Ear Disease Flashcards
A bone-gap in the audiogram indicates what
Conductive hearing loss
Ear discomfort can involve which nerves (5)
1) CN V 2) CN VII 3) CN IX 4) CN X 5) C2, C3 roots
Discharge from the ear (otorrhoea) can be due to what (3)
1) AOM 2) COM 3) CSF
Otitis externa is present in which group typically
Swimmers
Otitis externa will be a slow/rapid onset pain?
Rapid (<48 hours).
Otitis externa can cause what type of hearing loss
Conductive
What is the 1st line investigation in otitis externa?
Otoscopy
Should otitis externa be swabbed?
No
What is the main therapy for otitis externa?
Aural toilet (cleaning). If bacterial: ofloxacin drops. If fungal: topical antifungals (e.g. clotrimazole).
Secondary investigation in otitis externa?
CT (rule out malignant otitis externa)
What does this otoscopy indicate?
Otitis externa
Otitis media patients tend to be young/old. What are the common symptoms?
Young. Acute ear pain, irritability and sleep disturbance.
“Day care attendance” and “older siblings sick” is buzzword for what
Acute Otitis Media
What infection type is associated with AOM?
Upper respiratory tract
How is AOM diagnosed?
Otoscopy (bulging tympanic membrane) + history (URTI).
What’s the guidance around antibiotic prescription and AOM?
No antibiotics generally needed (as they will only reduce symptom duration by 1 day). If there is significant otorrhoea present, amoxicillin 500mg TDS is given (clarithromycin if allergic).
What is considered “chronic” otitis media?
>3 episodes in 6 months OR >5 episodes in 12 months
If severe, AOM can develop into what
Otitis media with effusion (can perforate TM)
What does this otoscopy show?
AOM
What does this otoscopy show?
Cholesteatoma
OME is also called…
Glue ear
How is glue ear treated?
Observe for 3 months.
If unchanged, if there is hearing loss ocnsider Groment insertion.
What does this otoscopy show?
OME
T/F: Cholesteatoma has no serious complications beside conductive hearing loss.
False - can erode into the bone.
What’s the gold standard investigation for diagnosing cholesteatoma?
Diffusion-weighted MRI
How is cholesteatoma treated?
Surgery to remove
Waldeyer’s Ring is composed of which tonsils
Palatine, pharyngeal (adenoids) and lingual
Which epithelium covers the adenoids?
Ciliated pseudostratified columnar
Most common cause of acute tonsillitis
Virus (mainly rhinovirus, influenza)
Important bacteria to consider in acute tonsillitis
Group-A beta haemolytic strep (S. pyogenes) as they can cause rheumatic fever and glomerluonephritis
Is throat swabbing recommended to diagnose acute tonsillitis?
No (pathogen recovery poor)
Spot Diagnosis
Acute tonsillitis
Most common bacterial isolates in tonsillitis
S. pyogenes, H. influenzae, S. pneumoniae
How can viral and bacterial sore throats be differentiated?
Bacterial tends to last 1 week (viral only 3-4 days).
Bacterial tends to be more severe where the patient cannot work (viral tends to be near-normal QoL)
What is the Centor Criteria
A system used to differentiate bacterial from viral infection.
1) History of fever
2) Tonsillar exudates
3) Tender anterior cervical lymph nodes
4) Absence of cough
5) Age <15
What Centor scores should receive an antibiotic?
4 or more empircal
2-3 give an antibiotic if symptoms worsen
How is tonsillitis treated?
Supportively (hot tea, rest, OTC analgesia).
Antibiotics if Centor indicated (penicillin 500mg QID or clarithromycin if allergic)
T/F: Tonsillectomy is routine in tonsillitis patients.
False - only done if there have been >7 treated sore throats in the past year
Peritonsillar abscess is a classical complication of what condition
Acute tonsillitis
Triad of peritonsillar abscess
1) Unilateral throat pain and odynophagia
2) Trismus (spasm of jaw muscles)
3) 3-7 days of preceding tonsillitis
How is quinsy treated
Aspiration & antibiotics (benzylpenicillin PO)
Cause of IM
EBV
Spot diagnosis: A patient presents with marked cervical lymphadenopathy, palatal petechia haemorrhages and gross tonsilar enlargement with a membranous exudate
Glandular Fever
Serious complication of IM
Hepato-splenomegaly
How is IM diagnosed
Atypical lymphocytes, +MonoSpot test, EBV IgM in clotted blood
How is IM managed?
Symptom relief.
Do NOT prescribe amoxicillin/ampicillin (can cause a generalised macular rash)
Which drug should be avoided at all costs in EBV infection?
Amoxicillin
Hyperplasia of which tonsils gives snoring?
Palatine tonsils
Hyperplasia of which tonsils can give a hyponasal voice?
Adenoids
T/F: Enlarged tonsils without symptoms need to be treated.
False
T/F: Glue ear/ AOM presents with signs of acute inflammation.
False - differentiates from AOM (where there is inflammation of the middle ear)
Otitis Media with Effusion is a cause of earache. T/F?
False
OME is a cause of hearing loss.
True.
OME can be triggered by what
Day care, household smoking, recurrent URTI, recurrent AOM
Air Bone gap suggests what
Conductive Hearing loss
How is OME treated?
Watchful waiting for 3 months
If persistent treatment depends upon age:
- <3 years old OR first-line therapy = Grommet insertion
- >3 years OR 2nd line therapy = Grommets AND adenoidectomy
nb: if nasal symptoms are present, adenoidectomy may be considered earlier on.
Investigations in OME
Otoscopy, tuning fork tests, audiometry, tympanometry
