ENT Flashcards
What is acute otitis media?
infection of the middle ear section, typically from the eustachian tube dysfunction
What is the eustachian tube?
Opening that connects the middle ear with the nasal-sinus cavity
What is the function of the eustachian tube?
- equilibration of the middle ear with atmospheric pressure
- Protect middle ear from reflux of nasopharyngeal content
- Drain secretion from the middle ear into the nasopharyngeal
Causes of Eustachian tube dysfunction
Infection
- oedema of the eustachian tube
- adenoid hypertrophy
Failing of the
- tensor veli palatini
- levator veli palatini
Common infection species that occur in acute otitis media are_____
Streptococcus pneumoniae
Haemophilus influenzae
morexilla catarrhalls
What is the pathophysiology of acute otitis media?
–> Viral infection happens in the nasal cavity and causes congestion oedema
–> The oedema causes the eustachian tube occlusion and create negative pressure in the middle ear
–> Which can cause accumulation of the fluid in the middle ear
–> Leading to secondary viral and bacterial infection in the middle ear
What is suppurative otitis media?
- It is where build-up pressure in the middle ear,
- causing perforation of the tympanic membrane
- and discharge (otorrhea)coming out of the ear
What terminology describes the discharge that comes out from the ear?
otorrhea
What is otitis media with effusion?
residual fluid in the middle ear cavity after acute otitis media
How can we resolve otitis media with effusion?
Nothing…it’ll resolve by itself after 3 months
recurrent acute otitis media definition
reinfection of the middle ear
/
The middle ear got infected again
Clinical presentation of otitis media
otalgia (ear pain)
pyrexia (fever)
hearing loss
otorrhea
—————————-
Upper respiratory tract infection
irritability
reduced appetite
fatigue
Otitis media is a sensory hearing loss/conductive hearing loss
conductive hearing loss
How can you diagnose otitis media?
direct visualization of the tympanic membrane with an otoscope / pneumatic otoscope
- culture of the middle ear
What is the first-line treatment for AOM?
oral analgesia & observe
*If no improvement after 24/48hrs
vv
Consider antibiotic therapy
(amoxicillin) –>5-7days
What is acute otitis externa?
Inflammation of the external auditory canal
how to know whether otitis externa is acute or chronic?
acute - less then 3 weeks
chronic - more than 3 months
How common is acute otitis externa?
most common in children and adolescents
ages around 7-12
Risk factors of otitis externa
Swimming
Humid air
Young age
Diabetes
Trauma
Narrow external auditory meatus
Obstructed external auditory meatus
Eczema, psoriasis
Radiotherapy
What is the most common cause of acute otitis externa?
Bacterial
Pseudomonas aeruginosa or Staphylococcus aureus
Fungal
Candida albicans or Aspergillus species.
Clinical features of otitis externa
Symptoms
- Itch
- Tenderness
- Hearing loss
- Discharge
Signs
- Inflamed external auditory canal
- Erythema
- Scaly skin
- Pre-auricular lymphadenopathy
investigation to diagnosis otitis externa
Ear swab (MC&S)
What is the treatment & management for otitis external?
- cleaning the external canal
- avoid swimming for at least 7-10 days
- analgesia —> paracetamol and ibuprofen
- topical antibiotic / topical steroid
(ciprofloxacin w fluocinolone)
-otomycin
what is mastoiditis?
a rare life-threatening complication of acute otitis media
Where infection of the mastoid air cells
what is the typical clinical feature of mastoiditis?
pain swelling and erythema behind the ear
systemic upset
What are the management to treat mastoiditis?
- early antibiotics
- myringotomy (drain the middle ear with a hole in the tympanic membrane)
- mastoidectomy (removal of infected tissue/bone)
What is Otosclerosis
Otosclerosis is a condition where there is remodelling of the small bones in the middle ear, leading to conductive hearing loss.
features about otosclerosis
- conducting hearing loss
- more common in women
- before 40years
- development can be environmental/genetic but not fully understood
- mostly autosomal dominant
what are the 3 auditory ossicles in the ears?
Malleus
incus
stapes
What does cochlea do in the ears?
coverts vibration into sensory signals
What is the site that binds between stapes and the cochlea?
Oval window
Explain the pathophysiology of otosclerosis
abnormal bone remodelling and formation of the oval window
causing stiffening and fixation of the base of the stapes and leading to conductive hearing loss
Clinical presentation of otosclerosis
- can be unilateral/bilateral
- affects hearing of lower-pitched sounds
- can hear female speech easier
- hearing loss
- tinnitus
- talks more quietly
^ (can hear their voice very loudly)
what examination can it be done to find otosclerosis?
otoscopy
weber’s test
rinne’s test
What result will it show in the examination of an otosclerosis patient?
otoscopy –> normal
Weber’s test
bilateral –> normal result
unilateral –> affected side will be louder
Rinn’s test
–> Bone conduction - able to hear
–> Air conduction - can’t hear
What investigations can it be done to find otosclerosis?
Audiometry - conduction hearing loss
tympanometry
High-resolution CT scan
What is the management for otosclerosis?
Conservative - hearing aids
surgical
- stapedectomy
- stapedotomy
What is the difference between stapedectomy and stapedotomy?
stapedectomy
Replace the whole stapes, put a prosthesis in it and hook it around the oval window
stapedotomy
drill a whole of the base of the stapes and put a prosthesis between the incus and the base of the stapes
What is Presbucusis?
Age-related hearing loss. It is a type of sensorineural hearing loss that occurs as people get older.
It tends to affect high-pitched sounds first and more notably than lower-pitched sounds.
The hearing loss occurs gradually and symmetrically.
Causes of presbycusis
loss of hair cells
loss of neurones
atrophy of the stria vascularis
reduce of the endolymphatic potential
Risk factors of presbycusis
increase age
male
family history
*** Loud noise exposure
diabetes
hypertension
ototoxic medication
smoking
Clinical presentation of presbycusis
gradual and insidious hearing loss
loss of high-pitched sounds
-male voices are easier to hear
not paying attention
missing details of conversations
concern about dementia
tinnitus
Diagnosis of Presbycusis
Audiometry
Normal at lower frequencies
Worsening hearing loss at higher frequencies
Management of presbycusis
CAN’T REVERSED
supporting normal function
- optimising the environment
- hearing aids
- cochlear implants
What is acoustic neuroma?
Acoustic neuromas are benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear.
Where does the acoustic neuroma occur?
at the cerebellopontine angle
What do bilateral acoustic neuroma associate with?
neurofibromatosis type II
Clinical presentation of Acoustic neuroma
40-60s
* unilateral sensorineural hearing loss
* unilateral tinnitus
- dizziness or imbalance
sensation of fullness in the ear
*leading to Facial nerve palsy
^ If the tumour grows large enough to compress the facial nerve
investigation for acoustic neuroma
Audiometry
MRI / CT
Management & treatment for acoustic neuroma
Conservative
- monitoring
surgery
- partial/total removal of tumour
Radiotherapy
- reduce the growth of the tumour
What are the risk factors for treatment in acoustic neuroma?
Injury to:
- vestibulocochlear nerve
–>hearing loss
–> dizziness
- facial nerve
–> facial weakness
What is sinusitis
Sinusitis refers to inflammation of the paranasal sinuses in the face. This is usually accompanied by nasal cavity inflammation and can be referred to as rhinosinusitis.
How do we differentiate acute and chronic sinusitis?
Acute sinusitis - less then 12weeks
chronic sinusitis - more than 12 weeks
What are the 4 sinuses in the nose?
Frontal
Ethmoid sinuses
Maxillary sinus
Sphenoid
Causes of sinusitis
Infection - viral upper respiratory tract infection
allergies - hayfever
obstruction of drainage - foreign body, trauma, polyp
smoking
Clinical presentation of sinusitis
- nasal congestion
- nasal discharge
- facial pain/headache
- Facial pressure
- facial swelling
- loss of smell
cough and sore throat
What is the likely cause of acute sinusitis?
viral upper respiratory tract infection
What will the examination show for a sinusitis patient?
tenderness
inflammation and oedema
discharge
fever
signs of systemic infection (tachycardic)
investigation of sinusitis
Nasal endoscopy
sinus culture
CT head
How to treat acute sinusitis?
Systemic infection/sepsis –> admission to hospital
symptoms < 10days–>
no antibiotics
resolve within 2-3weeks
symptoms >10days
- steroid nasal spray 14 days
(mometasone 200mcg twice a day)
- delay antibiotic prescription
(phenoxymethylpenicillin)
How to treat chronic sinusitis
saline nasal irrigation
steroid nasal spray/drops
functional endoscopic sinus surgery
What to do if a patient experiences recurrent episodes of sinusitis?
Refer to ENT specialist
another term for ear wax
cerumen
What is acute rhinosinusitis?
acute inflammation of the nose and paranasal sinuses
what’s the difference between acute and chronic rhinosinusitis?
acute - less than 4 weeks
chronic - more than 12 wwk
How does acute recurrent rhinosinusitis occur?
develop more than 4 episodes of acute rhinosinusitis within a year with resolution of symptoms between episodes
causes of sinuses
smoking
obstruction o drainage
allergies
swimming and asthma
Viral - Rhinovirus
bacterial
- Streptococcus pneumoniae
- Haemophilus influenzae
Clinical Presentation for sinusitis
symptoms:
- nasal congestion
- nasal discharge
- facial pain / headache
- facial pressure
- facial swelling over the affected areas
- loss of smell
- ear pain
- fever
Signs
- tenderness to palpation fo the zygomatic arch / maxillary sinus
- Erythema or swelling around the maxillofacial area
feature that support a bacterial over a viral infection in rhinosinusitis?
- persistent clinical features with no improvement more than 10 days
- double worsening
- persistent severe symptoms
(fever, severe facial pain for 3-4 days)
Red flags on rhinosinusitis
Severe, persistent headache
Periorbital oedema
Visual changes (e.g. reduce acuity, double vision)
Abnormal extra-ocular eye movements
Cranial nerve palsies
Proptosis
Pain on eye movement
Altered mental status
Meningism: headache, neck stiffness, photophobia
What investigation would you do for rhinosinusitis?
Cultures: nasal, sputum, sinus, blood
Bloods: FBC, U&E, LFT, Bone, CRP
Facial and head imaging (e.g. CT, MRI)
When should you give antibiotics to patients with rhinosinusitis?
Not give antibiotics for up to 10 days
What treatment would you give to a patient with rhinosinusitis?
first-line - phenoxymethylpenicillin
steroid nasal spray for 14days - mometasone 200mcg twice daily
