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MRCS ENT > Ears > Flashcards

Ears Flashcards

1
Q

What is the function of the pinna?

A

Collect sound waves and direct into the EAC - shape aids localisation of sound direction and amplification.

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2
Q

What is the function of the EAC?

A

Transmit sound waves to TM

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3
Q

Describe structure of the EAC?

A

Outer cartilaginous part, inner bony part

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4
Q

Investigation and treatment of microtia?

A

Hearing assessment, CT to assess middle ear/ossicles/anatomy, Rx: hearing support, removal of pinna and reconstruction with implants which can be inserted into bone to attach to an artificial pinna or BAHA

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4
Q

Label

A
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4
Q

Where does the pinna develop from?

A

6 hillocks of His

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5
Q

What is a pre auriciular sinus?

A

Small dimple anterior to tragus which may be external opening to a network of channels under skin, caused by incomplete fusion of hillocks of His.

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5
Q

Best suture to repair an ear lac?

A

5-0 prolene

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5
Q

Most common bug responsible for OE?

A

Pseudomonas aeruginosa

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5
Q

Where is the collection of blood in a pinna haematoma?

A

between perichondrium and cartilage

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5
Q

Complication of pinna haematoma and why?

A

Haematoma leads to pressure necrosis of cartilage with subsequent deformity, infection, fibrosis and cartilage loss resulting in cauliflower ear

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6
Q

What to consider in patients with NOE who arent improving?

A

Biopsy, ?malignancy - if initial biopsy negative consider further deep biopsy or cortical mastoidectomy for histology.

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6
Q

Excision margins of malignancy on pinna?

A

BCC 3mm, SCC 4mm, melanoma T1 <1mm excision 1cm, melanoma T2 1-2mm excision 1-2cm, T3 2-4mm excision 1-2c,, T4 >4mm excision 2cm and refer to melanoma centre for any deeper than 1mm for senital node biopsy

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6
Q

What are granulations on the floor of the EAC at junction between bony and cartilaginous part of canal suggestive of?

A

NOE

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6
Q

Which CNs can be affected in NOE?

A

CN VII + IX-XII if infection reaches petrous apex

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7
Q

Topical therapies for skin cancer on pinna?

A

Superficial BCC - cryotherapy, imiquimod five times per week for 6 weeks, radiotherapy, photodynamic therapy.
SCC in situ (Bowens or actinic keratosis) - fluotouracil cream BD for 3-4 weeks

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8
Q

Investigations for diagnosis of EAC malignancy?

A

Treat if infected, biopsy, CT to stage lesion, MRI to assess intracranial spread

9
Q

Rx of EAC malignancy?

A

Surgery (lateral temporal bone resection) +/-radiotherapy

10
Q

Name of staging system for EAC malignancy?

A

Pittsburgh staging - T1 limited to EAC, T2 not full thickness bonie erosion <).5cm soft tissue invovled, T3 erodes bony EAC with <0.5cm soft tissue or tumour involves middle ear/mastoid/both, T4 tumour eroding cochlear, petrous apex, medial wall middle war, carotid canal, etc or >0.5cm soft tissue involvement such as TMJ or stylomastoid foramen or facial nerve palsy

11
Q

Function of the middle ear?

A

Transduce sound waves, amplify them and pass them to the cochlea.

12
Q

Describe the structure of the TM?

A

3 layers, pars flaccida and pars tensa and are divided by anterior and posterior malleolar folds, the two pars differ in strength because tensa has radially arranged collagen fibres whereas flaccida has randomly arranged collagen and lots of elastin.

13
Q

What is the function of the stapedius muscle?

A

Contracts and dampens the movement of stapes

14
Q

What is the function of the tensor tympani muscle?

A

Contracts and stabilises the movement of the malleus

15
Q

How does the ear protect itself from loud noise?

A

Contraction of stapedius and tensor tympani

16
Q

How does the mastoid air cell system connect with the middle ear?

A

Via the antrum

17
Q

Label

A
18
Q

Label

A
19
Q

Blocked eustachian tube treatments?

A

Grommet, balloon dilatation, endoscopic widening with laser or debrider, adenoidectomy and treatment of rhinosinusitis if that is the cause

20
Q

Name 4 symptoms of glue ear

A

reduced hearing, recurrent ear infection, poor speech development, balance problems

21
Q

What is chronic suppurative otitis media without cholesteatoma?

A

Common condition associated with eustachian tube dysfunction, which presents with persistent reucrrent otorrhoea, perforation in TM and no cholestatoma

22
Q

Which ear perforations are ‘unsafe’ and which are ‘safe’?

A

Unsafe - marginal pars tensa and attic/pars flaccida are unsafe, central perforations are safe

23
Q

Management of chronic suppurative otitis media?

A

Antibiotics based on swab results, water precautions, regular microsuction, myringoplasty, cortical mastoidectomy.

24
Q

Subtypes of cholesteatoma?

A

Congenital - abnormal focus of squamous epithelium in middle ear space, ie a dermoid. Acquired - chronic eustachian tube dysfunction

25
Q

Describe the mechanism of development of cholesteatoma

A

Prolonged low middle ear pressure > pars flaccida retraction pocket > as this enlarges the neck becomes small compared to sac itself. Initially squamous epithelium migrates out of the sac with ease but as it enlarges the epithelium builds up and can’t escape, if infection supervenes on the impacted epithelium/keratin, lytic enzymes are released causing destruction of local structures.

26
Q

Investigations and management of cholesteatoma?

A

microsuction, topical antibiotics, CT temporal bone looking for pneumatisation of mastoid or erosion of scutum (outer attic wall). Rx: grommets to reverse development of cholesteatoma, surgery, close follow up

27
Q

Complications of cholesteatoma

A

Local - Conductive hearing loss due to disruption of blood supply to incus which causes thinning of incus and then loss of it’s attachment to stapes. Vertigo, facial nerve dysfunction, mastoiditis. Distant - meningitis, cerebral abscess, lateral sinus thrombosis and hydrocephalus, Bezold’s abscess (infection from mastoid spreads through mastoid tip and travels under SCM), Citelli’s abscess (infection spreads medially from mastoid tip to collect in digastric fossa)

28
Q

What surgical options exist for Chronic suppurative otitis and what are the principles?

A

Myringoplasty using temporalis fascia or tragal perichondrium to waterproof the ear. Cortical mastoidectomy (often with myringoplasty) to enter mastoid cavity via a post auricular incision, drill the air cells to form a continuous cavity which joins the middle ear space at the mastoid antrum so any diseased mucosa pockers are removed.

29
Q

What is otosclerosis?

A

New bone formation around stapes footplate leading to fixation and CHL

30
Q

Typical features of otosclerosis?

A

Schwartzes sign on examination, Carharts notch on PTA

31
Q
A

MRCS ENT (1 decks)

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