Ear, Nose And Throat Flashcards
What is a complication of pinna haematoma?
Cauliflower ear
Ischaemic necrosis and then fibrosis of the cartilage
What is the treatment for a Pinner haematoma?
Prompt drainage ideally within 24 hours
Ensure that other head injuries have been excluded and hearing mechanism is preserved
What are exostoses?
Irritation from cold wind and water exposure causes the bone surrounding the ear canal to develop smooth bilateral lumps of new bony growth which constrict the ear canal
Aka ‘Surfer’s ear’
What are the two main organisms that cause Otitis Externa?
Pseudomonas
Staphylococcus Aureus
What is bullous myringitis?
Very painful haemorrhagic blisters on deep meatal skin and the drum typically associated with influenza infection
What is malignant/necrotising otitis externa?
Aggressive, life-threatening infection of the external ear that can lead to temporary bone destruction and base-of-skull osteomyelitis. 90% are DM. Immuno suppression also a RF.
What is typically the organism that causes malignant/necrotising otitis externa?
Pseudomonas aeruginosa (Also proteus and klebsiella)
What is the treatment for malignant/necrotising otitis externa?
Surgical debridement, systemic antibiotics, specific immunoglobulins
Causes of discharge in ears?
Otitis externa - scanty watery
Otitis media - most common
Cholesteatoma - rare, often offensive discharge
CSF otorrhoea - CSF leaks may follow trauma
Typical symptoms of Otitis media?
Rapid onset of pain, fever +/- irritability, anorexia, vomiting
Often after a viral URTI
What are the common organisms that cause otitis media?
Pneumococcus, haemophilus, moraxella
What is the treatment for Otitis Media?
NSAIDs and analgesics
Systemic broad spectrum antibiotics if unwell - Amoxicillin
Decongenstants
Myringotomy and grommet insertion (if recurrent)
Adenoidectomy (if recurrent)
What is a Cholesteatoma?
cystic, inflammatory mass of keratinising stratified squamous epithelium which can go on to cause erosion of the middle-ear structures, the inner ear, and the surrounding temporal bone.
What is mastoiditis?
Middle ear inflammation leading to destruction of air cells in the mastoid bone +/- abscess formation
What is “glue ear”?
Otitis media with effusion
What is a pinna haematoma?
Bleeding into the external ear
Often due to trauma - Shearing forces can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage
What is the main mode of presentation of glue ear in children?
Parents notice a hearing impairment in 80% of cases
What would a tympanogram look like for a child with glue ear?
Low, Flat - acoustic impedance
Fluid in the middle ear makes the ear drum stiff, so most of the sound is reflected back to the probe.
What is the management for glue ear?
Usually resolves over time, often only needs reassurance and a 3 month review. Hearing aids or surgery considered if persistent bilateral OME
When would you consider treatment for OME?
If there is severe hearing loss, HL that’s causing significant problems with the child’s learning, development and social skills, Down’s syndrome or a cleft palate
How can childhood causes of deafness be classified?
A) congenital - central, conductive, SNHL,
B) perinatal and postnatal
What is Waardenburg syndrome?
A genetic disorder that causes deafness, white forelock, heterochromia iridis), white eye lashes, and wide-set inner corners of the eyes.
If an adult is found to have a sudden hearing loss, particularly if it is asymmetrical, what three things would you want to exclude?
Acoustic neuroma
Cholesteatoma
Effusion from nasophyngeal cancer
What is Ménière’s disease?
Excess accumulation of endolymph within the membranous labyrinth, causing progressive distension of the ducts. The resulting pressure fluctuations damage the thin membranes of the ear that detect balance and sound.
What is the presentation of Ménière’s disease?
Attacks occur in clusters and last up to 12h
Progressive SNHL
Vertigo and n/v
Tinnitus
Aural fullness
What is the most likely diagnosis for this presentation?
Attacks occur in clusters and last up to 12h, Progressive SNHL, Vertigo and n/v, Tinnitus, Aural fullness
Ménière’s disease
What is the most likely diagnosis?
Sudden vomiting and Severe vertigo exacerbated by head movement, following a febrile illness (eg. URTI)
Viral labyrinthitis
How does Viral Labyrinthitis present?
Sudden vomiting and Severe vertigo exacerbated by head movement, following a febrile illness (eg. URTI)
What is the management for viral labyrinthitis?
Cyclizine
Improves in days