ear conditions Flashcards
5 important ear related symptoms to ask about
vertigo/dizziness discharge hearing loss tinnitus pain
causes of referred ear pain (6 Ts)
teeth tongue throat trigeminal TMJ tonsil
commonest causative organism of otitis media
strep pneumoniae
also haemophilus influenzae, moraxella catarrhalis
key presenting features of acute otitis media
EAR PAIN generally unwell - fever irritability kids discharge if perforation (potential hearing loss more common in OME)
red, bulging tympanic membrane
main risk of otitis media
perforation of tympanic membrane - discharge
management of otitis media
conservative, most resolve within 3days-week
delayed antibiotics or if significantly ill/immunocompromised = amoxicillin or clarithromycin if pen allergy
key features of otitis media with effusion (glue ear)
acute hearing loss without unwell symptoms - longer term hearing loss than otitis media
no ear pain
poor school performance - behaviour problems, speech delay
appearance of otitis media with effusion on otoscopy
dull/retraction of tympanic membrane with air bubble or visible fluid level
management of otitis media with effusion
conservative for 3 months
post 3 months
- <3yrs = grommets
- > 3yrs
- first = grommets
- second intervention = grommets + adenoidectomy
(if nasal symptoms adenoids may be considered earlier)
cholesteatoma
abnormal collection of keratin + squamous eoithelial cells in middle ear
benign but can invade local tissues, nerves + bones of middle ear
can predispose infections
male predominance
cholesteatoma presentation
foul discharge from ear
unilateral condictive hearing loss
pearly white mass in middle ear
as expands - infection, pain, vertigo, facial nerve palsy
histological findings of cholesteatoma
squamous epithelium with abundant keratin production
assoc inflammation
cholesteatoma investigations
otoscopy = abnormal build up of whitish debris or crust in upper tympanic membrane
CT head = confirm diagnosis
MRI = assess invasion damage
management of cholesteatoma
surgical removal
discharge from ear after multipal course of topical antibiotics
fungal infection otitis externa - ab killed friendly bacteria
bacterial causes of otitis externa
staph aureus pseudomonas aeruginosa (immunocomp)
pseudomonas aeruginosa
gram neg aerobic rod-shaped bacteria
otitis externa presentation
ear pain
discharge
itchiness
conductive hearing loss if ear becomes blocked
management of otitis externa
conservative for 3 days then sofradex (drops, combo of antibiotic + steroid)
malignant otitis externa
found in immunocompromised
pseudommonas aeruginosa
infection spreads + progresses to mastoid + temporal bone osteomyelitis
otitis externa malignant presentation
diabetes or immunosuppress severe otalgia severe temporal headaches fever non-resolving otitis externa with worsening pain facial nerve palsy
investigations + management of malignant otitis externa
diagnosis = CT
biopsy + culture
emergency admission
IV antibiotics
otosclerosis
gradual remodelling of small bones of middle ear leading to conductive hearing loss
mainly affects base of stapes where it attaches to oval window - prevents from transmitting sound effectively
commoner in women - progresses rapidly in pregnancy
mode of inheritence of otosclerosis
autosomal dominant
otosclerosis presentation
hearing loss (conductive)
tinnitus
under 40yrs
affects lower pitch more - female speech EASIER to hear
management of otosclerosis
conservative = hearing aids
stapedectomy = prosthetic replacement of stapes
noise induced hearing loss audiometry
classical dip at 4kHz on audiometry
drugs that can cause hearing loss
gentamicin + other aminoglycosides
chemo drugs - cisplatin, vincristine
aspirin + NSAIDs in overdose
bilateral vestibular schwannoma (acoustic neuroma)
neurofibromatosis type 2
vestibular schwannoma (acoustic neuroma)
benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear VIII) that innervates inner ear
most unilateral + assoc with long exposure to loud noise
SLOW GROWING
presentation of vestibular schwannoma
aged 40-60 with gradual onset unilateral -
sensorineural hearing loss
tinnitus
dizziness or imbalance (not vertigo as slow growing)
aural fullness
