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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
Clinical features of otitis externa
* 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
ix for otitis externa
clinical diagnosis
27
differential for otitis externa
* Otitis media * Foreign body in ear * Ear wax * Mastoiditis * Malignant otitis * Neoplasm
28
When would you refer to patient while suspecting an otitis externa
Not getting better large amount of discharge CanaI swelling fungal infection
29
Management of otitis externa
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
Complication of otitis externa
* 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
what is ear wax
= 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
Pathophysiology of earwax
* 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
Aetiology of earwax
* 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
Features of earwax
* Pain * Feeling of ‘fullness’ in the ear * Reduced hearing * Tinnitus * Itchiness * Vertigo * Cough
35
differential for earwax
* Otitis externa * Foreign bodies * Keratosis obturans (rare, increase in keratin production) * Polyps of the ear * Osteoma of the ear canal
36
ix for earwax
clinical diagnosis when looking into ears
37
management of earwax
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
complications for earwax
conductive hearing loss vertigo infection
39
definition of deafness
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
Different types of deafness
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
aetiology of conductive hearing loss
earwax osteomata - new piece of bone Growing on another piece of bone glue ear haemotympanum ossicle dislocation/erosion otitis media foreign body cholesteatoma
42
sensorineural causes of deafness
congenital - TORCH syndrome, prematurity, downs, jaundice, meningitis/encephalitis, chemo ageing - presbycusis trauma acoustic neuroma drugs - aminoglycosides, salicyates, loop diuretics, cisplatin stroke
43
central causes of deafness
congenital
44
clinical features of deafness
* Depends on cause * Children: * Ignoring sounds * Frustration/bad behaviour/poor school performance * Poor speech and language development
45
investigation for deafness
UK national hearing screening programme turning fork test rinne's test weber's test MRI - localising symptoms/signs
46
general management of deafness
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
mangement for sensorineural deafness
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
management for conductive deafness
* Assistive listening devices e.g. personal hearing loops, personal communicators, TV amplifiers, vibrating devices * Hearing aids * Bone conduction implant * Surgery
49
management for central deafness
auditory brainstem implant
50
definition of labrinthitis
inflammation of the labyrinth caused by bacterial or virus that affects the inner ear which consists of the cochlea and vestibular system
51
what is the function of the labyrinth?
* 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
what are some inner ear/peripheral causes of dizziness?
BBPV labyrinthitis vestibular neuritis Meniere's disease
53
what are some central/brain causes of dizziness?
migraine stroke/TIA acoustic neuroma MS
54
what is the difference between labyrinthitis and vestibular neuritis?
vestibular neuritis - without hearing loss labyrinthitis - with hearing loss
55
what are the clinical features of Meniere's disease
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
what are some red flags for dizziness?
``` diplopia dysarthria dysphagia difficulty moving one side/limb dysesthesia on side/limb bowel/bladder distrubances raised ICP symptoms LOC prominent arrhythmia ```
57
ix for labyrinthitis
audiogram - sensorineural hearing loss Weber + Rinne's test
58
mx for labyrinthitis
* 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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