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ENT > Ear disease > Flashcards

Ear disease Flashcards

1
Q

What is microtia?

A

small ear

grade 1 = small but almost normal
grade 2 = some recognisable anatomy
grade 3 = small rudiment of soft tissue and no ear canal
grade 4 = no external ear and no ear canal

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2
Q

What anomalies can there be of the external auditory canal?

A

atresia
changes in curvature of canal
stenosis

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3
Q

What can happen if an auricular haematoma is left without being drained?

A

cartilage can necrose

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4
Q

How can you differentiate between otitis externa and perichondritis?

A

perichondritis spares the earlobe as it is only inflammation of the cartilage and the lobe contains no cartilage

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5
Q

Most common causative organisms of acute otitis externa

A

pseudomonas aeruginosa
staphylococcus aureus

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6
Q

How long does otitis externa have to last to be chronic?

A

> 3mo

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7
Q

Most common causative organisms of chronic otitis externa

A

aspergillus species
candida albicans

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8
Q

Otitis externa risk factors

A

swimming
skin conditions (eg. eczema, dermatitis, psoriasis)
hot, humid
trauma
climates
tightly fitting hearing aid
use of ear plug

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9
Q

Symptoms of otitis externa

A

itch
ear pain and tenderness of tragus and/or pinna
ear discharge
hearing loss due to ear canal occlusion (rare)

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10
Q

Signs of otitis externa

A

tenderness of tragus and/or pinna
red ear canal with discharge
cellulitis of pinna and adjacent skin
conductive hearing loss (less common)
tender regional lymphadenitis (less common)
scaly ear canal (chronic)

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11
Q

Otitis externa treatment

A

self care measures:
- avoid self cleaning
- water precautions
- acetic acid 2% ear drops or spray
- manage risk factors

analgesia
topical antibiotic with or without topical corticosteroid 7-14 days
oral antibiotic if immune compromised, severe infection or spread beyond external ear canal

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12
Q

What symptoms would suggest necrotising otitis externa?

A

night pain
not responding to usual treatment
immunocompromised
cranial nerve involvement

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13
Q

What is necrotising otitis externa?

A

progressive infection of external ear canal which may spread to cause osteomyelitis of the temporal bone and adjacent structures

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14
Q

Necrotising otitis externa causative organism and treatment

A

pseudomonas aeruginosa
CT temporal bone
long term anti-pseudomonas antibiotics

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15
Q

What connects the middle ear to the outer world?

A

eustachian tube

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16
Q

Where does the eustachian tube connect to?

A

connects middle ear to nasopharynx

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17
Q

What is a cholesteatoma?

A

stratified squamous epithelium in middle ear

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18
Q

Why are children more likely to get acute otitis media?

A

eustachian tubes shorter and broader
easier for infections to spread from nose

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19
Q

Otitis media pathogenesis

A

pressure on the eardrum, and fluid restricts the movement of the bones of the middle ear which impairs hearing

eardrum is initially pulled inward, causing pain

as infection progresses, the fluid pressure can cause the eardrum to bulge outwards

eustachian tube becomes inflamed and blocked

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20
Q

Acute otitis media risk factors

A

young age
smoking and/or passive smoking
day care/nursery attendance
formula feeding - breastfeeding is protective
craniofacial abnormalities eg. cleft palate
use of a dummy
prolonged bottle feeding in supine position
family history of otitis media
gastrooesophageal reflux
prematurity
recurrent URTI
immunodeficiency

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21
Q

Acute otitis media symptoms

A

earache
hearing loss
feel systemically unwell

younger children = tugging ear, fever, crying, poor feeding, restlessness

22
Q

Acute otitis media treatment

A

paracetamol/ibuprofen for pain
treat URTI if present
normal course = 3-7 days

antibiotics = 5-7 days amoxicillin

23
Q

Indications for antibiotics in acute otitis media

A

not better after 3 days
complications
rapidly worsening
immunocompromised

24
Q

When is a myringotomy used to treat otitis media?

A

(create eardrum perforation to release pressure)

rapidly progressing
facial palsy
refractory

25
Q

What are the subtypes of chronic otitis media?

A

suppurative (produces discharge):
- mucosal
- squamous

non-suppurative:
- effusion (glue ear)
- atelectasis
- adhesion

26
Q

What causes otitis media with effusion?

A

eustachian tube dysfunction or block

27
Q

Eustachian tube function

A

maintain pressure in middle ear

28
Q

Otitis media with effusion pathogenesis

A

eustachian tube block
negative pressure in middle ear
effusion in middle ear
absorption of effusion
retraction, adhesion, atelectasis

29
Q

Otitis media with effusion symptoms

A

hearing loss
pain
ear block

30
Q

Otoscopy signs of otitis media with effusion

A

clear fluid in middle ear
air bubbles behind tympanic membrane

31
Q

When are grommets indicated in otitis media with effusion?

A

persistent effusion causing hearing or speech impairment
bilateral more than or equal to 25dB

32
Q

What causes chronic otitis media - mucosal?

A

repeated otitis media prevents healing of the perforation - persistent perforation

copious mucopurulent discharge + hearing loss

33
Q

What is another name for chronic otitis media squamous?

A

cholesteatoma

34
Q

Cholesteatoma presentation

A

intermittent scanty foul smelling ear discharge which can be blood stained
hearing loss

35
Q

Cholesteatoma complications

A

facial nerve palsy
vertigo
abscesses

36
Q

What is otosclerosis?

A

stapes gets fixed
sound doesn’t pass through
conductive hearing loss

37
Q

Otosclerosis presentation

A

females»
hearing loss
worsening of hearing loss during pregnancy and childbirth
?hormonal

38
Q

What causes menieres?

A

increased production/decreased absorption of endolymph
causes endolymphatic hydrops (swelling)
swelling distorts balance an dsound information

39
Q

Menieres presentation

A

vertigo - 20mins-12hours
hearing loss - fluctuating
tinnitus - non-pulsatile
aural fullness

40
Q

How is menieres diagnosed?

A

clinical
audiogram - low frequency sensorineural hearing loss
calorics tests
electrococheogram
MRI to rule out central cause

41
Q

Menieres treatment

A

self limiting
diet and lifestyle
medical - diuretics, betahistine, intratympanic
surgical - endolymphatic sac surgery, sacculotomy, vestibular neurectomy, labyrinthectomy

42
Q

What is the difference between labyrinthitis and vestibular neuritis?

A

labyrinthitis affects whole inner ear - causes hearing loss too

vestibular neuritis only affects vestibular nerve - no hearing loss as cochlear not affected

43
Q

Causes of conductive hearing loss

A

fluid
allergies
foreign objects
ruptured eardrum
impacted ear wax

44
Q

Causes of mixed hearing loss

A

genetic disease
virus, disease or infection
head trauma

45
Q

Causes of sensorineural hearing loss

A

ageing
ototoxicity
loud noise
blast/explosion
tumours

46
Q

What is audiology?

A

measurement of hearing with the use of instrument

47
Q

What is audiometry?

A

measurement of hearing threshold at different frequencies using pure tones

48
Q

What does hearing level at 0dB mean?

A

normal hearing

49
Q

What does hearing level at 30dB mean?

A

has 30dB less than normal hearing
(would need to speak 30dB louder to be heard)

50
Q

How can ear discharge be described?

A

mucous
mucopurulent
purulent
bloody
clear
foul smelling

51
Q

If discharge is mucoid/mucopurulent, where is it coming from?

A

middle ear

52
Q
A

ENT (14 decks)

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