Ears Flashcards
Causes of otitis externa
Bacterial is 95%- pseudomonas and staph aureus are main culprits, can be E. coli
Fungal is rare, but think due to repeated courses of antibiotics. Candida or aspergillus
Treatment of otitis externa
Mild= acetic acid, ear calm or otomise spray
Moderate= Topical antibiotics- ciprofloxscin drops, genital icin (exclude perforation) and hydrocortisone
Who is at risk of malignant otitis externa and what is it usually caused by
Immunocompromised, diabetics and elderly
Pseudomonas
Presentation of malignant OE
Severe pain, temporal headaches, granulation tissue in ear canal and purlulemt otorrhes
Progresses to temporal bone osteomyelitis
Presentation of CSOM
More than 6 weeks of otohhrhea without fever or otalgia
What are the two types of CSOM
Inactive- perforated eardrum without infection
Active- perforated eardrum with infection and maybe cholesteatoma
Management of CSOM-
Active needs topical antibiotics - cipro or gentamicin +hydrocortisone
May need tympanoplasty
What is a cholesteatoma, where does it arise and most common age
Keratinised squamous epithelium in the pars flaccid of the tympanic membrane
Presents at 10-20 yo other recurrent foul smelling discharge and hearing loss
Complications of cholesteatoma
Vertigo due to semi circular canal erosion
Deafness due to ossicular damage
Facial palsy
Meningitis
Mx of cholesteatoma
CT head to confirm diagnosis
MRI for invasion
Surgery is often planned via madtoidectomy/exploration
Diagnosis of BPPV and treatment
Diagnosed with Dix hallpike - observe for ROTATIONAL nystagmus (or horizontal)
Treat with epley manoeuvred done by doctor, or Brandt Darrow for patient to do themselves
Pathophys of BPPV
Calcium carbonate crystal called otoconia build up in posterior semi circular canals, disrupt flow of endolymph
Pathophys of menieres
Excessive endo lymph
Presentation of meniers
Vertigo not triggered which can last from 20 mins to an hour.
Low frequency SSN hearing loss
Tinnitus
Aural fullness
Acute and prophylactic mx of menieres
Acute with prochloroperazine
Prophylaxis with beta histine
Presentation of vestibular neuronitis
Hx of URTI
Severe and constant vertigo initally
Often associated with quite severe nausea and vomiting
No other otological problems - hearing loss or tinnitus
Presentation of labrynthitis
May have hx of URTI
Severe rotator vertigo with tinnitus and hearing loss- due to infection of labrynth structures also
Tx of vestibular neuronitis and labrynthitis
Prochloroperazine only for the 1 st week so as to not hinder central compensation and delay recovery
What can help distinguish central from peripheral vertigo
Head impulse test
DVLA on vertigo
Patients must not drive and must inform DVLA
What is used to grade a facial palsy
House Brackman criteria
1 is normal and six is complete paralysis
What predisposes someone to Bell’s palsy
Diabetes and pregnany and concurrent viral illness
Management of Bell’s palsy
Ensure no stroke - forehead spared in stroke
Prednisolone 1mg/kg per day up to 60 mg for a week,then taper by 10 mg thereafter
Coprescribe with PPI
Presentation of Ramsay hunt syndrome
Reactivation of varicella zoster in geniculate nucleus of the facial nerve
Moderate to severe ear pain a few days before.
Progresses to facial palsy and patient may have vertigo and tinnitus.
Treat with valaycyclovir and pred
What type of HL is presbycusis and how is it seen
snhl at higher frequencies
What is SSHL and what is the mx
Rapid hearing loss over 72 hours - loss of 30db in three consecutive frequencies in 3 days
Immediate referral to on call ENT within 3 days
Acoustic neuromas - what are they and where do they arise.
What do they cause
What condition are bilateral ones associated with
Schwann cell tumours which arise at the cerbellopontine angles
Cause SNHLn tinnitus and vertigo, and can cause facial palsy
Bilateral are associated with NF2
What drugs cause SNHL
Aminoglycosides such as gentamicin
Furesomide
Aspirin
Platins
Commonest causes of bacterial tonsillitis palatine
Strep pyogenes
Strep pneumoniae
HMS
Cantor and Fpain criteria
Centor-
Fever over 38
Tonsiular exudate
Absence of cough
Cervical lymphadenopathy
Fpain-
Fevere during past 24 hrs
Purulent tonsils
Attended within 3 days
Inflamed tonsils
No cough
Abx treatment of tonsillitis
Penicillin V phenoxymethylpenecillin
Clarithromycin if allergic
