Ear Disease Flashcards
list common symptoms of ear disease
hearing loss earache - otalgia discarge tinnitus vertigo facial weakness/nerve palsy
what are the signs of ear disease
external scars discarge swelling bleeding masses swelling over mastoid facial weakness hearing loss
describe conductive hearing loss
impaired sound transmission via external canal and middle ear ossicles to the foot of stapes
describe sensorineural hearing loss
defect is central to the oval window of the cochlea
list some causes of conductive hearing loss
otitis externa acute otitis media perforation of tympanic membrane OME cholesteatoma otosclerosis
list some causes of sensorineural hearing loss
presbycusis
noise/drug induced hearing loss
vestibular schwannoma
describe what otitis externa is and its presentation
inflammation of the outer ear
presents with discharge, itch, pain, reduction in hearing later on
what microorganisms cause otitis externa
bacterial - most commonly pseudomonas or staph aureus
fungal - aspergillus or candida
trauma
swimming pools
otitis externa is more common in adults/children
adults, otitis media is more common in children
describe the likely mechanism of how someone could develop acute otitis media
previous URTI which has spread to the middle ear via the Eustachian tube
what are the most common pathogens associated with acute otitis media
RSV
strep. pneumonia
haemophilus influenza
moraxella
what is the clinical presentation of otitis media
otalgia, hearing loss and tympanic membrane perforation - usually resolves spontaneously
at what point is otitis media defined as chronic
> 3 months
chronic otitis media is associated with what condition and why?
glue ear - usually eustachian tube dysfunction or problems with adenoids
chronic otitis media in adults is associated with what conditions
rhinosinusitis
nasopharyngeal carcinoma
nasopharyngeal lymphoma
what is the treatment for chronic otitis media
surgery using laryngotomy - slit in ear drum to allow fluid to escape and insert grommet
describe cholesteatoma
presence of keratinising squamous epithelium in the middle ear - erodes bone and can spread around body leading to abscesses
how does cholesteatoma present
foul smelling discharge
tympanic membrane full of white gunk
possible invasion of ossicles and facial nerve
headache
what are the complications of untreated cholesteatoma
meningitis
abscess
mastoiditis
most commonly presents aged 5-15
what is otosclerosis
fixation of the stapes footplate causing slowly progressing conductive hearing loss
what are the causes of otosclerosis
genetics
linked to oestrogens - progresses more quickly in pregnancy and more common in women
how is otosclerosis treated
stapedectomy
what is presbycusis
gradual loss of hearing related to age - usually high frequency but rate of hearing loss variable
what are the clinical features of presbycusis
slurred speech
difficulty hearing high pitched ‘s’ and ‘h’ sounds
tinnitus
what is the management of presbycusis
hearing aids
what does noise induced hearing loss present with on audiometry studies
classical dip at 4kHz
what drugs are known to cause sensorineural hearing loss
gentamycin
chemotherapy eg cisplastin
aspirin and NSAIDs when in overdose
what is a vestibular schwannoma
benign tumour of vestibular nerve - arising from internal auditory meatus
how does vestibular schwannoma present
hearing loss
tinnitus
imbalance
what is the investigations and treatment of vestibular schwannoma
investigate with MRI
management - surgical removal depending on size, otherwise radiation and observation
glue ear presents with fluid in the ear with signs of acute inflammation true/false
false - presents with fluid in the middle ear but no acute inflammation
does otitis media with effusion present with otalgia or hearing loss
otalgia - no
hearing loss - yes
how does the tympanic membrane appear with OME
retracted with reduced motility
what is the initial treatment for OME
nothing - wait and see as majority resolve within 3 months
if OME has no resolved within 3 months what intervention is done
refer to ENT for grommet insertion, if second intervention is required grommet insertion + adenoidectomy
