Ear Disease

Question 1

What is otitis externa?

Answer 1

acute inflammation of the meatus (outer ear canal)

Question 2

What are the main bacterial causes of otitis externa?

Answer 2

pseudomonas

staph aureus

Question 3

What is the clinical presentation of otitis externa?

Answer 3

discharge
itch
pain
tragal tenderness

Question 4

What is the management of otitis externa?

Answer 4

cleaning EAC is key

topical antibiotic drops - gentamicin

Question 5

When would the use of gentamicin drops be contraindicated in otitis externa? Why?

Answer 5

If the patient had a perforated ear drum or a grommet

Potential risk of ototoxicity (gentamicin = amino glycoside)

Question 6

What is malignant/ necrotising otitis externa?

Answer 6

extension of OE into the bone surrounding the ear

Question 7

What can malignant OE lead to?

Answer 7

temporal bone destruction and base of skull osteomyelitis

Question 8

What is the main risk factor for malignant OE?

Answer 8

Diabetes - 90% of cases are diabetics

Question 9

What is the most common organism in malignant OE?

Answer 9

Pseudomonas aeruginosa

Question 10

What is the treatment of malignant OE?

Answer 10

surgical debridement, systemic antibiotics, specific immunoglobulins

Question 11

What is acute otitis media?

Answer 11

Inflammation of the middle ear, usually following a viral URTI

Question 12

What is the presentation of acute otitis media?

Answer 12

rapid onset of pain, fever and/or irritability, anorexia, vomiting

Question 13

What causes pain in acute otitis media?

Answer 13

Bulging of the tympanic membrane - this eases if the drug perforates, assoc. with purulent discharge

Question 14

What are some common organisms that cause acute otitis media?

Answer 14

Pneumococcus, H. influenzae, Strep pyogenes, Strep pneumonia

Question 15

What is the treatment of acute otitis media?

Answer 15

60% resolve within 24 hours without antibiotic treatment
If not - amoxicillin (erythromycin if allergic)
optimise analgesia

Question 16

When should you consider immediate antibiotic treatment in acute otitis media?

Answer 16

If the patient is systemically unwell or immunocompromised

If there is no improvement to the symptoms after more than 4 days

Question 17

What is chronic otitis media?

Answer 17

An ear with a TM perforation, as well as recurrent or chronic infection

Question 18

What are the symptoms of chronic otitis media?

Answer 18

hearing loss
otorrhoea
fullness
otalgia

Question 19

What are the different classes of chronic otitis media?

Answer 19

Benign/ inactive
Suppurative
Serous

Question 20

What is the treatment of chronic otitis media?

Answer 20

topical or systemic Abx, depending on the swab
aural cleaning
water precautions
surgery? - mastoidectomy, myringoplasty

Question 21

What is a cholesteatoma?

Answer 21

An abnormal collection of skin cells (squamous epithelium)

Destructive and expanding growth

Question 22

What is the cause of inflammation with a cholesteatoma?

Answer 22

Increased cell turnover and increased keratin production

Question 23

What are the symptoms of a cholesteatoma?

Answer 23

smelly discharge

gradual hearing loss

Question 24

What are some complications of a cholesteatoma?

Answer 24

meningitis, cerebral abscess, hearing loss, mastoiditis, facial nerve dysfunction

Question 25

What is the treatment of a cholesteatoma?

Answer 25

surgical removal

Question 26

What is otitis media with effusion? (OME, Glue Ear)

Answer 26

Inflammation of the middle ear accompanied by accumulation of fluid without signs or symptoms of acute inflammation

Question 27

What are some risk factors for OME?

Answer 27

``` Male Smoking household Atopy Downs syndrome Recurrent AOM or URTI ```

Question 28

What are the symptoms of OME?

Answer 28

``` Deafness Speech delay Poor school performance (inattention) Behavioural problems Balance problems ```

Question 29

What are the signs of OME?

Answer 29

TM retraction Visible ME fluid or bubbles Altered TM colour - grey, yellow, dull Decreased TM mobility

Question 30

What kind of hearing loss do you get in OME?

Answer 30

Conductive

Question 31

What is the treatment for OME?

Answer 31

Watchful waiting - 60% resolved within 3 months Surgery - insertion of a Grommet Hearing aids - if surgery not accepted

Question 32

What is a Grommet?

Answer 32

Used in treatment of OME Small tube that helps drain fluid and maintain pressure NOT CURATIVE - helps with symptoms

Question 33

What is a vestibular schwannoma?

Answer 33

A benign, slow growing intracranial tumour that develops from the vestibular portion of the vestibulocochlear nerve/ CN VIII