ENT Flashcards
What is quinsy?
A peritonsillar abscess
An abscess = collection of pus that forms near an area of infected skin or other soft tissue
What are the symptoms associated with quinsy?
Patients present with a severe sore throat (worse unilaterally), with associated severe odynophagia. Associated symptoms include stertor and trismus; in children, they can present in similar ways.
What is a Cholesteatoma?
Accumulation of benign keratinizing squamous cells (which most commonly involves the middle ear)
Squamous cells are hyperproliferating and secrete enzymes, which can be destructive.
What is the epidemiology of Cholesteatoma?
Both adults and children
More common in males
What is acquired Cholesteatoma?
Develops after birth.
Eustachian tube dysfunction results in tympanic membrane retraction and once the retraction is deep enough keratin migration from the tympanic membrane to the external auditory canal cam mo longer occur and the trapped keratin develops into a cholesteatoma.
Keratin debris can become infected, leading to chronic ear discharge.
What is congenital Cholesteatoma?
Results from persistent epithelial cells rests left within the middle ear during growth of the embryo and is diagnosed in children who have an intact tympanic membrane and no history of ear surgery
What are the symptoms of Cholesteatoma?
Persistent/recurrent ear discharge despite topical antibiotics
Unilateral hearing loss
What are the signs of cholesteatoma?
Otoscopy + micro suction (clear any wax to ensure that the whole TM is visualised paying particular attention to the superior part of the TM (attic area))
There is a deep retraction pocket in the TM with keratinous debris within it. There may be granulations around the margins of the retraction pocket and it is very common for adjacent bony erosion to occur
If secondary infection = discharge in the ear canal
In congenital cholesteatoma, the tympanic membrane is usually intact but it may be bulging and a white pearly mass will be visible through the tympanic membrane
What are the complications of cholesteatoma?
Actue Otitis Media
What investigations should be conducted if Cholesteatoma is suspected?
Pure tone Audiometry
CT scan of temporal bone
What is the treatment for Cholesteatoma?
Surgery:
- To remove the cholesteatoma sac and repair the tympanic membrane and any adjacent bony defect, to prevent recurrent discharge.
- The mastoid cavity is drilled to allow access to the middle ear and all of the cholesteatoma is removed.
- If there has been destruction of the ossicles, hearing can be reconstructed (ossiculoplasty) using a variety of techniques and the tympanic membrane is replaced with a graft
What is Acute otitis media?
Acute otitis media is an acute onset inflammation of the middle ear, usually of an infective origin.
What is the epidemiology of acute otitis media?
All ages, more common in infancy
What are the risk factors for acute otitis media?
Lack of breastfeeding as a baby Attending nursery/day care Positive family history Age between 6-18 months Exposure to smoking
What are the causes of acute otitis media?
Upper respiratory tract infection (URTI) results in inflammation of the upper airways and swelling causes obstruction of the Eustachian tube. Ascending infection results in hyperaemia of the middle ear mucosa with production of a purulent exudate. This is called acute otitis media (AOM)
Viral infections
- Respiratory syncytial virus, rhinovirus and enterovirus most common
Bacterial organisms
- Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis
What are the symptoms of acute otitis media in an infant?
fever
ear pulling
irritability
vomiting
What are the symptoms of acute otitis media in children and adults?
otalgia (ear pain)
fever
generally unwell
hearing loss
If the tympanic membrane bursts the pain may suddenly improve, but a purulent discharge develops from that ear
What are the signs of acute otitis media?
Bulging tympanic membrane
Injected tympanic membrane
If there is a perforation, there may be purulent discharge coming through.
There may also be secondary otitis externa
What are the complications of acute otitis media?
Split into intratemporal and intracranial
Intratemporal: tympanosclerosis (white patch on the ear drum due scarring), hearing loss, tympanic membrane perforation, mastoiditis, labyrinthitis, facial nerve palsy
Intracranial: meningitis, intracranial abscess, lateral sinus thrombosis, cavernous sinus thrombosis, subdural empyema
What are the investigations of acute otitis media?
Consider swab for M, C &S if ear discharging
Imaging (CT and/or MRI) if complications are suspected
What is the treatment for acute otitis media?
Analgesia (e.g. Ibuprofen) and anti-pyretics (e.g. Paracetamol)
If failure to improve within 24-48 hours, consider prescribing oral antibiotics. A 10 day course of Amoxicillin is first line.
If no improvement, switch to Co-amoxiclav.
