Ear conditions

Question 1

What is otitis media with effusion?

Answer 1

also known as ‘glue ear’ which is a collection of fluid within middle ear space without acute inflammation

caused by eustachian tube dysfunction, leading to fluid and negative pressure in middle ear affecting hearing

Question 2

how might glue ear present?

Answer 2

hearing loss, intermittent ear pain with fullness or popping, aural discharge, recurrent ear infections
- retracted and straw coloured TM

Question 3

how is glue ear managed?

Answer 3

most resolve spontaneously in 2-3 months

if persists and affects school performance may require grommets to equilibriate pressures

Question 4

what causes acute otitis media?

Answer 4

inflammation of middle ear, caused by virus or bacteria (like strep pneumoniae, H.influenzae)

common in children due to easier passage for infection via smaller eustachian tube

Question 5

how does otitis media present?

Answer 5

earache, young children tugging ear, fever, restlessness etc - symptoms WITH otoscopic : red, yellow TM, buldging of TM, or perforation of TM §

Question 6

how is otitis media managed?

Answer 6

admission if severe temperature in child, analgesia, abx amoxicillin for 5-7 days, review if ongoing

Question 7

what are some complications of otitis media?

Answer 7

can complicate to TM perforation, facial never involvement, mastoiditis or even intracranial complications

Question 8

what is mastoiditis?

Answer 8

inflammation of mastoid air cells, common in children, occurs following untreated middle ear infections

*redness, tenderness behind ear, otorrhoea, headache, loss of hearing, high temp, swelling behind ear causing ear to stick out otoscopy - buldging red TM, CT head if severe

Question 9

how is mastoiditis managed?

Answer 9

IV abx, myringotomy to drain middle ear, mastoidectomy if severe
- if secondary to otitis media refer to ENT

Question 10

what is a cholesteotoma?

Answer 10

abnormal sac of keratinizing squamous epithelium and accumulation of keratin within midde ear or mastoid air cell spaces which get infected and erode bone

Question 11

how might a cholesteotoma present?

Answer 11

asymptomatic, recurrent discharge foul smelling, conductive hearing loss, rare progression to vertigo, facial nerve palsy etc - attic crust

Question 12

what is chronic otitis media?

Answer 12

chronic inflammation of middle ear and mastoid cavity with recurrent ear discharge through TM perforation for 2 weeks, complication of acute otitis media

Question 13

how might chronic otitis media present?

Answer 13

persistent ear discharge without pain or fever, hearing loss in affected, hx of otitis media, glue ear, tinnitus - TM perforation and middle ear inflammation

Question 14

how is chronic otitis media managed?

Answer 14

urgent admission if serious complication
- referral to ENT, secondary care with abx, steroids and cleaning of ear - keep ear dry etc

*extracranial spread. - red flags: headache, nystagmus, vertigo, fever, labyrynthitis, facial paralysis etc

Question 15

what is otitis externa?

Answer 15

inflammation of of skin and subdermis of external ear canal, less than 6w, caused by staph. aureus or pseudomonas

Question 16

how does otitis externa present?

Answer 16

itchy ear canal, ear pain and tragus/ pinna tenderness, jaw pain, ear discharge and hearing loss

Question 17

how will Otitis external be managed?

Answer 17

keep ears clean and dry, OTC drops, cleaning EAC, topical abx and steroid for 7-14 days

Question 18

what is acute sinusitis?

Answer 18

Acute sinusitis
follows common cold, with increase in symptoms after 5 days or persisting beyond 10 days

Question 19

what is the presentation of acute sinusitis?

Answer 19

nasal blockage or discharge, facial pain/ pressure with reduced sense of smell

Question 20

what is chronic sinusitis?

Answer 20

inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer

Question 21

how does chronic sinusitis present?

Answer 21

facial pain: typically frontal pressure pain which is worse on bending forward

nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection

nasal obstruction: e.g. ‘mouth breathing’

post-nasal drip: may produce chronic cough

Question 22

how do you manage chronic sinusitis?

Answer 22

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

Question 23

what is acute labyrynthitis?

Answer 23

inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs, can be viral, bacterial or systemic, vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment

Question 24

how does acute labyrinthitis present?

Answer 24

vertigo: not triggered by movement but exacerbated by movement

nausea and vomiting
hearing loss: may be unilateral or bilateral, with varying severity

tinnitus

preceding or concurrent symptoms of upper respiratory tract infection

Question 25

how is acute labyrinthitis managed?

Answer 25

episodes are usually self-limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness

Question 26

what is vestibular neuritis?

Answer 26

cases in which only the vestibular nerve is involved, hence there is no hearing impairment

Question 27

how does vestibular neuritis present?

Answer 27

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

Question 28

how is vestibular neuritis managed?

Answer 28

buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
a short oral course of prochlorperazine, or an antihistamine (cinnarizine) may be used to alleviate less severe cases
vestibular rehabilitation exercises in chronic symptoms

Question 29

what causes congenital deafness?

Answer 29

maternal rubella, cytomegalovirus during pregnancy, autosomal recessive or dominant, downs syndrome associated