Ear infections

Question 1

What are the main features of otitis media?

Answer 1

• Otalgia
• Fever
• Hearing loss
• Recent URTI symptoms
• Ear discharge (if TM has perforated)

Question 2

Possible otoscopy findings of otitis media?

Answer 2

1. Bulging tympanic membrane
2. Opacification/ erythema of tympanic membrane
3. Perforation with purulent otorrhoea

Question 3

Diagnostic criteria for otitis media…

Answer 3

1. Acute onset of symptoms (otalgia)
2. Presence of middle ear infection (bulging TM, otorrhoea)
3. Inflammation of TM (erythema)

Question 4

When should antibiotics be used in otitis media?

Answer 4

• Symptoms lasting more than 4 days
• Systemically unwell - not requiring admission
• immunocompromised/ high risk of complications
• Younger than 2 with bilateral otitis media
• Otitis media with perforation

Question 5

What are the main features of otitis externa?

Answer 5

• Otalgia
• Itchiness
• Discharge
• Otoscopy reveals red, swollen, eczematous canal

Question 6

What is the initial management of otitis externa?

Answer 6

• Topical antibiotic or combined topical antibiotic + steroid
• Canal debris –> should be removed
• Extensively swollen canal –> use ear wick
  **If patient does not respond to topical antibiotics - referral to ENT is required

Oral abx such as flucloxacillin may be used if the infection is spreading

Question 7

What is the distinctive feature of otitis media with effusion?

Answer 7

• Sensation of fullness in the ear
• RETRACTED tympanic membran - not bulging

Question 8

What is malignant otitis externa?

Answer 8

Invasive bacterial infection originating in the soft tissues of external auditory meatus, which then involves bone ear canal and may progress to temporal bone osteomyelitis.

Question 9

Features of osteomyelitis…

Answer 9

• Mainly seen in diabetics (90%) and immunocompromised (10%)
• Severe, un-relenting, deep-seated otalgia
• Temporal headaches
• Purulent otorrhea
• Dysphagia/ hoarseness of voice

Question 10

Main features of cholesteatoma?

Answer 10

• Foul-smelling discharge
• Hearing loss
• Vertigo / facial nerve palsy - local invasion
• Otoscopy reveals “attic crust” - uppermost part of ear drum

Question 11

What is presbycusis?

Answer 11

Age-related sensorineural hearing loss
Difficulty following conversations

Question 12

What is otosclerosis?

Answer 12

Autosomal dominant condition, leading to replacement of normal bone with vascular spongy bone - causes conductive deafness.
Features: Tinnitus, family hx, conductive deafness

Question 13

What is glue ear and its main features?

Answer 13

Otitis media with effusion - mainly seen in young infants
Conductive hearing loss in children
Speech and language delay, behavioural and balance problems

Question 14

What are the main features of Meniere’s disease?

Answer 14

• Recurrent episodes of vertigo, tinnitus, hearing loss
• Sensation of aural fullness
• Other features include nystagmus
• Episodes last minutes to hours

Question 15

Common drugs that cause ototoxicity…

Answer 15

Aminoglyclosides - gentamicin
Furosemide
Aspirin

Question 16

Features of acoustic neuroma

Answer 16

CN VIII = tinnitus, vertigo, hearing loss
CN V = absent corneal reflex
CN VII = facial nerve palsy

Question 17

What are the Rinnes and Weber’s findings seen in conductive hearing loss?

Answer 17

Rinnes:
Bone > Air in affected ear
Air> Bone in unaffected ear

Webers:
Lateralises to affected ear

Question 18

What are the Rinnes and Weber’s findings seen in sensorineural hearing loss?

Answer 18

Rinnes:
Air> Bone bilaterally

Webers:
Lateralises to unaffected side

Question 19

What are the Rinnes and Weber’s findings seen in normal hearing?

Answer 19

Rinnes:
Air> Bone bilaterally

Webers:
Midline