Ear Trauma: Auricular Hematoma, Chondritis, Otitis Externa, Tympanic Membrane Perforation, Eustacian Tube Dysfunction, Otitis Media, Mastoiditis, Meniere's Disease, Peripheral Vertigo

Question 1

Auricular hematoma

• risk factors
• pathophysiology
• management

Answer 1

Rugby, boxing blunt trauma
-perichondral vessels damaged => avascular cartilaginous necrosis (cauliflower ear)

Aspiration

Question 2

Chondritis

• risk factors, causative organism
• pathophysiology
• management

Answer 2

Diabetic, IC, piercings=> P aeriginosa
Pus from infection accummulates between cartilage, perichondrium => ischemia and avascular cartilaginous necrosis

ABx, abscess drainage

Question 3

Otitis externa

• risk factors, causative organism
• presentation
• management

Answer 3

Swimmers, foreign bodies, skin conditions

Acute ear
-itch, pain, discharge, conductive hearing loss

P aeruginosa

Supportive - keep clean, simple analgesia
Medical - topical ABx but generally self limiting

Question 4

Tympanic membrane perforation

• causes
• presentation
• management

Answer 4

OM
Physical/baro/phonotrauma
Previous infection

Sudden hearing loss/tinnitus
Ear pain, itching, discharge
Fever if infected

Conservative normally enough
ABx for infection (avoid gentamicin!)
ENT follow up

Question 5

Glue Ear/Otitis Media with Effusion

• risk factors
• presentation
• investigations
• management

Answer 5

Recent OM U3 - prevalence high in Downs

Intermittent ear pain with fullness
Speech, language developmental issues
Recurrent ear/URTIs

Tympanometry, audiometry

Active surveillance - often self limiting
-Valsalva
Surgery - myringotomy/grommets/hearing aids

Question 6

Otitis Media

• risk factors, causative organisms
• presentation
• investigations
• management

Answer 6

U3
-recent URTI - S pneumonia, Hibs, M catarrhalis

Ear

• conductive hearing loss
• discharge if perforated
• URTI symptoms

Otoscopic examination

• middle ear effusion
• bulging membrane/purulent
• redness

Self limiting => simple analgesia
Amoxicillin given if
-symptoms lasting 4+ days
-systemically unwell
-IC, perforated eardrum, bilateral

Question 7

Mastoiditis

Answer 7

2ndary to OM => infection spreads via mastoid antrum entrance

• pain, red, swelling of mastoid => ear sticks out
• hearing loss
• fever

Blood and ear culture
Head CT

ENT referral
IV ABx
Surgery - myringotomy or mastoidectomy

Question 8

Meniere’s

• pathophysiology
• presentation
• investigations
• management

Answer 8

Excess pressure in endolymph - middle age
Unilateral episodes last mins-hours
-vertigo, tinnitus, hearing loss
-ear fullness
-nystagmus, +ve Romberg

ENT assessment confirms clinical diagnosis

Acute attack - prochlorperazine (antiemetic)
Prevention - vestibular rehab + betahistine

Self limiting but causes hearing loss

Question 9

Viral labyrinthitis vs viral neuronitis

• presentation of both
• diagnosis
• management

Answer 9

VL - Inflammation of vestibular + cochlear organs often with recent URTI
-vertigo + sensorineural hearing issues

VN - inflammation of vestibular nerve
-no hearing loss

Vestibular presentation

• N+V
• nystagmus, gait disturbance

Clinical diagnosis
-symptomatic - prochlorperazine, antihistamine

Question 10

Malignant otitis externa

• risk factors
• presentation
• investigations
• management

Answer 10

IC, diabetic => P aeriginosa
-granulation tissue within canal => temporal bone osteomyelitis

Severe ear pain
Stenosis of ear canal
Temporal headache
Purulent discharge
Dysphagia, hoarse voice, VII dysfunction

CT

IV Abx - pseudomonas cover

Question 11

BPPV

• population
• presentation
• investigation and management

Answer 11

Most common cause of vertigo (mainly in older)

Episodes last seconds

• sudden vertigo, dizziness triggered by head position
• nausea, nystagmus

Dixhallpike

Symptomatic relief - Epley and vestibular rehab
-Betahistine

Question 12

Acoustic neuroma

• presentation and associations
• investigations
• management

Answer 12

Cranial 5, 7, 8

• absent corneal reflex
• facial paralysis
• vertigo, sensorineural hearing loss, tinnitus

Mainly unilateral
Bilateral in neurofibromatosis 2

Audiometry + CPA MRI

Surveillance - slow growing, benign
Surgery/RT

Question 13

Pinna cellulitis

-how to differentiate between cellulitis and perichondritis

Answer 13

Cellulitis - involvement of whole ear

Chondritis - pinna sparing

Question 14

Foreign bodies

• differentiation
• management

Answer 14

Organic (more urgent due to decomposition risk) or non organic (less urgent)
Insects - mineral oil to drown it

Refer to ENT to remove it ASAP

Question 15

Labyrinthitis vs vestibular neuritis

Answer 15

Labyrinthitis - inner ear infection preceded by URTI?

• vertigo => difficulty walking or standing straight
• N+V
• hearing loss, tinnitus

Vestibular neuritis - inflammation of vestibular nerve
-similar presentation but NO HEARING LOSS

Prochlorperazine - N+V
Vestibular rehabilitation
Often self limiting - 2-6wks

Question 16

Differentiating between central and peripheral causes of vertigo

Answer 16

HINTS exam
Head impulse test
-rapid head shaking => corrective saccade (peripheral)

Nystagmus - unidirectional
-ask patient to look to the L and R without fixating on any objects
Peripheral - unidirectional nystagmus
Central - nystagmus changes direction/vertical
Stroke - bidirectional nystagmus

Test of skew - no skew
-ask patient to look at nose, you cover 1 eye
-quickly uncover and cover other eye
Central - vertical/diagonal corrective mv