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Year 5 Conditions > Ear > Flashcards

Ear Flashcards

1
Q

what is cholesteatoma

A

presence of keratinising squamous epithelium within the middle ear, or in other pneumatised areas of the temporal bone.

Rare in both adult and children

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2
Q

pathophysiology of cholesteatoma

A

This keratinising epithelium exhibits independent growth, leading to expansion and to resorption of underlying bone, eroding ossicles/mastoid etc.

Focal erosion of external canal bone with accumulation of keratin = external canal cholesteatoma

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3
Q

aetiology of cholesteatoma

A

• Acquired
o retraction of an area of the pars flaccid with or without associated atrophy of the pars tensa
o This epithelium becomes trapped and infected which then proliferated into a cholesteatoma
o Squamous membrane may also migrate through a defect in the tympanic membrane
o Can also happen if implantation of viable keratinocytes into the middle ear cleft following ontological surgery or after traumatic blast injury
• Congenital
o If no previous Hx of ear surgery, no perforation or retraction of tympanic membrane

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4
Q

clinical features of colesteatoma

A

Conductive hearing loss  can have a mixed hearing loss

Ear discharge resistant to antibiotic therapy

Attic crust – crust or keratin in the upper part of the middle ear, pars flaccida or pars tensa

White mass begins intact tympanic membrane  congenital

Other symptoms  tinnitus, otagia, altered taste, dizziness, facial nerve weakness

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5
Q

Ix for cholesteatoma

A

audiogram - hearing loss

CT of petrous temporal bone

culture

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6
Q

Mx for cholesteatoma

A

Surgical  canal wall up/down mastoidectomy + Abx cover post op

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7
Q

what is a acoustic neuroma

A

vestibular schwannoma

  • A benign cerebellopontine angle tumour that grows from the superior vestibular component of the vestibulocochlear nerve, usually presenting with unilateral sensorineural hearing loss
  • Affect female more than male
  • Rare tumour
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8
Q

aetiology and pathophysiology of acoustic neuroma

A

Tumour suppressor gene abnor on chromosome p22
Familiar autosomal dominant form  bilateral tumour + neurofibromatosis type 2
Tumour grows on the vestibular component of the vestibulocochlear nerve  dec hearing and episodes of dizziness or vertigo

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9
Q

clinical features of acoustic neuroma

A

Asymmetrical hearing loss
Facial numbness  facial nerve involvement, often in tongue/jaw and progress to entire face
Dizziness +/- nystagmus
Tinnitus difficulty localizing sounds

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10
Q

ix for acoustic neuroma

A

Audiogram

MRI head  absence of a dural tail/uniformly enhanced, dense mass extending into internal acoustic meatus

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11
Q

Mx of acoustic neuroma

A 
If small (<1 to 1.5cm)  observation
If any bigger  focused radiation or surgery (middle fossa or rectosigmoid approach – both are hearing preserving option, translabyrinthine – does not preserve hearing)
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12
Q

what is otitis media

A

infection/inflammation of mucosa of middle ear cleft, common complications of viral resp illnesses

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13
Q

peak incidence of otitis media

A

6 and 18 yrs old

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14
Q

aetiology of otitis media

A

children - eustachian tube is shorter and so high risk of infection

bacterial - S. pneumonia
viral - H. influenza & moraxella catarrhalis

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15
Q

what is a red flag when suspecting otitis media

A

facial palsy

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16
Q

clinical features of otitis media

A

otalgia - ear pain

bulging tympanic membrane

myringitis - inflammed tympanic membrane

fever + preceding URTI

viral symptoms

if chronic infection - permanet abnor of pars tensa/flacida, pus

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17
Q

Ix for otitis media

A

clinical diagnosis

ear swab - if have grommets

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18
Q

mx of otitis media

A

acute

  • regular analgesia
  • amoxicillin/clarithromycin orally for 5-7 days if < 2 years, bilateral, systemically unwell, perforated
  • supportive

failure of treatment - co-amoxiclic for 5-7 dys + referral to ENT

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19
Q

management of chronic otitis media

A

refer to ENT +/- removal of adenoids

keep ear dry

use topical therapy when needed

myringotomy

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20
Q

when will you refer a child to ENT specialist

A

fever of >38° if less than 3 months old/>39° if less than 6 months, complication of otitis media (see below)

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21
Q

complications of otitis media

A
  • Ear drum perforation – due to ↑ pressure from pus
  • Mastoiditis
  • Middle ear effusion – self limiting, part of the recovery process
  • Chronic: Glue ear – gromits indicated if effecting speech and language development, Down’s syndrome
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22
Q

definition of otitis externa

A

inflammation of the external ear canal which can involve the pinna or tympanic membrane

It is a form of cellulitis involves the skin and subdermis of the

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23
Q

what are the classification of otitis extena

A

localised

diffuse - swimmer/tropical ear - widespread inflammation of the skin and subdermis of the ear canal

Malignant/Necrotising - Aggressive Infection in immunocompromised

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24
Q

Aetiology of otitis externa

A
  • most common bacterial
  • Bacterial: pseudomonas aeruginosa, staphylococcus aureus
  • Fungal: Aspergillus, candida
  • Seborrheic/contact dermatitis
  • Trauma, chemical irritatns, allergy
  • Swimmers/cotton buds/trauma
25
Q

Clinical features of otitis externa

A
  • Itchy ear → becomes painful
  • Discharge – also seen when looking inside the ear
  • Hearing is okay but maybe dec
  • Painful to move/touch pinna
  • tragus pain
  • Severe - swelling of the ear canal
  • If fungal cause, discharge will look white and furry
  • Intense itching
  • No improvement after course of axb
26
Q

ix for otitis externa

A

clinical diagnosis

27
Q

differential for otitis externa

A
  • Otitis media
  • Foreign body in ear
  • Ear wax
  • Mastoiditis
  • Malignant otitis
  • Neoplasm
28
Q

When would you refer to patient while suspecting an otitis externa

A

Not getting better

large amount of discharge

CanaI swelling

fungal infection

29
Q

Management of otitis externa

A

Analgesia and heat on the area

1) Topical drop antibiotic and steroid combined e.g. aminoglycosides or ciprofloxacin/dexamethasone otic
1) Fungal: co-trimazole ear drops
2) Systemic abx e.g. flucloxacillin – systemic signs, cellulitis spreading beyond the ear, immunocompromised
2) Ear wicks – if canal is swollen
3) Drain pus – if severe pain and swelling (refer)

30
Q

Complication of otitis externa

A
  • Abscess
  • Chronic otitis externa
  • Regional dissemination of infection with: auricular cellulitis, chondritis, parotitis, spreading cellulitis
  • Fibrosis, leading to stenosis of the ear canal and conductive deafness
  • Myringitis (inflammation of the tympanic membrane)
  • Tympanic membrane perforation
  • Malignant otitis:
  • Facial nerve paralysis
  • Meningitis
31
Q

what is ear wax

A

= combination of sheets of desquamated keratin squames (the dead flattened cells on the outer layers of the skin), cerumen (a wax-like substance produced by ceruminous glands, which are modified sweat glands), sebum (from sebaceous glands), and various foreign substances (for example cosmetics and dirt)

32
Q

Pathophysiology of earwax

A
  • Normal physiological substance that protects the ear canal:
  • Aids removal of keratin from the ear canal (earwax naturally migrates out of the ear - aided by the movement of the jaw
  • Cleans, lubricates, and protects the lining of the ear canal, trapping dirt and repelling water
  • Mildly acidic and has antibacterial properties
  • Pathological – excessive build up of wax → impaction
33
Q

Aetiology of earwax

A
  • Abnormal ear anatomy:
  • Narrow or deformed ear canals
  • Numerous hairs in their ear canals
  • Benign bony growths in the external auditory canal (osteomata)
  • Down’s syndrome — people with Down’s syndrome tend to have small ear canals and dry, scaly wax
  • ↑ wax production/abnormal production:
  • Dermatological disease of the peri-auricular area or scalp
  • Elderly - as a person ages the cerumen glands atrophy causing the earwax to become drier
  • Foreign bodies:
  • Cotton buds
  • Hearing aids
  • Recurrent otitis externa
34
Q

Features of earwax

A
  • Pain
  • Feeling of ‘fullness’ in the ear
  • Reduced hearing
  • Tinnitus
  • Itchiness
  • Vertigo
  • Cough
35
Q

differential for earwax

A
  • Otitis externa
  • Foreign bodies
  • Keratosis obturans (rare, increase in keratin production)
  • Polyps of the ear
  • Osteoma of the ear canal
36
Q

ix for earwax

A

clinical diagnosis when looking into ears

37
Q

management of earwax

A

Olive oil/sodium bicarbonate/sodium chloride ear drops for 3-5 days – do not prescribe if suspecting perforated tympanic membrane

2) Ear irrigation - contraindicated in: perforation of tympanic membrane, Hx of perforation in the last 12 months, grommets, Hx of ear surgery, middle ear infection in the last 6 weeks
3) Use drops for a further 3-5 days then try irrigation again/instil water into the ear and try to irrigate 15 mins later/refer to ENT

• Removal of wax is indicated when there is: hearing loss, earache, tinnitus, vertigo, cough suspected to be due to earwax

38
Q

complications for earwax

A

conductive hearing loss
vertigo
infection

39
Q

definition of deafness

A

Anything that interferes with the movement of sound from the external ear to the middle ear to the inner ear, and then to the brain, can cause a hearing loss.

40
Q

Different types of deafness

A

3 types:
• Conductive deafness: external/middle ear disease prevent sound waves from getting to the cochlea
• Sensorineural deafness: damage/abnormality of the cochlea, cochlea nerve or central centres of hearing
• Central: affecting central auditory pathway

41
Q

aetiology of conductive hearing loss

A

earwax

osteomata - new piece of bone Growing on another piece of bone

glue ear

haemotympanum

ossicle dislocation/erosion

otitis media

foreign body

cholesteatoma

42
Q

sensorineural causes of deafness

A

congenital - TORCH syndrome, prematurity, downs, jaundice, meningitis/encephalitis, chemo

ageing - presbycusis

trauma

acoustic neuroma

drugs - aminoglycosides, salicyates, loop diuretics, cisplatin

stroke

43
Q

central causes of deafness

A

congenital

44
Q

clinical features of deafness

A
  • Depends on cause
  • Children:
  • Ignoring sounds
  • Frustration/bad behaviour/poor school performance
  • Poor speech and language development
45
Q

investigation for deafness

A

UK national hearing screening programme

turning fork test

rinne’s test

weber’s test

MRI - localising symptoms/signs

46
Q

general management of deafness

A

Sudden-onset/rapidly worsening/with additional symptom hearing loss in adults: refer to a specialist
Hearing difficulties suspected in adults:
1) Exclude impacted wax/acute infections
2) Arrange audiological assessment
3) Refer for additional diagnostic assessment if needed

47
Q

mangement for sensorineural deafness

A

heading aids - if some hearing is still present

bone anchored hearing aids

severe to profound deafness - cochlear implants

  • Idiopathic sudden hearing loss – consider steroids
  • Support with speech and language e.g. gestures, visual content, Makaton, specialist teaching
48
Q

management for conductive deafness

A
  • Assistive listening devices e.g. personal hearing loops, personal communicators, TV amplifiers, vibrating devices
  • Hearing aids
  • Bone conduction implant
  • Surgery
49
Q

management for central deafness

A

auditory brainstem implant

50
Q

definition of labrinthitis

A

inflammation of the labyrinth caused by bacterial or virus that affects the inner ear which consists of the cochlea and vestibular system

51
Q

what is the function of the labyrinth?

A
  • To convert mechanical signals from the middle ear into electrical signals, which can transfer information to the auditory pathway in the brain.
  • To maintain balance by detecting position and motion.
52
Q

what are some inner ear/peripheral causes of dizziness?

A

BBPV
labyrinthitis
vestibular neuritis
Meniere’s disease

53
Q

what are some central/brain causes of dizziness?

A

migraine
stroke/TIA
acoustic neuroma
MS

54
Q

what is the difference between labyrinthitis and vestibular neuritis?

A

vestibular neuritis - without hearing loss

labyrinthitis - with hearing loss

55
Q

what are the clinical features of Meniere’s disease

A

recurrent episodes
spinning/rocking
can last up to several days

classic symptoms - 
vertigo 
low pitched tinnitus 
feeling of fullness in the ears 
unidirectional, horizontal torsional nystagmus 
hearing loss
56
Q

what are some red flags for dizziness?

A 
diplopia 
dysarthria 
dysphagia 
difficulty moving one side/limb 
dysesthesia on side/limb
bowel/bladder distrubances 
raised ICP symptoms 
LOC 
prominent arrhythmia
57
Q

ix for labyrinthitis

A

audiogram - sensorineural hearing loss

Weber + Rinne’s test

58
Q

mx for labyrinthitis

A
  • Reassure that symptoms will settle over several weeks
  • Bed rest may be necessary for severe symptoms
  • Alcohol/tiredness/intercurrent illness may make symptoms worse
  • Prochlorperazine for nausea +/- prednisolone
  • If bacterial  follow the acute otitis media pathway
  • Referral to balance specialist if symptoms don’t start to improve after a week – vestibular rehabilitation therapy

Year 5 Conditions (19 decks)

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