Ear and Sinuses

Question 1

what is otitis externa?

Answer 1

inflammation of the outer ear canal

diffuse or localised (hair follicle)

Question 2

who gets otitis externa?

Answer 2

7-12yrs

SWIMMERS

Question 3

cause of otitis externa?

Answer 3

fungal (most common) - aspergillus niger, candida albicans
bacterial - staph aureus, pseudomonas aerguinosa, proetus
trauma
eczema

Question 4

treatment for otitis externa?

Answer 4

topical aural toilet
fungal - topical clotrimazole
bacterial - swab and antimicrobials e.g gentamicin drops
keep ears water free during treatment

Question 5

clinical features of otitis externa?

Answer 5

red swollen skin of ear canal
sore
itch
discharge
canal can become blocked - hearing affected

Question 6

what is malignant otitis externa?

Answer 6

extension of otitis externa into the bones surrounding the ear canal (temporal and mastoid)

Question 7

end result of malignant otitis externa?

Answer 7

osteomyelitis will involve skull and meninges

Question 8

features of malignant otitis externa?

Answer 8

pain
headache
facial nerve palsy
exposed bone in ear canal

Question 9

usual cause of malignant otitis externa?

Answer 9

pseudomonas aerguinosa

Question 10

investigations for malignant otitis externa?

Answer 10

PV/CRP
imaging
biopsy
culture

Question 11

risk factors for malignant otitis externa?

Answer 11

diabetes

radiotherapy to H&N

Question 12

treatment of malignant otitis externa?

Answer 12

surgical debridement and systemic antibiotics

Question 13

what is otitis media?

Answer 13

inflammation of the middle ear

Question 14

cause of otitis media?

Answer 14

viral usually
strep pneumonia, h influenzae, moxarella catarhallis
if chronic - pseudomonas aeruginosa

Question 15

symptoms of otitis media?

Answer 15

occuring after a URT infection
earache
fever
irritability

Question 16

investigations for otitis media?

Answer 16

swab of pus if eardrum perforates

otoscopy - bulging TM, opaque

Question 17

treatment for otitis media?

Answer 17

usually resolves

if antibios - amoxicillin or erythromycin

Question 18

what is chronic otitis media?

Answer 18

tympanic membrane perforation in the setting of recurrent of chronic ear infections

Question 19

define benign chronic otitis media?

Answer 19

perforation with no active infection

Question 20

define serous chronic otitis media?

Answer 20

straw coloured fluid drainage

Question 21

define suppurative chronic otitis media?

Answer 21

persistent purulent discharge through perforation

Question 22

define OME?

Answer 22

inflammation of the middle ear, accompanied by accumulation of fluid
(without symptoms and signs of acute inflam)

Question 23

another name for OME?

Answer 23

glue ear

Question 24

who gets OME?

Answer 24

children

recurrent URTI/AOM

Question 25

symptoms of OME?

Answer 25

``` deafness behavioural problems speech delay balance problems NOT OTALGIA ```

Question 26

investigations for OME?

Answer 26

otoscopy - dull, grey, yellow, TM retraction, visible fluid/bubbles, prominent blood vessels tuning fork tests - shows conductive hearing loss may need to do hearing tests

Question 27

treatment for OME?

Answer 27

watch and wait persistent for >3/12 REFER grommets

Question 28

what is a cholesteatoma?

Answer 28

chronic otitis media with an acquired perforated tympanic membrane, due to an abnormal growth of keratinising squamous epithelium

Question 29

where can a cholesteatoma occur?

Answer 29

superior/posterior/middle ear | petrous apex

Question 30

what is normal ear lining?

Answer 30

cuboidal/columnar glandular epithelium

Question 31

what lining is present in a cholesteatoma?

Answer 31

abnormally situated squamous epithelium

Question 32

pathology behind cholesteatoma?

Answer 32

high cell turnover keratin production inflammation

Question 33

clinical features of cholesteatoma?

Answer 33

``` foul discharge headache pain paralysis vertigo ```

Question 34

investigation for cholesteatoma?

Answer 34

CT | diffusion weighted MRI

Question 35

risks with a cholesteatoma?

Answer 35

``` OM eustachian tube dysfunction # ```

Question 36

treatment of a cholesteatoma?

Answer 36

surgery - canal wall up/down mastoidectomy

Question 37

causes of acute sinusitis?

Answer 37

viral usually | strep pneumonia, h influenzae, moxarella catarhallis

Question 38

clinical features of acute sinusitis?

Answer 38

mild discomfort over frontal/maxillary sinuses due to congestion often alongside URTI

Question 39

features of bacterial sinusitis?

Answer 39

severe pain tenderness purulent nasal discharge

Question 40

treatment of acute sinusitis?

Answer 40

usually self limiting, in around 10 days | if still bad after 10 days, consider antibios

Question 41

treatment for bacterial sinusitis?

Answer 41

1 - penicillin | 2 - doxycycline (not in children)