Ears Flashcards
Acute otitis media
- Definition
- Pathology
Inflammation of the middle ear (incus, malleous and stapes) typically due to an acute infection.
Causes
- Bacterial/ viral infection
- Bacterial: S. pneumoniae, Moraxella catarrhalis, non-typable H. influenzae
Presentation of acute otitis media
Ear pain/ fullness
Hearing loss
Otorrhoea
- After perforation
Diagnosis of acute otitis media
Otoscope examination:
- Bulging, erythematous tympanic membrane
- Loss of light reflex
- Discharge behind tympanic membrane
- Perforated membrane
- Tenderness of mastoid bone
Management of acute otitis media
Pain relief= analgesia
- Paracetamol, ibuprofen
Bacterial cause= antibiotic drops/ amoxicillin
- In children <2 with bilateral/ discharge
- Can be as delayed prescription after 48 hours
Myringotomy
- Indicated in persistent symptoms despite antibiotic use.
Chronic suppurative otitis media
- Definition
- Pathology
- Management
Persistence of AOM (3 months?), leading to a perforation of the tympatic membrane.
- Causes recurrent ear discharge
Caused by the same agents of AOM
- Strep. pneumoniae
- Moxarella catarrhis
- Non-typable H.influenzae
Management
- Myringoplasty, graft to repaire perforated membrane.
Cholesteatoma
- Definition
- Pathology and complications
Disorder of the epithelial cells of the ear canal, causing a growing mass of cells.
The mass continues to progress and can destroy surrounding tissue
- Ossicles
- Mastoid = mastoiditis
- Vestibulocochlear nerve
- Facial nerve: facial nerve palsy
- Skull= intracranial abscess, meningitis
Cholesteatoma
- Presentation
Ear ache
Malodorous ear discharge
Hearing loss
Tinnitus
Vertigo (when cochlear nerve is affected)
Cholesteatoma
- Diagnosis
Otoscope examination
- Keratin flakes/ crust in the upepr middle ear
- Retraction of tympanic membrane
- Aural polyp
CN examination
- CN5 palsy.
Cholesteatoma management
Mastoidectomy
- Removal of cholesteatoma
Topical antibiotics
- Ciprofloxacin
Otitis externa
- Definition and Pathology
Inflammation of the skin of the ear cannal.
- Commonly due to the ear being constantly wet.
Causative agents
- Pseudomonas aeruginosa
- Staphylococcus auereus
Complication of otitis externa
Necrotising/ malignant otitis externa
- Occurs when the infections spreads to surrounding soft tissue, adjacent neck spaces and skull base
Management of otitis externa
Conservation
- Ensuring that ear is kept dry
Bacterial cause
- Antibiotic drops (ciprofloxacin)
Analgesia= paracetamol/ ibuprofen
Necrotisn OE= oral antibiotics and debridement.
Otitis externa presentation and examination
Ear itchiness
Ear discharge
Mild hearing loss
Aural fullness
Examination
- Meatal tenderness
- Otoscope: debris, keratotic canal
- External meatus: erythematous/ oedematous
