spray
What is a furuncule? How would you treat it?
It is a staphylococcal abcess on hair follicle in ear = exquisitely tender
TREAT - flucloxicillin, wick insertion
What is necrotising otitis externa?
potentially fatal osteomyelitis of EAM nad bony tympanic plate (can spread along inferior surface of skull base)
What are risk factors for necrotising otitis externa?
DM, elderly, immunocompromised
How would you treat necrotising otitis externa? What are some complications of necrotising otitis externa?
Admission into hospital, IV antibiotics
Complications - meningitis, cerebral abscess, dural sinus thrombosis
What are the symptoms of necrotising otitis externa?
huge pain, not impacted by topical antibiotics
What is Rinne’s test?
press tuning fork against mastoid bone and then hold 1cm away
- is it louder behind hear or in front?
What is Weber’s test?
tuning fork placed in midline or forehead
- to find unilateral hearing loss
What is conductive hearing loss? Give 3 possible causes
problem with middle or inner ear, eardrum etc
- wax, osteosclerosis, otitis media
What is sensorineural deafness? Give 3 possible causes
problem with cochlear, nerves or brain function (bone conduction is better in tests
- congenital, age related, occupational, meniere’s disease, drug toxicity, post-infective
What is osteosclerosis?
commonest cause of hearing loss in young adults, F>M, autosomal dominant
conductive hearing loss from bone deposition around stapes footplate
What are symptoms of osteosclerosis?
hearing loss, tinnitus, vertigo
- worse in pregnancy, menstruation and menopause
How would you treat osteosclerosis?
surgically with stapedectomy or with hearing aids
What is Meniere’s disease?
uncommon condition where dilation of endolymphatic system in cochlear duct and saccule which can cause vestibular membrane of Reissner can rupture, compressing adjacent structures
What are the symptoms and treatment of meniere’s diasase?
attacks of nausea, vertigo, nystagmus, tinnitus and hearing loss that can last for up to 12 hrs
cyclizine helps for vertigo, possibly betahistamine can help, operative decompression helps prevent progression of disease
What are the common causative agents of labyrinthitis?
usually viral - mumps, cytomegalovirus, rubella
- usually spontaneous resolution
What is glue ear?
at least 3 months of persistant middle ear effusion
not infection, is mucus overproduction or under clearance
What are the symptoms of glue ear?
conductive hearing loss
pain is unlikely
How would you treat glue ear?
conservative
hearing aids
grommets
