ENT Flashcards
What often precedes Otitis Media
Viral upper Resp tract infection
Commonest Bacterial cause of Otitis Media?
Streptococcus Pneumoniae
Otitis Media Presentation:
Ear Pain,
Reduced hearing
Upper airway infection symptoms
Otitis Media Examination
Bulging, red, inflamed tympanic membrane
Otitis Media management
Most cases resolve w/o abx within 3 days
Immediate abx in patients w/ sig comorbidities
Amoxicillin for 5-7 days first line
Clarithromycin in penicillin allergy
Erythromycin (in pregnant women allergic to penicillin)
What is glue ear
Otitis media w/ an effusion
Glue ear features
Peaks at 2 years old
Hearing loss
Secondary problems eg speech and language delay, behavioural or balance problems
Glue Ear treatment
Grommet insertion
What is Presbycusis and what type of sound does it affect first?
Age related hearing loss
Tends to affect high pitched sounds first
Presbycusis risk factors
Loud noise exposure
Diabetes
HTN
Drug exposure (salicylates)
Presbycusis presentation
Hearing loss- gradual and insidious: loss of high pitched sounds
Presbycusis examination findings?
Normal
Presbycusis management
Optimise environment
Hearing aids
Cochlear implants (in patients where hearing aids aren’t sufficient)
Tinnitus types?
Primary- no identifiable cause
Secondary- identifiable cause
Tinnitus causes:
Ear wax
Meniere’s disease
Otosclerosis
Acoustic neuroma
Drugs: Aspirin/NSAIDs, Aminoglycosides, Loop diuretics, Quinine
Imaging criteria for tinnitus?
Generally non pulsatile tinnitus doesn’t require imaging unless unilateral or other neuro/otological signs.
MRI of the internal auditory meatuses is first line
Tinnitus management
Investigate underlying cause
Amplification devices
Psychological therapy may help a limited group of patients- eg CBT
Tinnitus support groups
Eustachian tube dysfunction presentation
Reduced or altered hearing
Popping noises/sensations in the ear
Fullness sensation in the ear
Pain
Tinnitus
Symptoms get worse when external air pressure changes and middle ear pressure can’t equalise the outside pressure eg flying, mountain climbing or scuba diving
Generally associated w/ recent viral URTI or hayfever
Eustachian tube dysfunction investigation
Tympanometry- tympanogram will show a peak admittance (most sound absorbed) w/ negative ear canal pressures
Eustachian tube dysfunction management
Can resolve spontaneously
Valsalva manouevre
Decongestant nasal sprays (short term only)
antihistamines and a steroid nasal spray for allergies or rhinitis
Otitis externa- AKA
Swimmer’s ear- exposure to water whilst swimming can lead to inflammation in ear canal
Causes of otitis externa? Which fungal causes are more susceptible in ppl who’ve had multiple topical abx courses
Bacterial infection- pseudomonas aeruginosa
Fungal infection- eg aspergillus or candida
Otitis externa presentation?
Ear Pain
Discharge
Itchiness
Conductive hearing loss (if ear becomes blocked)
Otoscopy findings?
Erythema and swelling in ear canal. Tenderness. Pus or discharge. Lymphadenopathy in neck/around ear.
Management of otitis externa?
Mild OE can be treated w/ acetic acid 2% - has antifungal and antibacterial effect
Moderate OE- treated w/ a topical abx and steroid eg Neomycin, dexamethasone and acetic acid
Severe/systemic OE- oral abx (eg flucloxacillin or clarithromycin) or discussion w/ ENT for admission and IV abx
Malignant otits externa- progresses to what?
Osteomyelitis of temporal bone
Malignant OE risk factors
Diabetes, immunosppuressed
Malignant OE symptoms
More severe than OE, w/ persistent headache, severe pain and fever
Malignant OE management
Emergency- admission to hospital under ENT team, IV abx, Imaging to assess extent of infection
Vestibular neuronitis presentation
Acute onset of vertigo
May be recent viral URTI
Symptoms are more severe first few days, initially vertigo may be constant after which it’s triggered or worsened by head movement
NO LOSS OF HEARING
Vestibular neuronitis diagnosis:
Head impulse test
Vestibular neuronitis management
