Ear disease

Question 1

What is microtia?

Answer 1

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

Question 2

What anomalies can there be of the external auditory canal?

Answer 2

atresia
changes in curvature of canal
stenosis

Question 3

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

Answer 3

cartilage can necrose

Question 4

How can you differentiate between otitis externa and perichondritis?

Answer 4

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

Question 5

Most common causative organisms of acute otitis externa

Answer 5

pseudomonas aeruginosa
staphylococcus aureus

Question 6

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

Answer 6

> 3mo

Question 7

Most common causative organisms of chronic otitis externa

Answer 7

aspergillus species
candida albicans

Question 8

Otitis externa risk factors

Answer 8

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

Question 9

Symptoms of otitis externa

Answer 9

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

Question 10

Signs of otitis externa

Answer 10

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)

Question 11

Otitis externa treatment

Answer 11

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

Question 12

What symptoms would suggest necrotising otitis externa?

Answer 12

night pain
not responding to usual treatment
immunocompromised
cranial nerve involvement

Question 13

What is necrotising otitis externa?

Answer 13

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

Question 14

Necrotising otitis externa causative organism and treatment

Answer 14

pseudomonas aeruginosa
CT temporal bone
long term anti-pseudomonas antibiotics

Question 15

What connects the middle ear to the outer world?

Answer 15

eustachian tube

Question 16

Where does the eustachian tube connect to?

Answer 16

connects middle ear to nasopharynx

Question 17

What is a cholesteatoma?

Answer 17

stratified squamous epithelium in middle ear

Question 18

Why are children more likely to get acute otitis media?

Answer 18

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

Question 19

Otitis media pathogenesis

Answer 19

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

Question 20

Acute otitis media risk factors

Answer 20

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

Question 21

Acute otitis media symptoms

Answer 21

earache
hearing loss
feel systemically unwell

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

Question 22

Acute otitis media treatment

Answer 22

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

antibiotics = 5-7 days amoxicillin

Question 23

Indications for antibiotics in acute otitis media

Answer 23

not better after 3 days
complications
rapidly worsening
immunocompromised

Question 24

When is a myringotomy used to treat otitis media?

Answer 24

(create eardrum perforation to release pressure)

rapidly progressing
facial palsy
refractory

Question 25

What are the subtypes of chronic otitis media?

Answer 25

suppurative (produces discharge): - mucosal - squamous non-suppurative: - effusion (glue ear) - atelectasis - adhesion

Question 26

What causes otitis media with effusion?

Answer 26

eustachian tube dysfunction or block

Question 27

Eustachian tube function

Answer 27

maintain pressure in middle ear

Question 28

Otitis media with effusion pathogenesis

Answer 28

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

Question 29

Otitis media with effusion symptoms

Answer 29

hearing loss pain ear block

Question 30

Otoscopy signs of otitis media with effusion

Answer 30

clear fluid in middle ear air bubbles behind tympanic membrane

Question 31

When are grommets indicated in otitis media with effusion?

Answer 31

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

Question 32

What causes chronic otitis media - mucosal?

Answer 32

repeated otitis media prevents healing of the perforation - persistent perforation copious mucopurulent discharge + hearing loss

Question 33

What is another name for chronic otitis media squamous?

Answer 33

cholesteatoma

Question 34

Cholesteatoma presentation

Answer 34

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

Question 35

Cholesteatoma complications

Answer 35

facial nerve palsy vertigo abscesses

Question 36

What is otosclerosis?

Answer 36

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

Question 37

Otosclerosis presentation

Answer 37

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

Question 38

What causes menieres?

Answer 38

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

Question 39

Menieres presentation

Answer 39

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

Question 40

How is menieres diagnosed?

Answer 40

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

Question 41

Menieres treatment

Answer 41

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

Question 42

What is the difference between labyrinthitis and vestibular neuritis?

Answer 42

labyrinthitis affects whole inner ear - causes hearing loss too vestibular neuritis only affects vestibular nerve - no hearing loss as cochlear not affected

Question 43

Causes of conductive hearing loss

Answer 43

fluid allergies foreign objects ruptured eardrum impacted ear wax

Question 44

Causes of mixed hearing loss

Answer 44

genetic disease virus, disease or infection head trauma

Question 45

Causes of sensorineural hearing loss

Answer 45

ageing ototoxicity loud noise blast/explosion tumours

Question 46

What is audiology?

Answer 46

measurement of hearing with the use of instrument

Question 47

What is audiometry?

Answer 47

measurement of hearing threshold at different frequencies using pure tones

Question 48

What does hearing level at 0dB mean?

Answer 48

normal hearing

Question 49

What does hearing level at 30dB mean?

Answer 49

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

Question 50

How can ear discharge be described?

Answer 50

mucous mucopurulent purulent bloody clear foul smelling

Question 51

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

Answer 51

middle ear