EAR Flashcards
** OTITIS MEDIA
2 types
RF
IVX
Prescribing
Complications
- 3- 6 years
- Acute: 6-12 months and often follows URTI: rhinorrhea, coryza, otalgia, discharge, mild hearing loss
- Secretary: middle ear effusion - lasts months, hearing loss and inattentive at school
Bacterial: Strep pneumonia, Group A B-haem strep, Hib
Viral: RSV, rhinovirs
RF: young, smoker, URTI
IVX: Otoscope
- Acute: Tympanic membrane BRIGHT, RED, BULDGING, Loss of normal light reflection
- Secretory: TM retracted and opaque
Conductive loss + flat trace tympanometry if hearing loss suspected –> indicates secretory OM
Management: Analgesia and fluids
Admission if children <3 months with temp or complications
Antibiotics: 5 day course of Amoxicillin if systemic upset or syx lasted 4 days without improvement
Surgical: Myringotomy - incision in TM to relieve pressure and Grommet insertion if recurrent
Complications: perforation, mastoidisitis –> meningitis, or Cholesteatoma
Otitis externa
Acute vs chronic
90% are?
CF
Management
- Inflammation of external ear canal
- Acute > 3 weeks
- Chronic <3 months
- Diffuse or Localised
- Bacterial 90% = Staph aureuas or Pseudomonas
- Fungal 10% Aspergillis
RF: moisture (swimming), hearing age, Immunocompromised
CF: Pruritis itchy ear, Otalgia esp on movement of tragus, Erythema and oedema
Late: Pre-auricular lymphanedopathy
IVX: Ear swab
Management: Ear hygiene advice
Moderate: Topical Neomycin + Topical Bethamethasone
If unresponsive consider malignancy
Rx : Necrotitising otitis externa - micro absesses, headache and facial nerve palsy - Urgent ENT referrral
Ear Wax
- Aural Hygiene advice
- Clean external canal, advise olive oil (for ear wax)
- If swollen/narrowed canal: Wick soaked in Sofradex (framycetin & dexamethasone) OR Thin strip of gauze w/ icthammol glycerine
NB: AVOID Cotton buds + Q tips
1) Labrythnitis
2) Vestibular Neuritis
Vestibular neuritis = only the vestibular nerve is involved, hence there is no hearing impairment;
Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.
- A spectrum of BALANCE & HEARING problems, depending on the site of the inflammation
Cause: Viral, bacterial or ischaemic
CF: SUDDEN ONSET Vertigo, N+V, Nystagmus + tinnitis and hearing loss
IVX: HINTS EXAM
- Head Impulse test
- Nystagmus Type
- Skew
Webers test- quieter in affected ear
Gait: falls toward affected side
CT to exclude mastoiditis
Sudden onset Unilateral hearing loss = ENt specialist
Tx: Procloperazine for dizziness and Surgery for underlying cause
Cholesteastoma
Physiology
Syx:
IVX
- Independently growing collection of epidermis in middle ear ↑pressure and release of osteolytic enzymes can be destructive to bones of middle ear
SYX: Small = Progressive CONDUCTIVE hearing loss (U/L)
Enlarging invades adjacent structures = Vertigo, Headache, Facial nerve palsy (affects forehead), Trigeminal neurlagia
Acquired: Painless PURULENT FOUL smelling discharge (otorrhea) – frequent + unremitting and Progressive U/L CONDUCTIVE hearing loss
Congential: presents in toddlers with conductive hearing loss
IVX: Otoscope -> crust in ear drum
CT assess size of lesion
Refer to ENT for tympanomastoidectomy
Acousitc Neuroma
aka Vestibular schwannoma
CF:
- Typically Benign. SLOW GROWING TUMOUR of CN 8
CF: Hearing loss, balance problems, ear ache
Headache worse when bending
Management: conservative or surgical resection
Deafness
Mild 20-40dB, Moderate 41-70dB, Severe 71-95dB & Profound >95dB
Conductive: occulsion, infection, perforate TM, Cholesteatoma
Sensorineural: presbyacusis is age related, immunie, OTotxics
Rhinnes – assesses difference in air & bone conduction within one ear
Webers – check to see if difference in hearing between ears
IVX: Audiometry
