Ear and ENT Flashcards
anatomy of the ear
a normal tympanic membrane will have a light reflection on examination
you can see the handle of the malleus
a membrane in acute otitis media might look
opaque
inflamed
bulging
typical history of acute otitis media
acute onset of pain (may be difficult to tell in young children)
fever
concurrent URRTI symptoms common
treatment for acute otitis media
antibiotics ??
more likely to help in bilateral OM in age <2
recommended in aboriginal children due to high prevalence of complications
symptomatic management is reasonable in non-severe cases
analgesia
otitis media with effusion
persisting middle ear effusion, follows acute otitis media or accompanies rhinitis/sinusitis
best confirmed by pneumotoscopy or tympanometry
painless, sometimes causes hearing loss
often resolves spontaneously within <3 months
when is hearing testing needed
if persists >3 months
when is ENT consult needed
bilateral hearing loss >30dB or
speech delay, educational impairment or behavioural difficulties
grommets are also called
tympanovstomy tubes
ventilation tubes
a grommet is
a small plastic tube, narrower in its middle than its ends
inserted surgically to maintain a hole in the tympanum
main indicators for grommet are
recurrent otitis media
otitis media with effusion
possible adverse effects of grommets
anaesthetic risks, ear discharge, persisting perforation, tympanosclerosis
chronic suppurative otitis media
chronic bacterial infection of the middle ear with persistent drainage of mucous from the middle ear via perforation
chronic suppurative otitis media may occur following
acute otitis media
chronic suppurative otitis media is especially common in
resource poor settings internationally
in remote aboriginal communities
chronic suppurative otitis media is an important cause of
conductive hearing loss
treatment of chronic suppurative otitis media
ear cleaning (aural toilet) - dry mopping with tissue spears or dilute butadiene washout
topical antibiotic
what sort of antibiotic is best for chronic suppurative otitis media
topical antibiotics are better
best evidence is for fluroquinolones which are also not ototoxic (unlike some other topical antibiotics)
perforation
may follow otitis media or trauma
often causes some hearing loss depending on extent of perforation
perforation prognosis
often heals spontaneously in absence of infection, especially in childhood
treatment for persistent perforation
tympanoplasty is a surgical option
involves grafting other tissue over the perforation
cholesteatoma
beware the attic perforation (perforation should always be at the bottom)
not actually a malignancy
expanding mass of keratinising squamous epithelium
potentially locally destructive including to ossicular chain
can lead to permanent hearing loss or vertigo
needs surgery
treatment for cholesteatoma
needs surgery - only option
is cholesteatoma a malignancy
no
cholesteatoma can cause
can lead to permanent hearing loss or vertigo
tympanosclerosis
local opacity or scarring of tympanum often seen after past perforation/grommets
commonly seen
often has little or no effect on hearing
often no treatment needed
what does otitis externally look like
acute otitis externa is due to
acute otitis exterrna is due to infection of the external auditory canal
chronic otitis externa is due to
is due to dermatological disease
common risk factors
- eczema
- swimming
- diabetes
acute otitis extra is characterised by
acute onset of ear pain, sometimes with discharge
risk factors for acute otitis externa
moisture (commonly swimming)
ear trauma or irritation
pre-existing skin disease in canal
causative agents of acute otitis externa
usually bacterial
pseudomonas most common
followed by staphylococcus species
about 10% fungal (immunocompromised or ear drops use)
treatment for acute otitis externa
aminoglycoside + anti fungal + steroid drops often used, only considered safe if there is an intact tympanum
quinolone-based drops considered safe in setting of tympanic perforation
if acute otitis externa does not respond to initial treatment
consider swab for microscopy and culture
if the acute otitis externa is severe
consider
oral antibiotics if there is a spreading infection
with if very swollen canal (to allow entry for medicines)
referral to ENT for canal cleaning (microscopic toilet)
with treatment, symptoms of acute otitis externa should last
6 days on average
what is an exostoses
benign bony overgrowth of external ear canal
associated with repeated water exposure - ‘surfer’s ear’
treatment for exostoses
usually of no consequence unless leading to frequent occlusion or infection (can then be treated surgically)
symptoms of wax impaction
hearing loss
pain, tinnitus, vertigo
diagnosis is usually obvious on examination but beware pathology behind the wax
treatment for wax impaction
- drops
- syringing
- manual removal by a specialist
drops for wax impacting
water based or oil based
not effective and uncertain evidence base
syringing for wax impaction
contraindications include current infection, perforation, grommets, recent trauma, past ear surgery
risks of syringing
small (1/1000?) risk of perforation
stop irrigation if severe pain or vertigo and have ENT review
hearing loss presentations in children
neonatal screening
low threshold for audiometry/referral
sudden idiopathic sensorineural hearing loss
often spontaneously improves but not always
high dose steroids are standard of care
refer urgently to an ENT
things to look for on throat examination
symmetry
tonsil size
tonsil inflammation or exudate (tonsil crypts are normal finding)
pharyngeal inflammation +/- lymphoid hyperplasia
ulcers
plaques
dentition
when is antibiotics recommended for sore throats
scarlet fever or rheumatic fever
some guidelines suggest antibiotics for tonsillitis if criteria are met
peritonsillar abscess
aka. quinsy
presents with severe unilateral throat pain, high fever, perhaps change in voice or truisms
treatment for peritonsillar abscess
surgical - emergency due to potential airway obstruction
plus penicillin
mouth ulcers
often viral/idiopathic
beware malignancy in ulcer persisting >2 weeks especially in the setting of risk factors eg. smoking, chewing tobacco, alcohol
hoarseness
commonly post viral
also benign nodules with overuse e.g in singers
beware malignancy - refer to ENT if hoarseness lasts >3 weeks and red flags present
red flags in voice hoarseness
significant smoking history
otalgia
dysphagia/odynophagia
stridor
haemoptysis
fevers/night sweats /weight loss
neck mass
hot potato voice
which hand do you use to hold an otoscope
right hand for right ear
left hand for left ear
otitis media may progress to
mastoiditis
what happens if you miss sudden idiopathic sensorineural hearing loss
can progress to permanent hearing loss without treatment
what is trismus
being unable to open their mouth
what to do if hot potato voice
emergency contact ENT surgeon
