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MO1 > Ear conditions > Flashcards

Ear conditions Flashcards

1
Q

when examining the ear what do you check?

A
  • Inspect outer ear - redness/ swelling/ discharge/ bleeding
  • Check pinna – dermatitis, ulcer/blistering
  • Mastoid area – apply pressure directly behind the ear- if tender possibly infection of the mastoid bone of the skull
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2
Q

how do you inspect the ear canal for a adult/ child?

A
  • adult - hold top of ear and firmly pull up and back
  • child - gently firmly pull lobule down and back
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3
Q

what is ear wax?

A

combination of cerumen, sebum,
dead skin cells, sweat, hair, foreign matter
(e.g. dust).
Normal and natural physiological substance
that protects ear canal. Quantity produced
varies.

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4
Q

how does the colour and consistency differ in various patient groups?

A
  • Asians- dry type (grey and flaky)
  • White & Africans – moist type (honey to dark brown)
  • This is genetically determined!
  • Soft cerumen - Children
  • Hard cerumen – Adults
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5
Q

what can result from excessive or impacted ear wax?

A
  • Lots of hair growing in ears
  • Narrow ear canals
  • Use of hearing aids/ear plugs
  • Age
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6
Q

what is the natural cleaning process of the ear?

A
  • “Conveyor belt” process
  • Cells formed in centre of tympanic membrane
    migrate outwards
  • Accelerate towards the entrance of the ear canal
  • Cerumen also carried outwards, taking with it
    dirt, dust etc
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7
Q

what is the purpose of cerumenolytics?

A
  • Available as ear drops to soften hardened wax.
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8
Q

what are the different types of cerumenolytics?

A

Water-based
* Urea Hydrogen Peroxide 5% (Otex)
* Sodium Bicarbonate 5%+ glycerol
* Docusate sodium 0.5% (Waxsol)
Oil-based Beware peanut allergies!!
* Almond oil
* Olive oil
* Arachis oil/chlorbutanol

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9
Q

how long do cerumenolytics take to achieve the desired effect?

A

7 days

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10
Q

when is ear syringing contraindicted?

A

Hx of perforation of tympanic
membrane, unilateral deafness, Hx of
recurrent otitis externa

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11
Q

how should you use ear drops?

A
  • Warm the ear-drop bottle
  • Unscrew cap of the bottle, draw liquid into dropper.
  • Either lie on your side or tilt your head over
  • Gently pull your earlobe upwards, away from neck,
  • Squeeze correct no. of drops into ear.
  • Keep your head tilted for about 5 mins
  • Straighten your head, wipe away any excess liquid
  • Replace the cap on bottle.
  • Complete the course.
  • Discard any drops left over at end of course.
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12
Q

when should you not use ear drops?

A

Perforation of Tympanic membrane
present, previous, suspected, or grommets
* Previous middle ear or mastoid surgery
* Recurrent Otitis Externa or chronic middle ear disease
* Dizziness or tinnitus
* People with nut allergies should not use arachis / almond oil.

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13
Q

what are the common outer ear disorders?

A
  • Dermatitis – dry, itchy irritation of pinna / ear canal
  • Tx – Emollients
  • Contact dermatitis – sensitivity to earrings/ ear plugs/ aids
  • Tx – Topical HC – advise avoid nickel containing earrings
  • Seborrhoeic dermatitis – can affect ear in isolation
    or alongside scalp dandruff / eye brow scaling
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14
Q

what is otitis externa?

A

swimmers ear
* Inflammation of the pinna skin/external ear canal* Localised/ diffuse* Acute/ chronic

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15
Q

what are the pre-disposing factors to otitis externa?

A
  • Ear trauma* Use of cotton buds* Syringing* Excessive moisture* Humid environment* Chemicals – shampoo/hair dye
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16
Q

what are the different types of otitis externa?

A
  • Infective exudate discharged
  • Reactive form of dermatitis (atopic/contact)
  • Furuncle (boil like) – s.aureus, severe pain, small red swelling
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17
Q

what are the common symptoms of acute cases of otitis externa?

A
  • Pain in the ear canal (usually mild)
  • Itching
  • Impaired hearing (usually mild)
  • Fowl smelling discharge
  • Red ear
  • Swollen / scaly ear
18
Q

what is the POM treatment for acute otitis externa?

A
  • Corticosteroid drops – for inflammation
  • Topical ABx drops – for infection
  • No more than 7 days Tx course
19
Q

what is the OTC treatment for otitis externa?

A
  • Acetic acid 2% Spray - 1st line for mild bact/fungal
  • adults & over 12yr olds
  • one spray tds - continued two days after symptoms resolved.
  • Maximum dosage frequency one spray every 2 - 3 hours
  • Max 7 days usage
20
Q

when should you refer otitis externa?

A
  • Internal Ear pain- likely infection
  • Foreign body: suspect particularly in children.
  • Otitis media: ear pain, if eardrum perforates,
    purulent smelly discharge….see later
  • Mastoiditis: pt feels unwell, has marked hearing
    loss, or mastoid tenderness/swelling
  • Barotrauma: Possible in divers or patients who have recently flown or had a blow to the ear
21
Q

what is otitis media?

A
  • Middle ear inflammation
  • It occurs in the area between the tympanic membrane and the inner ear
  • It is one of the most common causes of otalgia - earache
  • Often preceded by upper respiratory symptoms, including
    a cough and rhinorrhoea.
22
Q

what may happen with otitis media?

A

The tympanic membrane may perforate known as suppurative otitis media …..key symptom is otorrhoea (fluid discharge)

23
Q

what does an inflamed tympanic membrane look like?

A

bulging and injection of blood vesselsLimited mobilisation of the membrane

24
Q

who is acute otitis media most commonly seen in?

A
  • 1 in 4 children have 1 episode before age 10
  • peak incidence: 3-6 years of age
  • causes pain and deafness.
25
Q

what are the signs of acute otitis media?

A
  • Pulling at the ear
  • Sleeplessness
  • Irritability
  • Fever
  • Perforation of ear drum gives relief & usually heals naturally
26
Q

are antibiotics needed for acute otitis media?

A

usually not needed
may cause unwanted effects such as diarrhoea, stomach pains and rash
as well as antibiotic resistance

27
Q

what is the treatment for acute otitis media?

A

paracetamol for both adults and children

28
Q

what is otitis media with effusion?

A

Glue ear” inflammation of the middle ear accompanied by accumulation of fluid…blockage of the eustachian tube

29
Q

does glue ear occur reularly?

A
  • Spontaneous resolution is common
  • 50% resolve within 3 months , 95% within a year
  • If episodes frequent / persistent, speech/language development,
    behaviour may be adversely affected
30
Q

what are the risk factors for glue ear?

A
  • Gender - Males
  • Exposure to tobacco smoke
  • Young age (peak 2yrs old)
  • Formula feeding
  • Season (more prevalent in winter)
  • Sibling Hx of G.ear
31
Q

what is tinnitus?

A

Inner Ear Disorders
* Tinnitus – sound in absence of stimuli
* Buzzing, ringing, whistling, hissing
* Varies between- intermittent, continuous, pulsatile

32
Q

what is tinnitus associated with?

A

hearing impairment, impacted wax, head injury, toxicity, Meniere’s disease,

33
Q

what is the treatment for tinnitus?

A
  • No cure
  • Correct hearing loss
  • Counselling
  • Sound therapy
  • Support group
34
Q

what is meniere’s disease?

A
  • Progressive disorder of inner ear – unknown cause
  • Fluid build up in the inner ear
  • Age 30-60
  • Attacks can last 20mins - hours
  • Attack frequent/once every few months
35
Q

what are the symptoms of meniere’s disease?

A
  • Vertigo
  • Dizziness
  • Nausea
  • Vomiting
  • Dulled hearing, Tinnitus
  • Pressure
  • Headache (migraine like aura)
36
Q

what is vertigo?

A

A symptom rather than a condition!
Problem with the balance functions of
the inner ear

37
Q

what are the causes of vertigo?

A
  • Viral infection
  • Brain stem ischaemia
  • Eustachian tube dysfunction
  • Chronic Otitis media
  • Epilepsy/MS
  • Head injury
  • Travel sickness
  • Nasopharyngeal carcinoma
38
Q

how should menieres be managed?

A
  • Acute attacks: Prochlorperazine 5mg tds 7/7 (POM)
  • Vertigo & nausea & vomiting
  • Buccally /rectally
  • Cinnarizine 30mg tds 7d…can be supplied OTC
39
Q

what is the prophylactic management of menieres?

A
  • Betahistine (POM)
  • BNF: 24-48mg od with food
  • RCT – statistically significant reduction in intensity & no. of attacks, treated with betahistine 16mg BD for 3 months
40
Q

what drugs can cause hearing impairment?

A
  • Chemotherapeutics - Cisplatin
  • Antibiotics - Aminoglycosides
  • Loop diuretics - Furosemide
  • Antimalarials - Mefloquine
  • NSAID - aspirin

MO1 (50 decks)

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