Ear conditions

Question 1

Otitis Media

Answer 1

-RFs- URTI, bottle feed, passive smok, adenoids, malformations, dummy.
-px-
Acute OM- rapid onset pain due to drum bulging, fever, anorexia, vom, irrit. Often post viral URTI. Purul disch if perforates.
Chronic is inflamm with fluid for sev mnth. (3 mnth bilat effus, 6 mnth uni).
-orgs- pneumococcus, haemophilus, moraxella, strep, staph.
-mx
Analgesia, amoxicillin maybe with clavulanate. NO AB if well.
-contin disch can indic- mastoiditis, petrositis, labyrinthitis, facal plasy, mening, IC abcess.

Question 2

Acoustic neuroma

Slow grow, benign. Arise from super vestib N schwann cells.

Answer 2

NO CORNEAL REFLEX
Fascial palsies due to trigeminal comp. 
Vertigo rarely. Dizziness comm. 
Tinnitus prog ipislat. Possib sensorineural deafness by cochlear N comp. 
large tum cause ipsi cerebellar signs or RICP signs. 
CN V,VI,VII inv. 
ix- MRI
Tx- furosemide, gentamicin, asp

Question 3

Otosclerosis

Answer 3

20/40. Autosomal domin. Conductive.
Tinnitus.
Norm tympanic mem, 10% flamingo pink tinge.
Tx- hear aid, stapedectomy.

Question 4

Acute otitis media

Mid ear inflamm

Answer 4

Ache, rubbing, fever, irritable, crying, feed less, restless, cough, rhinorrhoea.
Mx- consid AB IF under 3 month old, bilat AOM, systemic ill, high risk complics eg imm supp and CF. for others no AB or delayed.
Av durat untreated is 4d.
Admit acc to NICE feverish illness in kids guidelines.
Admit all with susp complics eg mening, mastoiditis (give IV AB, fluclox for staph, or co amox), facial paral.

Question 5

Otitis externa

Answer 5

Local or diffuse
Acute under 3wk, chronic over 3 mnth
Malig/ necrotising form extends to mastoid and temporal bones. Typical in eld diabetics, LOT pain.
-px-
Minimal disch, itch, pain, tragal tenderness due to AI of meatus skin. Can cause hear loss and canal stenosis.
-causes- moisture eg SWIMMING, trauma, humidity, lack wax, narrow ear canal, hear aids. Pseudomonas and Sa common.
-Mx-
Swab.
Aural toilet
topical tx for 7d- acetic ac/ AB plus steroid/ gentisone HC. If no perforation. If perforated give oral AB.
If wax/swelling/cellulitis be careful as cant see if perforated- pope wick to open ear, dry mopping, microsuction.
Local drops if chronic- betamethasone (maybe plus neomycin), gentisone (HC plus gentamycin), clioquinol plus flumetasone, Na bicarb. Drops risk fungal infec.
Advise for preven- clean, dry, tx psoriasis/eczema.
If topical fail- rev diag and compliance, ?PO fluclox/erythromycin, ?fungal, swab and ref.

Question 6

Tinnitus

Answer 6

Can be related to any ear dis. Also CVS. Psych causes. Drugs eg asp, loops, aminoglycosides, quinine, alc.
-mx- aids if sig deafness, psych eg hear therapists tinnitus retraining therapy or CBT.
Betahistine if menieres. Melatonin. Baclofen. Hypnotics.

Question 7

TMJ dysfunc

Answer 7

-px
Ear ache, face pain, jnt popping, bruxisn, jnt derangement, stress. Jnt pain worse by lat movem of open jaw, or trigger pts in pterygoids.
-ix- MRI. ?dep, ehlers.
-mx
NSAID eg diclofenac, stabilising orthodontic occlusal prostheses, CBT, physio, surg, acupunc.

Question 8

Chronic suppurative OM

Answer 8

• px- serang and foul disch, hear loss, NO pain. Central drum perforat.
• mx- aural toilet, AB plus ster drops, quinolones but cult dep.

Question 9

Mastoiditis

Answer 9

Mid ear inflamm causes destruc air cells in mastoid and abcess format. Risk IC extension.

• px- tender mastoid, protruding auricle, pyrexia.
• ix- CT
• mx- hosp admiss, IV AB, myringotomy maybe with masotidectomy.

Question 10

Cholesteatoma

Answer 10

Stratif squam epith in mid ear that is locally destructive via growth, expans and collagenases.
Pearly white with surr inflamm.
Congential or acq (prim or sec).
-px- foul disch or deafness. Often late px with headache, pain, facial paral, vertigo (in this case likely IC complics eg mening and cerebral abcess).
-mx- surgic remov.

Question 11

Glue ear

When effusion present after AOM symps.

Answer 11

2-3 yo. Speech and lang delay. Behav probs.
-RF- boys, atopy, downs, cleft palate, winter, passive smok.
-causes- unclear but possib URTI, large adenoids.
-px- drum retrac or bulging. Dull/grey/yellow. Bubbles, fluid level, superfic radial vess. Reduced drum mobil.
-ix- audiogram, impedence audiometry, cult.
-mx- us self resolve, 3 monthly review. Possib LT low dose AB but lack ev. Oral or topical intra nasal ster plus AB. Eust tube inflat using otovent.
Surg if persis- myringotomy plus suction. Grommet. Adenoidectomy.

Question 12

Deafness

Answer 12

Congenital
Peri and post natal- anoxia, birth trauma, CP, mening, ototox drugs, lead, skull frac.
Sensorineural eg noise expos, gentamicin, mumps, acoustic neuroma, MS, vasculopathy, TB.
Conduc eg infec, occlusive, trauma, frac.
Otosclearosis when vasc spongy bone repls norm lamellar bone of otic capsule around oval window which fixes stapes fott plate. Conductive.
Presbyacusis- loss hih freq sound with age.