Ear Pain/ infections

Question 1

what is ottitis externa and how does it present

Answer 1

infection of the ear canal.

red, hot and painful external ear
itch
discharge

Question 2

causes of ottitis externa

Answer 2

bacterial:
staph aureus
proteus
pseudomonas

fungal:
candida
aspergillum

Question 3

treatment of ottitis externa

Answer 3

topical aural cleaning
acetic acid 2% tds until 2 days after its clear

swab if severe

clotrimazole - fungal
gentamicin - pseudomonas

Question 4

what is ottitis media and how does it present

Answer 4

infection of the middle ear

proceeded by an URTI
crescendo-decrescendo pain (intense pain that does away once pus has drained)

reduced hearing in affected ear

discharge is tympanic membrane ruptures

Question 5

causes of ottitis media

Answer 5

viral URTI 
secondary bacterial infection 
-h.influenza 
-strep pneumoniae
- strep pyogenes

Question 6

why is ottitis media common in kids

Answer 6

they have a short eustachian tube so infection can easily travel to ear

Question 7

which bacteria causes chronic otitis media

Answer 7

pseudomonas

Question 8

ottitis media treatment

Answer 8

usually resolves on its own
if severe/bilateral
- amoxicillin

Question 9

what is ‘ glue ear’

Answer 9

ottitis media with effusion

conductive hearing loss in affected ear

often seen in kids 2-8 years

Question 10

treatment of glue ear

Answer 10

monitor for 3 months then grommet insertion

Question 11

what is malignant ottitis

Answer 11

when ottitis externa spreads into the surrounding bones of the ear canal causing osteomyelitis of the mastoid and temporal bones

can lead to meningitis

Question 12

presentation of malignant ottitis

Answer 12

pain and headache

granulation tissue at bone/cartilage junction of ear canal

facial nerve palsy

Question 13

most common cause of malignant ottitis

Answer 13

pseudomonas

Question 14

malignant ottitis risk factors

Answer 14

diabetes

radiotherapy to head/neck

Question 15

what is a cholesteatoma

Answer 15

presence of keratinised squamous epithelium in the middle ear (should be columnar)

the skin builds up and erodes the bones of the ear canal

high cell turn over

Question 16

causes of cholesteatoma

Answer 16

chronic otitis media

perforation of tympanic membrane

Question 17

treatment of cholesteatoma

Answer 17

do CT scan if suspicion

surgical excision and reconstruction needed

Question 18

how does acute sinusitis present

Answer 18

discomfort over frontal/maxillary sinuses due to viral congestion

pain
tenderness
rhinorrhoea

Question 19

treatment of acute sinusitis

Answer 19

if uncomplicated avoid antibiotics

if secondary bacterial infection (rare) give penicillin (2nd line - doxy)

Question 20

most common cause of ear pain in adults

Answer 20

referred pain

Question 21

which nerves cause referred pain to the ear

Answer 21

CNIX - glossopharyngeal

CNV3 - mandibular nerve

CNVII - facial nerve

CNX- vagus

C2,C3 spinal nerves

Question 22

where does CNIX referred pain come from

Answer 22

(innervates pharynx and middle ear) - from tonsillitis, posterior 1/3 of the tongue

Question 23

where does CNV3 referred pain come from

Answer 23

innervates outside of the tympanic membrane and tmj, salivary gland and tooth problems

Question 24

where does CNX referred pain come from

Answer 24

piriform fossa/larynx

Question 25

where does CNVII pain come from

Answer 25

pain from geniculate herpes, sphenoid damage, nasal pathology (Ramsay-hunt syndrome)

Question 26

where does C2,C3 spinal nerve referred pain come from

Answer 26

cervical spondylosis

Question 27

what is Ramsay- Hunt syndrome

Answer 27

shingles affecting the laical nerve causing facial pain and vesicles on the tympanic membrane or roof of mouth