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MC > Ear pain > Flashcards

Ear pain Flashcards

1
Q

Of patients presenting with earache, 77% can be expected to have ____ and 12% ___

A

acute otitis media

otitis externa.

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2
Q

Otitis media is unlikely to be present if the

__________

A

tympanic membrane (TM) is mobile.

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3
Q

_______ greatly assists diagnosis since the most valuable sign of otitis media is absent or diminished motility of the TM

A

Pneumatic otoscopy

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4
Q

________ which causes haemorrhagic blistering of the eardrum or external ear canal, is an uncommon cause of severe pain. It is caused by a virus, probably influenza

A

Bullous myringitis,

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5
Q

The antibiotic of first choice for acute otitis media (children and adults) is _______

A

amoxycillin

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6
Q

Otitis externa can be distinguished from otitis

media by ________

A

pain on movement of the pinna

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7
Q

Red flags for painful ear

A 
• Offensive discharge >9 days
• Downward displacement of pinna
• Swelling behind ear
• Neurological symptoms (e.g. headaches,
drowsiness)
• Older person: unexplained, intractable ear pain
• Persistent fever
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8
Q

Disorders of the _______ are a

commonly overlooked cause of periotic pain

A

upper cervical spine

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9
Q

movement of the jaw usually causes an exacerbation of ______

A

TMJ arthralgia or severe otitis externa.

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10
Q

T or F

Impacted wax may not explain the otalgia.

A

T

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11
Q

Swabs from discharge, especially to determine bacterial causes, such as _____ or _______

A

Staphylococcus aureus or

Pseudomonas spp. infection

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12
Q

How to extract foreign bodies. What methods?

1
2

A

Probe method

Rubber catheter suction method

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13
Q

The only equipment required for this relatively simple and painless method is a ________

A

straight rubber catheter (large

type) and perhaps a suction pump

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14
Q

Persistent middle ear effusions may follow

and affect the _____ and _______

A

language and cognitive development of

young children

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15
Q

2 peaks of otitis media in children

A

6–12 months of age and

school entry

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16
Q

MC cause of otitis media in children

A

Streptococcus pneumoniae,
Haemophilus influenzae and
Moraxella catarrhalis

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17
Q

The main symptomsof otitis media in older children are ____ and ______

A

increasing earache and hearing loss

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18
Q

Possible clinical indications for antibiotics

in children with painful otitis media

A 
• <2 years with bilateral otitis media
• Sick child with fever
• Vomiting
• Red–yellow bulging TM
• Loss of TM landmarks or perforation
• Persistent fever and pain after 48 hours
conservative approach
• Risk of complications in those at risk
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19
Q

______ is also the preferred choice of otitis media in the US and UK

A

Amoxycillin

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20
Q

With appropriate treatment most children with

acute otitis media are significantly improved within ________

A

48 hours

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21
Q

A randomised trial has found that _________are superior to oral antibiotics for the treatment of acute otorrhoea in children with grommets

A

antibiotic eardrops

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22
Q

Cx of otitis media
1
2
3

A

Middle ear effusion
Acute mastoiditis
Chronic suppurative otitis media

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23
Q

WHat to do if effusion is still present at 6–8 weeks

A

a second

course of antibiotics should be prescribed

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24
Q

This is a major complication that presents with pain, swelling and tenderness
developing behind the ear associated with a
general deterioration in the condition of the
child

A

Acute mastoiditis

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25
Q

Discharge through a perforation of the TM >6 weeks

A

Chronic suppurative otitis media

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26
Q

Rare Cx of otitis media

A

labyrinthitis, petrositis, facial paresis and intracranial abscess

27
Q

This represents
incomplete resolution of suppurative otitis
media.

A

Serous otitis media (glue ear).

28
Q

Serous otitis media (glue ear). signs

A

loss of drum mobility,
hearing loss and
abnormal impedance confirmed
by pneumatic otoscopy or tympanometry

29
Q

a proposed_____ and ________ may be an effective preventive

measure for childhood otitis media

A

S. pneumoniae and H. influenzae

conjugate vaccine

30
Q

Define recurrent OM

A

it occurs more often than every other

month or for three or more episodes in 6 months or >4 in 12 months:

31
Q

How to Tx recurrent OM

A

chemoprophylaxis (for about 4 months)

amoxycillin twice daily (first choice)
or
cefaclor twice daily

32
Q

The commonest organisms for acute OM in the elderly

A

viruses (adenovirus and enterovirus), and the bacteria H. influenzae, S. pneumoniae, Moraxella (previously Neisseria catarrhalis ) and β -haemolytic streptococci

33
Q

The two cardinal features of diagnosis acute OM in the elderly are

A

inflammation and middle ear effusion

34
Q

T or F

If the middle ear structures are clearly
visible through the drum, otitis media is likely

A

F

Likely

35
Q

The normal TM is a shiny pale-grey to

brown: a yellow colour is suggestive of an _________

A

effusion.

36
Q

In acute OM,

The inflammatory process usually begins in the _________

A

upper posterior quadrant and spreads peripherally and down the handle of the malleus

37
Q

Late sign of acute OM

A

Bulging of the drum is a late sign

38
Q

Treatment of acute otitis media (adults)

A

• Analgesics to relieve pain
• Adequate rest in a warm room
• Nasal decongestants for nasal congestion
• Antibiotics until resolution of all signs of infection
• Treat associated conditions (e.g. adenoid
hypertrophy

39
Q

First choice of abx in pts on OM:

A

amoxycillin 750 mg (o) bd for 5 days 7
or
500 mg (o) tds for 5 days

40
Q

Abx duration of acute otitis media (adults)

A

longer course (up to 10 days) may be required depending on severity and response to 5-day course.

41
Q

alternative to Amox in OM

A

doxycycline 100 mg (o) bd for 5–7 days (daily for milder infections)
or
cefaclor 250 mg (o) tds for 5–7 days

42
Q

if with resistance to Amox in OM

A

or (if resistance to amoxycillin is suspected or proven) amoxycillin/potassium clavulanate 500/125 mg (o) tds for 5 days (the most effective antibiotic)

43
Q

How to tx CSOM

A

If aural discharge persists for >6 weeks after course of antibiotics, treatment can be with topical steroid and antibiotic combination drops, following ear toilet

44
Q

Red flags for cholesteatoma include
1
2
3

A

meningitis type features,
cranial nerve deficits, sensorineural
hearing loss and persistent deep ear pain

45
Q

Characteristics of unsafe dc

A

Cholesteatoma source
Foul
Usually scant, never profuse
Purulent

46
Q

Characteristics of safe dc

A

Mucosa source
Can be profuse amount
Mucopurulent nature

47
Q

also known as ‘swimmer’s ear’, ‘surfer’s ear’ and ‘tropical ear’, is common in a country whose climate and coastal living
leads to extensive water sports.

A

Otitis externa

48
Q

Common bacteria causing otitis externa

A 
— Pseudomonas sp.
— Escherichia coli
— S. aureus
— Proteus sp.
— Klebsiella sp.
49
Q

Common fungi causing otitis externa

A

— Candida albicans

— Aspergillus sp.

50
Q

Malignant’ otitis externa occurs in _____

due to Pseudomonas infection at base of skull.

A

diabetics

51
Q

MX of otitis externa

A

Aural toilet
Syringing
Dressings
Topical antimicrobals

52
Q

This severe complication usually due to Pseudomonas aeruginosa can occur in the immunocompromised, diabetic or elderly patient

A

Necrotising otitis externa

53
Q

These periosteal bony overgrowths are usually caused by water retention in the ear. They are often multiple. They tend to trap keratin, wax and water, leading to infection

A

Ear exostoses (‘surfer’s ear’)

54
Q

_______ is a staphylococcal infection of the hair follicle in the outer cartilaginous part of the ear canal. It is usually intensely painfu

A

Furunculosis

55
Q

_________ is infection of the cartilage of the ear characterised by severe pain of the pinna, which is red, swollen and exquisitely tender

A

Perichondritis

56
Q

Organisms for perichondrtitis

A

P. pyocaneus

57
Q

Infected ear lobe

The cause is most likely a contact allergy to nickel in an earring, complicated by a_____

A

S. aureus infection

58
Q

This is a common cause of discomfort. Symptoms include fullness in the ear, pain of various levels and impairment of hearing

A

Eustachian tube dysfunction

59
Q

Common causes of tubal dysfunction

A

oedema of the tubal lining, such as viral URTI and allergy when the tube
is only partially blocked

60
Q

MX of Eustachian tube dysfunction

A

Systemic and intranasal decongestants

Autoinflation by forced exhalation against closed nostrils

61
Q

_____ is damage caused by undergoing rapid changes in atmospheric pressure in the presence of an occluded Eustachian tube

A

Barotrauma

62
Q

Barotrauma Signs

A

(in order of seriousness):
retraction; erythema; haemorrhage (due
to extravasation of blood into the layers of the TM); fluid or blood in the middle ear; perforation

63
Q

Consider_________ if foul-smelling discharge is present over 7 + days

A

mastoiditis

MC (90 decks)

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