ENT Flashcards
Signs of an “unsafe” TM perforation on otoscopy
- Superior and/or posterior edge of tympanic membrane perforation
- Perforation involving fibrous edge or annulus of the tympanic membrane
- Associated granulation tissue
- White mass within middle ear seen through perforation
- Bone erosion
What is the diagnosis and what is initial management?
Normal tympanic membrane
No management required
What is the diagnosis and what is initial management?
Acute OM
Antibiotics only if:
- <6 mo
- <2y with bilateral infection
- Associated otorrhoea
- at high risk of suppurative complications (e.g. ATSI child living remotely, immunosuppression)
- systemically unwell
What is the diagnosis and what is initial management?
Attic Cholesteatoma
Refer to ENT
What is the diagnosis and what is initial management?
Cholesteatoma with bone destruction of external ear canal
Refer to ENT for surgical management
What is the diagnosis and what is initial management?
Cholesteatoma with retraction pocket
Refer to ENT for surgical removal
What is the diagnosis and what is initial management?
Congenital cholesteatoma
Refer to ENT for removal
What is the diagnosis and what is initial management?
Exostoses
No management required, if become so large that are obstrucing ear canal and affecting hearing, can refer to ENT for removal
What is the diagnosis?
Haemotympanum
What is the diagnosis?
Osteoma
What is the diagnosis and what is initial management?
Retracted TM
Observation
If associated hearing loss, suscpicion of cholesteaoma or erosion of ossicles, refer
What is the diagnosis and what is initial management?
“Safe” subtotal central TM perforation
Watch and wait, if not healing, refer for tympanoplasty
What is the diagnosis and what is initial management?
Otitis media with effusion
Referral for tympanostomy tube required if:
- persisting >6 months
- associated speech delay or learning problems
- structural damage to tympanic membrane (e.g. retraction, cholesteatoma)
- bilateral hearing loss on audiometry
What is the diagnosis and what is initial management?
Central TM perforation
This would be considered “Safe” a is central, not inovlving the posterior or superior edges and no signs of underlying cholesteatoma.
Appropriate to watch and wait +/- treat underlying cause (e.g. with ABx if AOM)
If not healing, consider referral to ENT for tympanoplasty
What is the diagnosis and what is initial management?
Total perforation - this one would be considered “Safe” as it does not involve the annulus.
Conservative management to begin with would be appropriate (watch and wait), if not healing, could be referred for tympanoplasty
What is the diagnosis and what is initial management?
Tympanosclerosis
What is the diagnosis and what is initial management?
Cholesteatoma - note the white keratin deposits in the attic
Refer to ENT for consideration of surgical removal
What is the diagnosis?
Tympanosclerosis
What is the diagnosis and what is initial management?
Otitis media with effusion
Referral for tympanostomy tube required if:
- persisting >6 months
- associated speech delay or learning problems
- structural damage to tympanic membrane (e.g. retraction, cholesteatoma)
- bilateral hearing loss on audiometry
What is the diagnosis and initial management?
Severe AOM - I’d probably start antibiotics for this
What is the diagnosis and what is initial management?
Acute OM
Antibiotics only if:
- <6 mo
- <2y with bilateral infection
- Associated otorrhoea
- at high risk of suppurative complications (e.g. ATSI child living remotely, immunosuppression)
- systemically unwell
What is the diagnosis and initial management plan
Normal TM, no management
What is the diagnosis and initial management
Bullous myringitis
Often caused by viral or mycoplasma infection
Treat with analgesia and antibiotics to cover mycoplasma
What is the diagnosis and initial management?
Exostoses
No management required unless obstructing the ear canal an impairing hearing
What is the diangosis and initial management plan?
Foreign body in External auditory meatus
Removal required - in young children this may require sedation.
As is a round bead, suction may be more approriate that trying to grasp with forceps
