ENT Flashcards

Question

Causes of conductive hearing loss?

Answer 1

wax exostoses otitis externa FB atresia stenosis

Answer 2

Swimmers ear common organisms - pseudomonas, staph aureus **features** very painful, smelly ear swelling of skin external aud cannal **Ix** **swab MCS + fungal culture** **Rx** keep ear dry when washing/swimming (cotton wool + vasaline or blue tack) clean debris (tissue spears, Ear Clear- has peroxide component which bubbles ear wax ot) topical ear drops ciloxin or *ciproxin HC (steroid component)* if suspect concurrent otitis media → Rx w PO ABx (augmentin) *NB: if suspect perforation OR pt has grommets in situ → dont use ciproxin HC as preservative can be toxic to middle/inner ear. Ciloxin safe.* **if fungal otitis media** black spores - aspergillus nigra wet blotting paper - candida itchy, generally not very painful conductive hearing loss **Rx** topical antifungals * IF EAR DRUM INTACT:locacortin-viofrom drops, nilstrat, kenacomb (antifungal, candida, bacterial, steroid) keep ear dry, can take ~1 month to settles

Answer 3

* glue ear (otitis media w effusion) * perforation * ossicular chain disruption or fixation eg: tympanosclerosis * mass in middle ear * acquired cholesteatoma

Answer 4

**OME** * very common, esp daycare ~80% preschool children * 50% get OME post episode of AOM * most resolve spontaneously - 60% cleared by 1 month, 90% cleared by 3 months * if OME \>3 months = **chronic and needs Mx** * biofim created, often polymicrobial RF * season * FHx * URTI * cleft palate/downs syndrome, muscopolysaccharidoses * childcare centres O/E dull drum, amer fluid behind, airlfuid lvlsdrum retraction or bulging pneumatico-otoscopy useful to see if drum moves (absent movment) or tympanometry (flat line) Chronic OME = \> 3 months → risk of complications * hearing loss * behavioural difficulties * speech delay \*controversial * damage to drum → secondary damage to ossicles/erosion * drum retraction (precursor to cholesteatoma) Mx antibiotics - full orlow dose (daily dose of abx) for 1 month to remove biofilm DONT use steroids otovent to drain ET if drum retraction = atelectasis - grommets if drum retracted but not stuck down - surgery: exploration, dissection of drum off ossicles

Answer 5

persistent bilateral OME w effusion present for \>3 months WITH bilateral hearing loss OR damage to drum or ossicles

Answer 6

allow aeration of middle ear * stops negative middle ear pressure * stops bugs tracking up from nose (as vacuum removed) * stops TM retraction + Cx from this * aeration reverses metaplasia * ie: 80% goblet cells (creating mucoid) return to 20% goblet cells * O2 tension, disrupts biofilm 20% of kids will need second set of gromets last 6-18mo keep dry small chance perforation + retention they will come out themselves shouldnt have discharge through grommet

Answer 7

Cx of AOM * facial palsy (need to drain middle ear + insert grommet + ABx) * mastoiditis → abx if early, surgery * TM perforation * labrynthitis * abscesses (brain, sub+extradurral) * lateral sinus thrombosis * meningitis

Answer 8

AOM peak incidence: 6 - 12 months, smaller peak 4 to 5yo common (2/3 of children by age 3, 50% have 3+ episodes by age 3) cant tell if bacterial or viral, but most are bacterial ( s.pneumo, Hib, moraxella, 25% viral features (can progress VERY quickly) - fever - erythema in TM w bulging pus behind it painful → 60% painfree in 24hrs w/o Abx hearing loss Rx watch an wait w most pt before Rx, EXCEPT FOR children \<2 yo (complications hrder to pick up) if pt unlikely to come back for F/U in next few datys cochlear implant children Abx choice - amoxil, augmentin, ceclor (shorter courses \<5 days have more treatment failures.relapses = re-infections than longer 8 to 10 day courses) less AOM -. chronic OME w conjugate penumococcal vaccine (prevenar) - ;)

Answer 9

better outcomes if in middle of TM per If acute perf - likely to heal on own * keep dry to prevent contamination * F/U in 1-3 months Myringoplasty (patch hole) hearing aid (if conductive loss)

Answer 10

* OME - bilateral for \>3 months, w hearing loss or drum changes * Speech/language delay or cognitive issues w OME * Frequent episodes AOM 3-4 per 6 months * chronic ear discharge (needs cholesteatoma ruled out) * unusual otoscopic findings eg: atelectasis of drim or if suspect cholesteatoma * hearing loss w possile sensori-neural component

Answer 11

often occurs at ant-sup segment **presenting features** * CHL * chronic ear discharge * polyp * scaly skin from one area of drum * deep retraction pocket that cant see edges of recurrent ear infections O/E old dry skin, attic retraction Ix: CT scan (specific slices), audiogram Mx: surgical removal (tympanoplasty, mastoidectomy)

Answer 12

all of the above