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ENT > Ear Infections > Flashcards

Ear Infections Flashcards

1
Q

What are the risk factors for otitis externa?

A 
Frequent water contact (swimmers)
Humid environments
Ear polyps
Foreign bodies
Narrow ear canal
Ear eczema or psoriasis
Local trauma (hearing aids, cotton buds)
Immunocompromised + DM (+increased risk of complications)
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2
Q

What are the common bacterial causes of otitis externa?

A

Staph aureus
Proteus
Pseudomonas aeruginosa

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3
Q

What are the fungal causes of otitis externa?

A

Aspergillus niger

Candida albicans

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4
Q

What are the clinical features of otitis externa?

A 
Ear pain
Purulent discharge
Itchiness
Ear fullness
Less commonly: hearing loss + tinnitus
Swollen, erythematous ear canal
Swollen pinna, tender tragus
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5
Q

How is otitis externa diagnosed and which investigations can be done?

A

Diagnosed clinically

Swab discharge if not resolving or fungal cause suspected
High resolution CT if complications

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6
Q

How is otitis externa managed?

A

Topical aural toilet
Antibiotic drops (gentamicin or ciprofloxacin) - only if complicated e.g. signs of cellulitis
Topical clotrimazole

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7
Q

What is malignant otitis externa?

A

Life threatening complication

–> extension of OE into temporal and mastoid bone

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8
Q

What are the clinical features of malignant otitis externa?

A

Severe pain + headaches
Granulation tissue/exposed bone in the canal
Facial palsy

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9
Q

How is malignant otitis externa investigated and managed?

A

Urgent high resolution CT + biopsy for culture

–> urgent debridement + IV antibiotics

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10
Q

What causes acute otitis media (AOM)?

A

Nasopharyngeal bacteria/virus –> middle ear via Eustachian tube

Bacteria: H. influenzae, S. pneumoniae, S. pyogenes, M. catarrhalis

Viruses: RSV, rhinovirus, enterovirus

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11
Q

What are the risk factors for AOM?

A 
Age (peak 6-15 months)
Boys
Passive smoking
Bottle feeding 
Craniofacial abnormalities
Nursery/day care
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12
Q

What are the clinical features of AOM?

A

Preceded by URTI
Pain, malaise, fever + coryzal symptoms lasting a few days
In young children: ear tugging, irritability, loss of appetite, vomiting
May be conductive hearing loss
Purulent discharge if TM bursts (pain improves)

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13
Q

What might be seen on examination in AOM?

A 
Otoscopy:
- erythematous bulging TM
- injected TM
- may be rupture + discharge
Cervical lymphadenopathy
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14
Q

Function of which nerve needs to be checked in AOM?

A

Facial nerve

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15
Q

What is the management for AOM?

A

Analgesia (ibuprofen) and anti-pyretic (paracetamol)
- majority self limiting in 1 - 3 days
Oral antibiotics if no improvement in a few days or:
- systemically unwell
- known risk factor for complications
- discharge (take swabs first)

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16
Q

Which antibiotics are used for AOM?

A

First line: amoxicillin 5 days

Second line: clarithromycin

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17
Q

When should you consider admission for AOM?

A
  • child < 3 months with temperature > 38
  • child 3-6 months with temperature > 39
  • evidence of complications
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18
Q

What are the intratemporal complications of AOM?

A
  • tympanosclerosis (white patch on ear drum due to scarring)
  • hearing loss
  • TM perforation
  • mastoiditis
  • labyrinthitis
  • CN VII palsy
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19
Q

What are the intracranial complication of AOM?

A
  • meningitis
  • intracranial abscess
  • lateral sinus thrombosis
  • cavernous sinus thrombosis
  • subdural empyema
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20
Q

Why does mastoiditis occur and what is the pathology?

A

Middle ear + mastoid are one cavity –> always a degree of mastoiditis with AOM
If inflammation in air cells progresses to necrosis + subperiosteal abscess –> very concerning

21
Q

What does mastitis look like?

A

Boggy, erythematous swelling behind ear, can push pinna forward if not treated

22
Q

How is mastoiditis managed?

A

Admit for IV antibiotics
CT if no improvement in 24 hours
Mastoidectomy if no improvement with antibiotics (high risk of intracranial spread)

23
Q

What is otitis media with effusion (OME)?

A

Middle ear effusion without signs of infections (glue ear)

24
Q

Why is OME more common in young children?

A

Immature shape of Eustachian tube

25
Q

What should be considered if new onset unilateral OME in an adult?

A

Red flag for malignancy blocking Eustachian tube

26
Q

What are the risk factors for OME?

A 
Bottle fed
Passive smoking
Atopy
CF or primary ciliary dyskinesia
Craniofacial disorders e.g. Down's, cleft palate
27
Q

What are the clinical features of OME?

A

Conductive hearing loss (may be unilateral or bilateral)
–> may present as behaviour problems or poor speech development
Sensation of pressure +/- popping or clicking noises

28
Q

What would be seen on otoscopy in OME?

A

Dull TM +/- fluid level line
Light reflex will be lost
May see bubble behind TM

29
Q

Which investigations should be done for OME?

A

Pure tone audiometry –> conductive hearing loss
Tympanometry
In adults –> full ENT exam + flexible nasoendoscopy

30
Q

What would tympanometry show in OME?

A

Flat trace due to reduced membrane compliance

–> type B curve

31
Q

How is OME managed?

A

Active surveillance for 3 months (most resolve)
If no improvement:
- non-surgical: hearing aid while waiting for resolution
- surgical: myringotomy + ventilation tube (grommet) insertion

32
Q

What are the indications for grommet insertion?

A

> 3 months of bilateral OME + hearing in better ear < 25-30 dBHL

33
Q

How long does a grommet last and what are the complications?

A

Usually fall out after about 9 months

Complications:

  • tympanosclerosis (scar)
  • TM rupture
34
Q

Which surgical procedure can be done for recurrent OME?

A

Adenoidectomy

35
Q

How are types of chronic otitis media categorised?

A

Mucosal: TM perforation in presence of recurrent/persistent ear infection
Squamous: gross retraction of TM with formation of keratin collection

Active: infection present
Inactive

36
Q

What is an inactive mucosal chronic otitis media?

A

Dry perforation

37
Q

What is an inactive squamous chronic otitis media?

A

Retraction pocket

Potential to become active with retained debris (keratin)

38
Q

What is an active mucosal chronic otitis media?

A

Wet perforation with inflamed middle ear + discharge

39
Q

What is an active squamous chronic otitis media?

A

Cholesteatoma

40
Q

What are the clinical features of mucosal COM?

A

Hearing loss
Chronic discharge
May develop secondary otitis externa
Often history of recurrent AOM, previous ear surgery or trauma

41
Q

How is mucosal COM managed?

A

Aural toiletting + topical steroid/antibiotic cream (if active)
Most TM perforations heal, but large holes may require surgery

42
Q

What are the surgical options for a large TM perforation in COM?

A

Myringoplasty –> closure of perforated pars tensa using a patch of autologous graft (cartilage or fascia)
Tympanoplasty –> a myringoplasty with reconstruction of the ossicular chain

43
Q

What is a cholesteatoma?

A

Accumulation of benign keratinised squamous cells in middle ear
Secrete enzymes which can be locally destructive

44
Q

How does a cholestatoma form?

A

Usually ET dysfunction/otitis media
–> retraction of pars flaccida causing a pocket to form in attic of middle ear
–> cell debris builds up –> cholesteatoma
Debris can become infected –> chronic discharge

45
Q

What are the clinical features of cholesteatoma?

A

Conductive hearing loss on background of chronic otitis media
Persistent discharge despite antibiotics

46
Q

What is seen on otoscopy in cholesteatoma?

A

Pay particular attention to superior TM (attic)

  • deep retraction pocket with keratinous debris within it -“pearly mass”
  • may be granulations + bony erosion
  • discharge if secondary infection
47
Q

Which investigations need to be done for a cholesteatoma?

A

Pure tone audiometry

CT of temporal bone

48
Q

How is cholesteatoma managed?

A

Surgery –> removal of entire cholesteatoma or it will recur

  • mastoid cavity drilled to allow access to middle ear
  • once removed, any destructed ossicles can be reconstructed (ossiculoplasty) + TM replaced with graf

ENT (14 decks)

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