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Surgery c > Ears > Flashcards

Ears Flashcards

1
Q

Causes of otitis externa

A

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

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2
Q

Treatment of otitis externa

A

Mild= acetic acid, ear calm or otomise spray

Moderate= Topical antibiotics- ciprofloxscin drops, genital icin (exclude perforation) and hydrocortisone

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3
Q

Who is at risk of malignant otitis externa and what is it usually caused by

A

Immunocompromised, diabetics and elderly

Pseudomonas

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4
Q

Presentation of malignant OE

A

Severe pain, temporal headaches, granulation tissue in ear canal and purlulemt otorrhes

Progresses to temporal bone osteomyelitis

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5
Q

Presentation of CSOM

A

More than 6 weeks of otohhrhea without fever or otalgia

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6
Q

What are the two types of CSOM

A

Inactive- perforated eardrum without infection

Active- perforated eardrum with infection and maybe cholesteatoma

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7
Q

Management of CSOM-

A

Active needs topical antibiotics - cipro or gentamicin +hydrocortisone

May need tympanoplasty

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8
Q

What is a cholesteatoma, where does it arise and most common age

A

Keratinised squamous epithelium in the pars flaccid of the tympanic membrane

Presents at 10-20 yo other recurrent foul smelling discharge and hearing loss

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9
Q

Complications of cholesteatoma

A

Vertigo due to semi circular canal erosion
Deafness due to ossicular damage
Facial palsy
Meningitis

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10
Q

Mx of cholesteatoma

A

CT head to confirm diagnosis
MRI for invasion

Surgery is often planned via madtoidectomy/exploration

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11
Q

Diagnosis of BPPV and treatment

A

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

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12
Q

Pathophys of BPPV

A

Calcium carbonate crystal called otoconia build up in posterior semi circular canals, disrupt flow of endolymph

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13
Q

Pathophys of menieres

A

Excessive endo lymph

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14
Q

Presentation of meniers

A

Vertigo not triggered which can last from 20 mins to an hour.
Low frequency SSN hearing loss
Tinnitus
Aural fullness

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15
Q

Acute and prophylactic mx of menieres

A

Acute with prochloroperazine
Prophylaxis with beta histine

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16
Q

Presentation of vestibular neuronitis

A

Hx of URTI

Severe and constant vertigo initally
Often associated with quite severe nausea and vomiting

No other otological problems - hearing loss or tinnitus

17
Q

Presentation of labrynthitis

A

May have hx of URTI

Severe rotator vertigo with tinnitus and hearing loss- due to infection of labrynth structures also

18
Q

Tx of vestibular neuronitis and labrynthitis

A

Prochloroperazine only for the 1 st week so as to not hinder central compensation and delay recovery

19
Q

What can help distinguish central from peripheral vertigo

A

Head impulse test

20
Q

DVLA on vertigo

A

Patients must not drive and must inform DVLA

21
Q

What is used to grade a facial palsy

A

House Brackman criteria

1 is normal and six is complete paralysis

22
Q

What predisposes someone to Bell’s palsy

A

Diabetes and pregnany and concurrent viral illness

23
Q

Management of Bell’s palsy

A

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

24
Q

Presentation of Ramsay hunt syndrome

A

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

25
Q

What type of HL is presbycusis and how is it seen

A

snhl at higher frequencies

26
Q

What is SSHL and what is the mx

A

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

27
Q

Acoustic neuromas - what are they and where do they arise.

What do they cause

What condition are bilateral ones associated with

A

Schwann cell tumours which arise at the cerbellopontine angles

Cause SNHLn tinnitus and vertigo, and can cause facial palsy

Bilateral are associated with NF2

28
Q

What drugs cause SNHL

A

Aminoglycosides such as gentamicin
Furesomide
Aspirin
Platins

29
Q

Commonest causes of bacterial tonsillitis palatine

A

Strep pyogenes
Strep pneumoniae
HMS

30
Q

Cantor and Fpain criteria

A

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

31
Q

Abx treatment of tonsillitis

A

Penicillin V phenoxymethylpenecillin

Clarithromycin if allergic

Surgery c (6 decks)

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