Ear pain

Question 1

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

Answer 1

acute otitis media

otitis externa.

Question 2

Otitis media is unlikely to be present if the

__________

Answer 2

tympanic membrane (TM) is mobile.

Question 3

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

Answer 3

Pneumatic otoscopy

Question 4

________ 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

Answer 4

Bullous myringitis,

Question 5

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

Answer 5

amoxycillin

Question 6

Otitis externa can be distinguished from otitis

media by ________

Answer 6

pain on movement of the pinna

Question 7

Red flags for painful ear

Answer 7

• 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

Question 8

Disorders of the _______ are a

commonly overlooked cause of periotic pain

Answer 8

upper cervical spine

Question 9

movement of the jaw usually causes an exacerbation of ______

Answer 9

TMJ arthralgia or severe otitis externa.

Question 10

T or F

Impacted wax may not explain the otalgia.

Answer 10

T

Question 11

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

Answer 11

Staphylococcus aureus or

Pseudomonas spp. infection

Question 12

How to extract foreign bodies. What methods?

1
2

Answer 12

Probe method

Rubber catheter suction method

Question 13

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

Answer 13

straight rubber catheter (large

type) and perhaps a suction pump

Question 14

Persistent middle ear effusions may follow

and affect the _____ and _______

Answer 14

language and cognitive development of

young children

Question 15

2 peaks of otitis media in children

Answer 15

6–12 months of age and

school entry

Question 16

MC cause of otitis media in children

Answer 16

Streptococcus pneumoniae,
Haemophilus influenzae and
Moraxella catarrhalis

Question 17

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

Answer 17

increasing earache and hearing loss

Question 18

Possible clinical indications for antibiotics

in children with painful otitis media

Answer 18

• <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

Question 19

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

Answer 19

Amoxycillin

Question 20

With appropriate treatment most children with

acute otitis media are significantly improved within ________

Answer 20

48 hours

Question 21

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

Answer 21

antibiotic eardrops

Question 22

Cx of otitis media
1
2
3

Answer 22

Middle ear effusion
Acute mastoiditis
Chronic suppurative otitis media

Question 23

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

Answer 23

a second

course of antibiotics should be prescribed

Question 24

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

Answer 24

Acute mastoiditis

Question 25

Discharge through a perforation of the TM >6 weeks

Answer 25

Chronic suppurative otitis media

Question 26

Rare Cx of otitis media

Answer 26

labyrinthitis, petrositis, facial paresis and intracranial abscess

Question 27

This represents incomplete resolution of suppurative otitis media.

Answer 27

Serous otitis media (glue ear).

Question 28

Serous otitis media (glue ear). signs

Answer 28

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

Question 29

a proposed_____ and ________ may be an effective preventive | measure for childhood otitis media

Answer 29

S. pneumoniae and H. influenzae | conjugate vaccine

Question 30

Define recurrent OM

Answer 30

it occurs more often than every other | month or for three or more episodes in 6 months or >4 in 12 months:

Question 31

How to Tx recurrent OM

Answer 31

chemoprophylaxis (for about 4 months) amoxycillin twice daily (first choice) or cefaclor twice daily

Question 32

The commonest organisms for acute OM in the elderly

Answer 32

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

Question 33

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

Answer 33

inflammation and middle ear effusion

Question 34

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

Answer 34

F Likely

Question 35

The normal TM is a shiny pale-grey to | brown: a yellow colour is suggestive of an _________

Answer 35

effusion.

Question 36

In acute OM, The inflammatory process usually begins in the _________

Answer 36

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

Question 37

Late sign of acute OM

Answer 37

Bulging of the drum is a late sign

Question 38

Treatment of acute otitis media (adults)

Answer 38

• 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

Question 39

First choice of abx in pts on OM:

Answer 39

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

Question 40

Abx duration of acute otitis media (adults)

Answer 40

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

Question 41

alternative to Amox in OM

Answer 41

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

Question 42

if with resistance to Amox in OM

Answer 42

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

Question 43

How to tx CSOM

Answer 43

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

Question 44

Red flags for cholesteatoma include 1 2 3

Answer 44

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

Question 45

Characteristics of unsafe dc

Answer 45

Cholesteatoma source Foul Usually scant, never profuse Purulent

Question 46

Characteristics of safe dc

Answer 46

Mucosa source Can be profuse amount Mucopurulent nature

Question 47

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.

Answer 47

Otitis externa

Question 48

Common bacteria causing otitis externa

Answer 48

``` — Pseudomonas sp. — Escherichia coli — S. aureus — Proteus sp. — Klebsiella sp. ```

Question 49

Common fungi causing otitis externa

Answer 49

— Candida albicans | — Aspergillus sp.

Question 50

Malignant’ otitis externa occurs in _____ | due to Pseudomonas infection at base of skull.

Answer 50

diabetics

Question 51

MX of otitis externa

Answer 51

Aural toilet Syringing Dressings Topical antimicrobals

Question 52

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

Answer 52

Necrotising otitis externa

Question 53

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

Answer 53

Ear exostoses (‘surfer’s ear’)

Question 54

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

Answer 54

Furunculosis

Question 55

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

Answer 55

Perichondritis

Question 56

Organisms for perichondrtitis

Answer 56

P. pyocaneus

Question 57

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

Answer 57

S. aureus infection

Question 58

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

Answer 58

Eustachian tube dysfunction

Question 59

Common causes of tubal dysfunction

Answer 59

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

Question 60

MX of Eustachian tube dysfunction

Answer 60

Systemic and intranasal decongestants | Autoinflation by forced exhalation against closed nostrils

Question 61

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

Answer 61

Barotrauma

Question 62

Barotrauma Signs

Answer 62

(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

Question 63

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

Answer 63

mastoiditis