Ear Disease Flashcards
Describe the epithelium present within the ear.
- EXTERNAL AUDITORY CANAL - squamous
- MIDDLE EAR CLEFT - respiratory epithelium
- Inner ear - neuroepithelium
- Outer surface of tympanic membrane is squamousal and inner surface is mucosal
Describe the function of earwax.
Keeps external ear canal - important in infection prevention
Identify some commensals found in the ear
- Staph. aureus and Pseudomonas aeruginosa (BACTERIA - Gram positive coccal and Gram negative rod shaped respectively )
- Candida albicans (FUNGI)
STAPH AUREUS - CAUSES CELLULITIS
What are some ear-related symptoms you’d want to check for in an ear history?
- Hearing loss
- Ear discharge (otorrhea)
- Ear pain (otalgia)
- Ringing in ear (tinnitus)
- Dizziness/vertigo
- Facial weakness
- Other ear – any symptoms?
- “Which ear is your better hearing ear?”
IN EXAMINATION - ALWAYS START WITH BETTER HEARING EAR
What is otitis externa and list some risk factors?
INFECTION OF EXTERNAL AUDITORY MEATUS
- Trauma - cotton buds
- Swimming
- Humidity
- Eczema
- Literally anything affecting the acidic pH of the ear canal
List some symptoms and signs upon examination for otitis externa.
OTALGIA AND OTORRHOEA
- Pain on palpating the tragus
- Debris on otoscopy
Describe treatment for otitis externa
ORAL ANTIBIOTICS DO NOT WORK
- Use drops - antifungal e.g clotriamzole/ antibiotic - aminoglycoside/quinolone
- 3 drops, 3 times a day for 1 week
SOMETIMES - EAR MICROSUCTIONING - FOR DEBRIS REMOVAL
Is there ever any instances oral antibiotics can be used for otitis externa?
- NECROTISING OTITIS EXTERNA
- PERICHONDRITIS +/- SUPERFICIAL SPREADING CELLULITIS (with flucloxacillin or ciprofloxacin)
Describe necrotising otitis externa.
- Non-neoplastic infection of ear canal - commonly caused by Pseudomonas
- Severe ear pain associated with granulations in ear canal in diabetic or immunocompromised patients
- May involve lowe cranial nerves (CN VII-XII)
- Treat with topical AND systemic quinolones such as ciprofloxacin for 6-12 weeks
- AT RISK - ELDERLY DIABETICS WITH DEEP EAR PAIN - ADMIT TO HOSPITAL with IV antibiotics
Describe acute otitis media.
Acute inflammation of middle ear cleft
- Root of problem is usually dysfunction of Eustachian tube leading to poorly ventilating middle ear
Why is AOM more common in kids?
Narrower Eustachian tube
Describe the mechanisms leading to AOM.
- Dysfunction of Eustachian tube
- Negative pressure in middle ear
- Hyperaemia leading to exudation which leads to hearing loss in kids
- Bacterial migration from nasopharynx leading to suppuration
- Pus passing through eardrum - which heals overtime
Describe some risk factors in AOM.
- Age <7 years
- Male gender
- Upper respiratory tract infection
- Anatomical abnormalities: cleft palate, craniofacial anomalies
- Immunological deficiencies: immunoglobulin deficiencies, AIDS, leukaemia, immunosuppressants
What happens when pus isn’t released in AOM?
- Can pass to mastoid process - mastoiditis which can lead to abscesses
- Can pass to brain - meningitis
- Can pass to inner ear - vertigo
COALESCENCE OCCURS RATHER THAN RESOLUTION
Name 3 bacteria associated with AOM.
- Strep. pneumoniae
- Haemophilus influenzae
Moraxhella catharralis
ALL ARE ENCAPSULATED - LOCATED IN ADENOIDS
What does it mean for a bacteria to be encapsulated?
Presence of polysaccharide capsule
- Linked to B cell receptor signalling and production of complement fixing
- Opsonising IgG for host defence against pathogens
Describe AOM presentation and management. PART 1
Typically an unwell, often pyrexial child tugging ear.
1st 24-48 hrs, supportive measures only as >80% will self- resolve:
* Antipyretics: paracetamol/ibuprofen
* Fluids
* If not settling, then consider oral amoxicillin.
Describe AOM presentation and management. PART 2
- If still not settling after 72 hrs from starting amoxicillin, possible drug resistance – change to co-amoxiclav (amoxicillin with clavulanic acid).
- If still not settling (rare) – cut ear drum under GA to
release pus (myringotomy) - If STILL not settling, check IgG levels and if low, refer to immunologist.
What can be done during recurrent AOM?
Insert a ventilation tube which prevents fluid build up
Describe common symptoms of chronic otitis media.
- Intermittently or persistently discharging ear without fever
- Smelly ear
- Pain
- Hearing loss – tympanic membrane perforation +/- ossicular chain erosion
Describe some other presentations of COM.
Facial weakness – CN VII involvement
* Vertigo – labyrinthine involvement
* CNS symptoms – intracranial involvement
Describe COM classification
- Either squamous disease (retracted drum) or mucosal disease (hole in drum)
Compare and contrast the two sub-conditions of squamous disease in COM.
- INACTIVE SQUAMOUS (Retraction pocket) - Mainly observe if not causing problems
- ACTIVE SQUAMOUS (Cholesteatoma - skin cell trapping - causing erosion within ear canal) - Surgery (tympanomastoidectomy)
Compare and contrast the two sub-conditions of mucosal disease in COM.
- INACTIVE MUCOSAL (Perforation) - Observe or surgery (patient choice)
- ACTIVE MUCOSAL (Chronic suppurative OM - infective perforation) - Observe or surgery (tympanoplasty)
