Ear Disease Flashcards
What is otitis externa?
acute inflammation of the meatus (outer ear canal)
What are the main bacterial causes of otitis externa?
pseudomonas
staph aureus
What is the clinical presentation of otitis externa?
discharge
itch
pain
tragal tenderness
What is the management of otitis externa?
cleaning EAC is key
topical antibiotic drops - gentamicin
When would the use of gentamicin drops be contraindicated in otitis externa? Why?
If the patient had a perforated ear drum or a grommet
Potential risk of ototoxicity (gentamicin = amino glycoside)
What is malignant/ necrotising otitis externa?
extension of OE into the bone surrounding the ear
What can malignant OE lead to?
temporal bone destruction and base of skull osteomyelitis
What is the main risk factor for malignant OE?
Diabetes - 90% of cases are diabetics
What is the most common organism in malignant OE?
Pseudomonas aeruginosa
What is the treatment of malignant OE?
surgical debridement, systemic antibiotics, specific immunoglobulins
What is acute otitis media?
Inflammation of the middle ear, usually following a viral URTI
What is the presentation of acute otitis media?
rapid onset of pain, fever and/or irritability, anorexia, vomiting
What causes pain in acute otitis media?
Bulging of the tympanic membrane - this eases if the drug perforates, assoc. with purulent discharge
What are some common organisms that cause acute otitis media?
Pneumococcus, H. influenzae, Strep pyogenes, Strep pneumonia
What is the treatment of acute otitis media?
60% resolve within 24 hours without antibiotic treatment
If not - amoxicillin (erythromycin if allergic)
optimise analgesia
When should you consider immediate antibiotic treatment in acute otitis media?
If the patient is systemically unwell or immunocompromised
If there is no improvement to the symptoms after more than 4 days
What is chronic otitis media?
An ear with a TM perforation, as well as recurrent or chronic infection
What are the symptoms of chronic otitis media?
hearing loss
otorrhoea
fullness
otalgia
What are the different classes of chronic otitis media?
Benign/ inactive
Suppurative
Serous
What is the treatment of chronic otitis media?
topical or systemic Abx, depending on the swab
aural cleaning
water precautions
surgery? - mastoidectomy, myringoplasty
What is a cholesteatoma?
An abnormal collection of skin cells (squamous epithelium)
Destructive and expanding growth
What is the cause of inflammation with a cholesteatoma?
Increased cell turnover and increased keratin production
What are the symptoms of a cholesteatoma?
smelly discharge
gradual hearing loss
What are some complications of a cholesteatoma?
meningitis, cerebral abscess, hearing loss, mastoiditis, facial nerve dysfunction
What is the treatment of a cholesteatoma?
surgical removal
What is otitis media with effusion? (OME, Glue Ear)
Inflammation of the middle ear accompanied by accumulation of fluid
without signs or symptoms of acute inflammation
What are some risk factors for OME?
Male Smoking household Atopy Downs syndrome Recurrent AOM or URTI
What are the symptoms of OME?
Deafness Speech delay Poor school performance (inattention) Behavioural problems Balance problems
What are the signs of OME?
TM retraction
Visible ME fluid or bubbles
Altered TM colour - grey, yellow, dull
Decreased TM mobility
What kind of hearing loss do you get in OME?
Conductive
What is the treatment for OME?
Watchful waiting - 60% resolved within 3 months
Surgery - insertion of a Grommet
Hearing aids - if surgery not accepted
What is a Grommet?
Used in treatment of OME
Small tube that helps drain fluid and maintain pressure
NOT CURATIVE - helps with symptoms
What is a vestibular schwannoma?
A benign, slow growing intracranial tumour that develops from the vestibular portion of the vestibulocochlear nerve/ CN VIII
