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ENT Specialty > Ear > Flashcards

Ear Flashcards

1
Q

S+S of otitis externa

A

Swelling in the ear canal is typical of an early presentation of localised otitis external; later the swelling has a white or yellow centre filled with pus; occasionally this progresses and the swelling eventually completely occludes the ear canal
Discharge (serous or purulent) may be present in the ear canal
Inflamed eardrum, which may be difficult to visualise if the ear canal is narrowed or filled with debris
Symptoms:
Itch (typical)
Severe ear pain, disproportionate to the size of the lesion (typical)
Pain made worse when the trigs or pinna is moved, or when an otoscope is inserted (typical)
Tenderness on moving the jaw
Tender regional lymphadenitis - may be present (less common)
Sudden relief of pain if the furuncle otitis external bursts (rare)
Loss of hearing if there is sufficient swelling to occlude the ear canal (rare)

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2
Q

organisms responsible for infective otitis externa

A

bacteria - usually pseudomonas

fungal” candida/aspergillis

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3
Q

Treatment of otitis externa

A

Clean
Treat pain if present with analgesia and application of local heat e.g. warm flannel
Oral or topical antibiotics if required e.g. 7 day course of flucloxacillin or clarithromycin (if allergic to penicillin)
Topical antibiotics if fungal
Topical steroids
Drain pus if necessary

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4
Q

Predisposing factors for otitis externa

A

skin conditions (eczema, psoriasis)
systemic conditions (DM)
cotton bud abuse
cosmetics

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5
Q

S+S of necrotising (“malignant”) otitis externa

A 
pain +++ - Keeps them awake at night
Discharge
Diabetic/immunocompromised
Granulation tissue on floor of ear canal
\+/- facial nerve palsy or Abducens palsy
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6
Q

Tx of necrotising (malignant) otitis externa

A

Refer to ENT on-call for admission
IV antibiotics with bone penetration for at least 6 weeks
CT temporal bones
Medical management of immunocompromised

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7
Q

Symptoms of acute otitis media

Organism in AOM

A 
Otalgia
Pyrexia
Hearing loss
Discharge if drum perforates
Pain —> then discharge

Bacteria:Streptococcus pneumonia (pneumococcus) - most common. H influenzas, staph aureus, mortadella catarrhalis, strep pyogenes

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8
Q

Mx of acute otitis media

A

Analgesia if uncomplicated
Antibiotics if no improvement
Oral abs if less than 2 years old
Do not need ENT referral if drum perforates as will usually heal

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9
Q

Cx of acute otitis media

A

Intracranial abscess
Facial palsy
Mastoiditis
Meningitis

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10
Q

what is otitis media with effusion and when is it most commonly seen

A

It is mucus in the middle ear space - glue ear.
It is very common after a URTI or an episode of acute otitis media but is usually short-lived and not considered pathological

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11
Q

Signs on otoscope of OME

A

The TM is dull and retracted, may have yellow or grey colour.
There are prominent blood vessels on the surface of the TM running radially

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12
Q

Red flags for OME

A

Young south-east asian men, unilateral - think ?nasopharyngeal mass

Middle-aged adults - neck nodes

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13
Q

S+S of OME

A

most have minimal symptoms.
May have persistent conductive hearing impairment - usually presents as speech delay

Pain, fever, discharge (infective) - are not seen in OME

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14
Q

Tx of OME

A

The best option for most children is to watch and wait, but for the small minority when the hearing loss is significant and persistent surgery may be appropriate.

Grommets - small ventialtion tubes that are inserted into TM and are very effective in getting rid of the fluid and improving the hearing back to normal.
Adenoidectomy will get rid of the source of the problem and it improves the health of the ears in the long erm. No non-surgical treatment has been shown to have any benefits in glue ear
Decongestant nose drops to nasopharynx
Valsalva manoeuvre/otovent
Hearing aid

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15
Q

Causes of tympanic membrane perforation

A

Infection
Purulent AOM with tympanic membrane perforation
Chronic otitis media with tympanic membrane perforation
Trauma:
To the tympanic membrane e.g. cotton bud
To the temporal bone
Iatrogenic

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16
Q

Presentation of TM perforation

A

Hearing loss/ bleeding ear/discharge

17
Q

What is Cholesteatoma

A

Sometimes also referred to as Chronic Squamous Otitis Media
Squamous epithelium in middle ear or mastoid

Build up of keratin debris within a squamous epithelia lined sac, expands at expense of local structures

18
Q

Suggested aetiology of cholesteatoma

A

Interrupted epithelial migration
Retraction pockets secondary to negative middle ear pressure
Iatrogenic implantation
Residual epithelial rest cells within middle ear (congenital cholesteatoma)

19
Q

Presentation of cholesteatoma

A

Discharging ear, conductive hearing loss, dizziness if stapes footplate/lateral canal involved

Discharging ear that does not resolve with abx Tx

20
Q

Mx of cholesteatoma

A

Mastoid exploration and removal of disease +/- reconstruction of hearing, use of VII nerve monitor intro
Useful to have a pre op CT

Surgery: Mastoidectomy, atticotomy

21
Q

What is otosclerosis

A

It is a genetically mediated metabolic dysplasia, affecting the bony tissue of the otic capsule (the skeletal elements enclosing the inner ear mechanism) and the auditory ossicles
There is a pathological increased bony turnover leading to sclerosis and dfailure of the sound conduction mechanism, due to ankylosis of the stapes footplate in the fenestra ovals of the cochlea —> slowly progressive conductive hearing impairment

It is the single most common cause of hearing impairment

22
Q

Presentation of otosclerosis

A

gradual-onset, bilateral, painless hearing loss in adults aged 30-50 years
Symptoms may be unilateral and tinnitus may or may not be present.
The ear canal and TM usually appear normal

23
Q

Tx of otosclerosis

A

Sodium fluoride 20-120mg daily — > effects bone metabolism
Bisphosphonate Tx
Surgical:
- Stapedectomy (extraction of the footplate) or stapedotomy (a small hole made in the stapes footplate) aims to improve the circulation of fluid within the cochlear canal

24
Q

What is BPPV

A 
Rotational vertigo
Lasts seconds
Related to head movement
- Commonly turning in bed
- Looking up
25
Q

Causes of BPPV

A 
diopathic
Head injury (even minor)
26
Q

Pathophysiology and Dx of BPPV

A

Pathophysiology:
Otolith dislodgement in posterior semicircular canal causing scapula irritation
Cupulolithiasis - otoliths adherent to cupula

Hallpike test usually positive
Negative hallpike does not exclude diagnosis

27
Q

Tx of BPPV

A

Epley manoeuvre:

All positions held for at least 30 seconds or until symptoms resolve
Turn patients head to affected side
Assist the pt to lie flat with their head off the couch and turned to the affected side
Turn head towards the good side
Patient rolls on to the good side then turns head to look at the floor
Assist the patient in sitting up. Patient puts their chin on their chest

28
Q

what is vestibular neuronitis

A

inflammation of the vestibular nerve and often occurs after a viral infection

29
Q

Presentation of vestibular neuronitis

A

Vertigo, nausea, vomiting and unsteadiness

Signs - nystagmus

30
Q

Tx of vestibular neuronitis

A

prochlorperazine (short course as regular use leads to extrapyramidal symptoms)

31
Q

What is Meniere’s disease

A

A disorder affecting the inner ear which can affect balance and hearing

32
Q

presentation of meniere’s disease

A

It is a clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss and tinnitus and is associated with a feeling of fullness in the affected ear
Cardinal prodrome of tinnitus, hearing loss and aural fullness then vertigo
Hearing loss and tinnitus fluctuate
Low frequency hearing loss may develop and persist

33
Q

Tx of meniere’s disease

A

Conservative:
Lifestyle - low salt, reduce caffeine

Medical 
Preventative medications
Betahistine - limited evidence
Symptomatic medications
Buccal prochlorperazine

Surgical - vestibular destructive
Disabling vertigo and patient not coping
Intratympanic gentamicin

34
Q

What is vestibular schwannoma (acoustic neuroma)

A

A slow growing, benign tumour (usually arising from Schwann cells in the vestibulocochlear nerve sheath) which causes hearing loss due to compression of the vestibulocochlear nerve

35
Q

S+S of vestibular schwannoma

A

Typically presents with gradual onset, unilateral hearing loss which may be associated with tinnitus and/or vertigo
Ear examination is usually normal
Neurological symptoms and signs may be present if tumour is advanced and has extended into the posterior cranial fossa causing cerebellar/brainstem compression
In patients with known neurofibromatosis acoustic neuromas are often bilateral

ENT Specialty (1 decks)

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