ENT- ear Flashcards
What are the congenital risk factors for SNHL?
Prematurity, jaundice, NICU stay, family history, syndrome eg Down’s syndrome
What are the hearing tests in children of different ages?
Otoacoustic emissions (cochlea itself makes a sound in response to being stimulated). any age Auditory brainstem response testing (measure EEG changes in response to sound). any age, used in those <7 months or if developmetal delay Visual reinforcement audiometry (child turns head to sound and is rewarded with a visual reward eg dancing toy). 7 months onwards Play audiometry (carry out play action in response to sound). 2-5 years
What is used to remove foreign bodies from the ear?
Wax hook Croc forceps (not for beads) Suction Oil/alcohol to kill buzzing insects Syringing best avoided GA if uncooperative Batteries need removal, other things can wait several days
What is acute otitis media?
Acute middle ear infection (viral/bacterial/barotrauma)
Recurrent >3 in 6 months, >4 in 12 months
What is chronic otitis media?
Effusion =, no symptoms/signs of acute inflammation
Chronic supparative otitis media- inflammation, TM perforation
Cholesteatoma: squamous epithelium in middle ear
How common is acute otitis media?
Most common specific diagnosis of a febrile illness in children
50% of children have an episode by 1st birthday
80% of children have an episode by 3rd birthday
What are acute otitis media symptoms?
Preceding URTI Fever Ear ache / tugging Irritability Poor feeding Otoscopic assessment carries relatively more weight
What are the features of the tympanic membrane in otitis media?
Bulging/fullness of TM (most important finding)
May be retracted in early stages
most feverish crying children have a reddish TM with increased vascularity (usually bilateral)
What are the predisposing factors for otitis media?
Environmental: crowding, day care, nutrition, smoking
Bottle (vs breast) feeding; pacifier use
Race: White & American Indians
Sex: male
Age: 6 month to 3 years (AOM); 2.5-5 yrs (OME)
Prior / early AOM
Comorbidity: cleft palate, craniofacial abnormality, prematurity, immunodeficiency, ciliary dyskinesia, Down’s syndrome
FHx of middle ear disease
Winter
Which organisms cause otitis media?
Bacteria (in 75%)
Streptococcus pneumoniae 25-50%
Haemophilus influenzae (non typeable) 15-30%
Moraxella catarrhalis 3-20%
Common virususes: RSV, Parainfluenza, Influenza, Rhinovirus, Enterovirus, CMV, Adenovirus
What is the management for otitis media?
Supportive. Most don’t need abx
Abx if: <6/12 old, or at risk of infectious complications, or symptoms >4 days, or systemically unwell. (consider if bilateral, perf/discharge, <2 yrs old)
ENT referral: failure of resolution, persistent discharge, complication (facial palsy, mastoiditis, intracranial sepsis)
What are the guidelines for using eardrops in otitis media?
Cipro drops for perf/discharge
Aminoglycoside drops in TM perf providing it’s acute and short course
Don’t use cipro for otitis externa as that is caused by Pseudomonas which can become resistant to cipro quickly.
What is the management for recurrent AOM?
≥3 episodes in 6/12 or ≥4 in 12/12
Mostly get better after 2 yrs old
Avoid pacifiers
Treat each episode individually (usually the best option as condition usually resolves once more than 2 yrs old)
Long term abx: 1.5 fewer episodes (azithro weekly)
Grommets: 1.5 fewer episodes of AOM
(grommets and abx only effective whilst treated)
What are the features of TM perforation?
Caused by direct trauma, blow, or due to AOM
Most heal within 6 weeks
Keep dry
GP follow up after 6 weeks
See ENT if- severe bleeding, deafness, tinnitus, vertigo, facial palsy
How does acute mastoiditis present?
Complication of AOM Otalgia, hearing loss, malaise, pyrexia, post auricular swelling Pinna-down and forwards Loss of post aural sulcus Complication- intracranial abscess
What is the management for acute mastoiditis?
IV antibiotics
Grommet
Cortical mastoidectomy if not settling or abscess or intracranial complication
What is otitis media with effusion (glue ear)(OME)?
Fluid in middle ear, no symptoms or signs of acute infection
Commonest cause of deafness is developed world
90% resolve within 3 months
What is the presentation of OME?
Overlap with AOM (children with OME suffer 5x more AOM)(50% of OME follows AOM (esp younger children) Hearing impairment: mild Failed hearing screening Speech delay School problems
What does OME look like on otoscopy?
Varied appearance Difficult diagnosis Negative ME pressure indicated by: horizontal handle malleus cone-shaped PT neo-annular fold Colour change: grey to blue opaque PT
What is the management for OME?
3 months observation Grommets (if infected use cipro drops (better than oral abx)) Hearing aid Further observation Autoinflation (Valsalva or otovent balloon)
What is the management for recurrent acute otitis media?
> 3 episodes in 6/12
4 in 12/12
Mostly get better after 2 yrs old
Avoid pacifiers
Treat each episode individually (usually the best option as condition usually resolves once more than 2 yrs old)
Long term abx: 1.5 fewer episodes (azithro weekly)
Grommets: 1.5 fewer episodes of AOM
What are the features of TM perforation?
Direct trauma, blow or due to AOM Most heal within 6 weeks Keep dry, GP follow up after 6 weeks ENT to see if: Severe bleeding, deafness, tinnitus, vertigo, facial palsy
What are the features of acute otitis external?
Boil in external auditory meatus
Acute pain on moving the pinna
Conductive hearing loss if lesion is large
When rupture occurs pus will flow from ear
Treatment: Ear packs, topical antibiotics, operative debridement in severe
What are the features in chronic otitis externa?
Chronic combined infection in the external auditory meatus usually combined staphylococcal and fungal infection
Chronic discharge from affected ear, hearing loss and severe pain rare
Treatment: cleansing the external ear, anti fungal and antibacterial ear drops
What is chronic supportive otitis media?
With or without cholesteatoma
With cholesteatoma: perforation of pars flaccida
Impaired hearing, foul smelling discharge
Without cholesteatoma: perforation of the pars tensa
Intermittent discharge (non-offensive)
What is the management for chronic supportive otitis media?
Simple pars tensa perforations may be managed non operatively or a myringoplasty considered if symptoms troublesome.
Pars flaccida perforations will usually require a radical mastoidectomy
What are the features of mastoiditis?
otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated
