ENT- ear diseases Flashcards
what is otitis media
inflammation of the middle ear
who does otitis media predominantly affect
children
most common bacterias of bacterial acute otitis media
strep pneumoniae
h.influenza
strep pyogens
bacterial otitis media, if chronic which bacterias
pseudomonas
staph aureus
fungal
how does the infection extend in otitis media
infection extends from throat to ear via the Eustachian tube
what are the symptoms of acute otitis media
ear pain
fever
irritability
may have hearing loss
what are some signs seen in acute otitis media
ear appears inflammed
middle ear effusion
opaque tympanic membrane
bulging tympanic membrane
mobility of tympanic membrane impaired
80% of cases of acute otitis media resolve within how long without antibiotics
4 days
antibiotics (amoxicillin/erythromycin) should be prescribed immediately for acute otitis media if-
symptoms worsen/don’t improve within 4 days
systemically unwell but not needing hospitalised
immunocompromised or high risk for complications
< 2 years with bilateral Otis media
perforation and/or discharge in the canal
what are some complications of acute otitis media
sensorineural hearing loss
tinnitus
acute mastoiditis
brain abscess/meningitis
vertigo
facial palsy
venous sinus thrombosis
what is otitis media with effusion aka
‘glue ear’
what is otitis media with effusion
inflammation of the middle ear with accumulation of fluid without the signs and symptoms of acute inflammation
what is otitis media with effusion associated with
Eustachian tube dysfunction/obstruction
what are the most common organisms of otitis media
strep pneumonia
H.influenza
Moraxella
what are the risk factors of otitis media with effusion
day care
older siblings
smoking household
recurrent URTI
craniofacial/genetic abnormalities
prematurity
immunodeficiencies
causes of otitis media in adults
rhinosinusitis
nasopharyngeal carcinoma/lymphoma
signs of otitis media with effusion
middle ear effusion- bubbles/fluid
altered TM colour
TM retraction
impaired TM mobility
what is the first line investigation for otitis media
otoscopy
90% of otitis media with effusion resolve within how long
3 months
when to refer those with otitis media with effusion for surgery-
persistent (>3mnths) bilateral OME
CHL >25dB
speech/language problems
developmental/behavioural problems
what is the first line surgical management for otitis media with effusion
grommets
what are some possible complications of grommets
infection/discharge
early extraction
retention
persistent perforation
swimming/bathing issues
what is cholesteatoma
growth consisting of kertanised squamous epithelium in the middle ear and/or mastoid process; non-cancerous but destructive and expanding
acquired causes of cholesteatoma
chronic otitis media
perforated tympanic membrane
what is a key risk factor for cholesteatoma
frequent ear surgery
what is the most common symptom of cholesteatoma
unilateral discharge often foul smelling
what is the definitive management of cholesteatoma
mastoid surgery, reconstruction
which type of carcinoma account for the majority of the tumours of the ear
squamous cell carcinoma
what is squamous cell carcinoma of the ear related to
chronic inflammation/radiation
what is vestibular schwannoma
rare, benign tumour of the CN VIII sheath that arises in internal auditory meatus
if have vestibular schwannoma bilateral and young consider what?
neurofibromatosis type 2
what is the first line investigation for vestibular schwannomas
MRI
what is the definitive management of vestibular schwannomas
surgical excision
what are the symptoms of vestibular schwannomas
Progressive sensorineural unilateral hearing loss and tinnitus
imbalance in larger tumours
facial numbness can occur
inner/middle/external ear affected in conductive hearing loss?
external and middle
inner/middle/external ear affected in sensorineural hearing loss?
inner ear
what is otitis externa
inflammation of the outer ear canal
what is otitis external almost always caused by
infection
bacterial causes of otitis externa
staph aureus
proteus spp
pseudomonas aeuruginosa
fungal causes of otitis externa
Aspergillus niger
Candida albicans
common triggers of otitis externa
water exposure
cotton buds
skin conditions
clinical features of otitis externa
redness and swelling of ear canal
itchy
sore and painful
discharge/ear wax
hearing may be affected
first line management for otitis externa
topical aural toilet
what is a perforated tympanic membrane often associated with
acute otitis media
examples of trauma that cause perforation of tympanic membrane
sudden negative pressure
inserting something into the ear
clinical features of perforated tympanic membrane
sudden severe pain
bleeding from ear
hearing loss
tinnitus
what is otosclerosis
hereditary disorder in which new bony deposits occur within the stapes footplate and the cochlear, resulting in new onset gradual hearing loss
is otosclerosis more common in men/women
women
which decades is otosclerosis usually seen in
2nd-3rd decade
what is otosclerosis linked to and therefore can be worse during when
linked to high oestrogen
worse during pregnancy
what investigation is used to diagnose otosclerosis
audiometry
which surgical option is used to restore hearing in patients with otosclerosis
stapedectomy
what is presbycusis
degenerative disorder of the cochlear resulting in hearing loss
onset of presbycusis is variable but when is it usually seen
old age
which frequencies are affected most in those with presbycusis
high frequencies
is presbycusis usually conductive/sensorineural hearing loss?
sensorineural
when does noise-induced hearing loss characteristically dip on audiometry
classical dip at 4 kHz
which drugs are well known to cause sensorineural hearing loss
gentamicin and other aminoglycosides
chemotherapeutic drugs
aspirin and NSAIDs
furosemide (rarer)
if a patient reports dizziness that occurs for seconds what is the most likely cause
BPPV
if a patient reports dizziness that occurs for hours what is the most likely cause
Menieres
if a patient reports dizziness that occurs for days what is the most likely cause
vestibular neuritis
if a patient reports dizziness that occurs for variable time lengths what is the most likely cause
migraine associated vertigo
patients get dizzy when rolling over in bed- what is most likely cause
BPPV
patients first attack of dizziness was severe, lasting hours, with nausea and vomiting- what is most likely cause
vesicular neuritis
patient experiences dizziness and gets light-sensitive during dizzy spells- what is most likely cause
vestibular migraine
patient reports dizziness and one ear feels full and experiences tinnitus around time of dizzy spell- what is most likely cause
Menieres disease
what is menieres disease
idiopathic disorder causing vertigo
Menieres disease attacks are compromised of a triad of?
severe paroxysmal vertigo
sensorineural hearing loss
tinnitus
what is vertigo
recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 mins (often lasting hours)
Menierres disease is typically low/high frequency sensorineural hearing loss
low frequency
what is vestibular neuritis
inflammation of the vestibular nerve
how long does dizziness associated with vestibular neuritis last
days
which medications can help reduce the sensation of dizziness
antihistamines
prochlorperazine
what is BPPV (benign positional paroxysmal vertigo)
vertigo associated with presence of otoliths (ear stones) in the semi-circular canal instead of the urticle
what is the most common cause of vertigo on looking up
BPPV
causes of BPPV
head trauma
ear surgery
idiopathic
when do patients with BPPV experience vertigo-
on looking up
turning in bed
first lying in bed at night
getting out of bed in morning
bending forward
rising from bending
moving head quickly
how long do attacks of vertigo last in patients with BPPV
seconds
what manoeuvre is used to diagnose BPPV
Dix-Hallpike manoeuvre- geotropic, torsional nystagmus
what is acute mastoiditis
complication of acute otitis media involving infection of the mastoid air cells
how does acute mastoiditis present
pain, tenderness, and swelling behind the ear
what investigations are carried out to diagnose acute mastoiditis
CT
MRI
how do you treat acute mastoiditis
IV antibiotics
surgical drainage in some cases
complication of acute mastoiditis
meningitis
what is a relatively rare complication of Otitis externa
malignant (necrotising) otitis externa
what is the most common cause of malignant Otitis external (bacterial)
pseudomonas
risk factors for malignant otitis externa
diabetes
radiotherapy to head and neck
which medication is commonly used to prevent episodes of menieres
betahistine- antihistamine
what is the most common cause of hearing impairment post head injury
perforated tympanic membrane
is otosclerosis conductive/sensorineural hearing loss
both- most commonly conductive
does Menieres disease usually affect one or two ears
one
is Menieres disease sensorineural/conductive hearing loss
sensorineural
which is associated with hearing loss- labyrinthitis/vestibular neuritis?
labyrinthitis
if hearing loss occurs in cholesteatoma is it conductive/sensorineural
conductive
