Ear Pathology

Question 1

5 types of external ear infection

Answer 1

otitis externa,

malignant otitis externa,

piercing infection,

mastoiditis,

furunculosis - hair cell abscess

Question 2

pathologies affecting the middle ear

Answer 2

acute OM
chronic OM
OM with effusion / glue ear
cholesteatoma
perforated Tympanic membrane (trauma / AOM)
otosclerosis
blocked eustachian tube

Question 3

pathologies affecting the inner ear

Answer 3

Vestibular Schwannoma
labryrinthitis
neuritis
Menieres 
BPPV

Question 4

what does Battle’s sign show?

Answer 4

it is bruising over the mastoid (behind the pinna)

it shows a base of skull fracture - middle cranial fossa

Question 5

what can a base of skull fracture cause? (3)

Answer 5

hearing loss - both sensorineural + conductive
facial palsy if CN7 affected
CSF leakage

Question 6

describe the complications of a cholesteatoma

• direct problems in hearing
• serious complications

Answer 6

the keratinising epithelium can become infected.

this infection can spread in multiple directions within the head, with the capacity to cause

• conductive hearing loss through erosion of the ossicles
• sensorineural hearing loss
• tinnitus
• vertigo

also. ..
- brain abscess
- meningitis
- posterior venous sinus thrombosis
- facial nerve palsy

Question 7

what is a cholesteatoma?

Answer 7

a collection of abnormal keratinizing epithelium that forms when the TM gets sucked in, forming a pocket.

Question 8

how can you manage a glue ear?

• initial period
• threshold for Tx
• options

Answer 8

• observation only for 3 months*
• assess if hearing loss is worse than 25dB*

nasal autoinflation with balloon

you can make a hole (m?) in the TM and insert a grommet

you can give temporary hearing aids

Question 9

high risk / complicated groups of children with glue ear? how are they generally treated?

Answer 9

down’s syndrome - prone and thick glue
cleft lip / palette

straight to specialist. hearing aid

Question 10

what do swimmers + psoriasis patients + diabetics classically get?

Answer 10

otitis external

itchy skin conditions inc eczema make people itch their ears, leading to trauma + infection

Question 11

associated Hx with AOM?

Answer 11

history of an URTI

Question 12

what does “chronic otitis media” encompass? (3)

Answer 12

glue ear (OM with E)
perforation
cholesteatoma

Question 13

classic presentation of a kid with glue ear

Answer 13

hearing loss
bad behaviour / speech delay
big adenoids causing them to sit with mouths open

Question 14

name for age related hearing loss?

what freq is lost first?

Answer 14

presbycusis

lose high frequency sounds first

Question 15

what drugs can cause hearing loss? (3 types)

Answer 15

gentamicin and other aminoglycosides - irreversible

chemotherapy - vincristine, cisplatin

OVERDOSE on aspirin or NSAIDS - may be reversible

Question 16

what are the presenting features of a vestibular schwannoma?

rate of onset?

Answer 16

hearing loss
tinnitus
balance problems

very slow growing!

Question 17

what is the classic audiogram for noise-induced hearing loss?

Answer 17

a dip at 4 kHz

Question 18

classic age for cholesteatoma

Answer 18

younger than you’d think….

5-15 years old

Question 19

what 2 bacterial commonly cause otitis externa?

how would you treat a mild case of it?

Answer 19

pseudomonas aeuringinosa
staph aureas

topical antibiotics +/- steroid drops

Question 20

describe the dangers of severe otitis externa and who you’d expect to get it

Answer 20

“malignant” or necrotizing
can cause temporal bone destruction / osteomyelitis of the base of skull

commonly diabetics with pseudomonas

Question 21

where does Furuncluosis occur and what bacteria causes it?

Answer 21

very painful abscess from the hair follicles within the ear canal

staph aureas

Question 22

jemma is 14, has bilateral SNHL, tinnitus and balance problems. she gets headaches.

what 2 conditions are you worried about?

Answer 22

young + bilateral symptoms of vestibular schwannoma

so you are worried about Neurofibromatosis type 2, too

Question 23

a tender cartilaginous inflamed nodule on the upper helix of a builder?

Answer 23

Chondrodermatitis Nodularis Helicis

cause unknown but could be ischaemia / vasoconstriction in cold

Question 24

what happens in a pinna haematoma?

Answer 24

blunt trauma causes bleeding in the subperichondrial area, causing a haematoma to form in the perichondrium

cartilage ischaemia causes fibrosis –> misshapen –> Cauliflower ear

Question 25

what is auditory exostosis?

Answer 25

“surfer’s ear”
smooth swellings in the bony canals from hypertrophy

harmless unless they build up with wax causing conductive hearing loss

Question 26

name some risk factors for otitis media - most are for children

(not quite the same as OME)

Answer 26

URTI and asthma
big adenoids
bottle feeding + dummies
passive smoking
cleft pallete

adults - high BMI, GORD

Question 27

risk factors for OME (not quite the same as OM)

• inc gender
• inc genetic condition

Answer 27

boys
downs syndrome
cleft palete

passive smoking
winter + URTI

Question 28

proper treatment of a pinna haematoma?

short term advice?

Answer 28

aspiration / incision with drainage

pressure dressing

off contact sports for 2 weeks

Question 29

how do you manage a severe ear laceration?

Answer 29

clean + debride
local anaethetic
suture together
give antibiotics

Question 30

what 2 types of temporal bone fracture is there, and where do they occur?

what % is the occurance split?

Answer 30

longitudinal = 80%.
Fracture is parallel to the long axis of the petrous pyramid

transvers = 20%. # at right angles to the long axis of petrous pyramid.

Question 31

what type of temporal bone # gives a conductive hearing loss? why?

Answer 31

conductive = longitudinal. a Haemotympanum forms

Question 32

what type of temporal bone # causes SNHL? why?

Answer 32

SNHL = transverse. Damage to the CN8 (and CN7) as it crosses the IAM

Question 33

what type of temporal bone fracture is more likely to cause CSF leakage and blood leakage within the ear?

Answer 33

longitudinal

• CSF leak
• Haemotypanum (conductive hearing loss)

can also have facial palsy in 20%

Question 34

what type of temporal bone fracture is more likely cause SNHL and facial palsy?

Answer 34

transverse as it affects the IAM
- CN7 + 8

also commonly get vertigo

Question 35

what sign, appearing in some temporal bone fracture, indicates increased risk of infection by 10%?

Answer 35

CSF leaking

Question 36

what are the criteria for “sudden” SNHL?

Answer 36

rule of 3s

• occurring in less than 3 days
• loss is a drop of 30dH
• at 3 different frequencies

Question 37

what is the immediate treatment for “sudden” SNHL?

Answer 37

high dose steroids

• presnisalone
• ITS injection if unsuccessful