Ear pathology Flashcards
Conditions of the external ear
Haematoma
Otitis externa
Costochondritis
Ear wax
Conditions of the middle ear
Otitis media with effusion Chronic suppurative otitis media Tympanic perforation Otitis media Sinusitis Cholesteatoma
Inner ear conditions
Mastoiditis
Meniere’s disease
Labyrinthitis
Age relate hearing loss
Red flag signs
Inflammation behind ear - mastoiditis
Facial droop - facial nerve palsy
Unilateral tinnitus - Acoustic neuroma
Smelly discharge that causes recurrent ear infections - cholesteatoma
Otitis externa
Presentation: inflammation of the external ear canal
- red, swollen, or eczematous with shedding of the scaly skin.
- Discharge may be present in the ear canal
- Pruritis
- Severe ear pain
- Tender over jaw
Causes:
- bacterial infection
- fungal infection
- Seborrhoeic dermatitis
- Contact dermatitis
- Trauma
Prognosis :
- Symptoms usually improve within 48–72 hours of initiation of treatment
Acute vs chronic otitis externa
Acute - lasts 3 weeks or less
Chronic - lasts longer than 3 months
Malignant (necrotising) otitis externa
Aggressive infection that predominantly affects people who are immunocompromised.
Otitis externa spreads into the bone surrounding the ear canal (the mastoid and temporal bones).
Common causative organism of otitis externa
Bacterial:
Psuedomonas aeruginosa
Staphylococcus aureus
Fungal:
Aspergillus
Candida
Deep - trichophyton
Mx of otitis externa
Conservative:
- Analgesia and heat pad
- Clean external auditory canal
Medical:
- Otomize Ear Spray - topical abx + corticosteroid- minimum of 7 days
- Oral antibiotics for severe infection - 7-day course of flucloxacillin or clarithromycin
Chronic:
Fungal infection - topical antifungal - Acetic acid spray or clotrimazole
7-day course of a topical corticosteroid without antibiotic
When are oral antibiotics indicated in otitis externa
Cellulitis extending beyond the external ear canal.
When the ear canal is occluded by swelling and debris, and a wick cannot be inserted.
People with diabetes or compromised immunity, and severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa
Methods for cleaning external auditory canal
Syringing or irrigation
Dry swabbing
Microsuction
Complications of untreated ear haematoma
Cauliflower ear - costochondritis
Cartilage is avascular and receives blood supply from skin therefore if disrupted causes necrosis of cartilage
Mx of ear haematoma
Pack skin against cartilage
Drain blood
Acute otitis media definition and causes
Inflammation in the middle ear accompanied by the rapid onset of symptoms and signs of an ear infection - commonly in children
Causes: Bacterial: - Haemophilus influenzae - Streptococcus pneumoniae - Moraxella catarrhalis - Streptococcus pyogenes
Viral:
- respiratory syncytial virus
- rhinovirus
- adenovirus
- influenza virus
- parainfluenza virus
Acute otitis media with effusion
Fluid in the middle ear, not associated with symptoms and signs of an acute ear infection
Fluid caused by a build up of exudate and causes TM retraction
Why are children more likely to get acute otitis media
Acquire viral infections more often
Have shorter and more horizontal eustachian tubes
Presentation of acute otitis media
Otalgia
Younger children - tugging at ear, fever, crying
Coexisting systemic
illness, such as bronchiolitis
Hearing loss - conductive
Otoscopic findings of acute otitis media
Distinctly red, yellow, or cloudy tympanic membrane.
Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks
- bubbles behind the tympanic membrane - indicates effusion
Perforation of the tympanic membrane and/or discharge in the external auditory canal - suppurative OM
Mx of acute otitis media
- Advise usual course of acute otitis media is ~ 3 days, but can be up to 1 week.
- Regular doses of paracetamol or ibuprofen for pain
- 5–7 day course of amoxicillin back up
- 5–7 day course of co-amoxiclav 2nd line
Otitis media with effusion causes and mx
Causes:
- Impaired eustachian tube function causing poor aeration of the middle ear.
- Low-grade viral or bacterial infection.
- Adenoidal infection or hypertrophy
Mx
- observe for 6 - 12 wks as active resolution is common
- hearing aid
- grommets
Congenital deafness
Sx:
- Muffling of speech
- Difficulty understanding words
- Delayed speech development
- Not being startled by loud sounds
Dx and Mx of congenital deafness
Dx:
- Neonatal hearing-screening programme
- Referral paeds ENT
- CT or MRI - temporal bone and internal acoustic meatus
- FHx & Genetic testing
Mx:
- Hearing aids
- Cochlear implants
- Surgery
Cholesteatoma presentation
Sx:
- Smelly otorrhea
- Recurrent or chronic purulent discharge that does not respond to antibiotics
- Hearing loss
- Tinnitus
Signs:
- Inflamed lesion in ‘attic’ of pars flaccida
- Retracted tympanic membrane
- Crust or discharge
- Perforation - insight into middle ear
Cholesteotoma Dx and Mx
Diagnosi:
- Clinical suspicion from history and otoscopy findings
Management:
Semi urgent referral to ENT (emergency if pt has facial nerve palsy or vertigo)
Audiology assessment
CT scan
Topical antibiotics for discharge
Surgery - canal wall up mastoidectomy + 9 - 12 month follow up
Cholesteatoma
Abnormal accumulation of squamous epithelium and keratinocytes within the middle ear or mastoid air cell spaces
Chronic suppurative otitis media
Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation
- Ear discharge persisting for more than 2 weeks, without ear pain or fever.
- Hearing loss in the affected ear.
- A history of acute otitis media (AOM), ear trauma, or glue ear and grommet insertion.
- A history of allergy, atopy, and/or upper respiratory tract infection.
- Tinnitus and/or a sensation of pressure in the ear may also be present.
Chronic suppurative otitis media mx
Do not swab the ear or initiate treatment
Refer for ENT assessment
Secondary care: abx and steroids (usually topical), and intensive cleaning of the affected ear
Mastoiditis
Acute inflammation of the mastoid periosteum and air cells occurring when AOM infection spreads out from the middle ear
Presentation of mastoiditis
- History of acute or recurrent episodes of otitis media.
- Intense otalgia and pain behind the ear.
- Fever.
- Swelling, redness or a boggy, tender mass behind the ear.
- Tympanic membrane bulges and is erythematous.
Mx of mastoiditis
Refer to secondary care
Acoustic Neuroma
Inner ear pathology:
Symptoms:
- unilateral sensorineural hearing loss
- tinnitus
- vertigo
- facial numbness
- loss of corneal reflex
Ramsey Hunt syndrome
Viral infection - Herpes Zoster
- painful rash
- vertigo
- sensorineural hearing loss
- facial palsy
Vestibular neuronitis presentation
- episodes of vertigo - hours
- occurs after a recent viral illness
- nausea and vomiting
- hearing is not affected
Otosclerosis presentation and Mx
Presentation: Bilateral hearing loss - conductive Tinnitus Pink tinge on otoscopy FHx Onset is usually at 20-40 years
Mx:
Hearing aid
Stapedectomy
Otitis media with perforation Mx
First line - amoxacillin
2nd line - erythromycin
When to give abx for otitis media
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal - otorrhoea
