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Finals RP > ENT - ears > Flashcards

ENT - ears Flashcards

1
Q

Features of Acute Otitis media?

A

Severe pain and tympanic membrane inflammation (erythema), usually in children

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2
Q

Which part of ear is infected in Otitis Media?

A

Middle

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3
Q

Most common organism causing Acute Otitis Media?

A

S pneumoniae

all URTI organisms really

Viruses include RSV and rhinovirus

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4
Q

What is a sign of rupture?

A

ear pain that suddenly goes away then discharge

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5
Q

What nerve is important to test in middle ear infection?

A

Facial nerve

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6
Q

Management of Acute Otitis Media?

A

Painkillers first for 3 days and observe

Then amoxicillin if not improved

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7
Q

Main complication of Acute Otitis Media?

A

Mastoiditis - bulgy swelling behind ear, pushing ear forward

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8
Q

How to deal w Mastoiditis?

A

Admit, IV antibiotics, CT head if no improvement in 24h –> mastoidectomy definitive management

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9
Q

What are the two types of chronic otitis media?

A

Mucosal (i.e. supparative) - where tympanic membrane ruptures + chronic discharge

Squamous - where tympanic membrane is pushed back - assoc w choleastoma

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10
Q

Main feature of Chronic Mucosal Otitis Media?

A

Chronic discharge for over 6 weeks WITHOUT pain or fever

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11
Q

First Ix for ear pain?

A

Otoscopy

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12
Q

What are common causes of Chronic Mucosal Otitis Media?

A

Anything that can burst the ear:

Recurrent AOM
Trauma to ear
Previous ear surgery

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13
Q

What type of hearing loss is caused by Chronic Otitis Media?

A

Conductive

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14
Q

Investigation for suspected cholesteatoma?

A

CT scan of petrous temporal bone

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15
Q

Treatment for uncomplicated chronic mucosal otitis media?

A
  • Aural toileting techniques

- Antibiotic and steroid drops

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16
Q

Who should be referred to ENT in chronic OM?

A

if symptoms >6 weeks or lots of debris

They must keep ear dry!

17
Q

Two types of surgery for large perforated tympanic membrane?

A

Myringoplasty

Tympanoplasty

18
Q

two types of squamous chronic OM?

A

Acquired - from constant negative ear pressure due to eustachian tube defect = TM retracts and forms a pocket where debris accumulates –> cholesteatoma

Congenital - epidermoid cysts in middle ear

19
Q

What will be seen on otoscopy in Squamous chronic OM?

A

pearly waxy mass

20
Q

Investigations for chronic OM?

A

otoscopy
pure-tone audiogram

If cholesteatoma suspected, CT of petrous temporal bone

21
Q

Mx of choleasteatoma?

A

surgery

22
Q

Common injuries following ear trauma?

A

Pinna Haematoma
Pinna laceration
Temporal bone fracture
Tympanic perforation

23
Q

Who is pinna haematoma common in?

A

Boxers and rugby players

24
Q

Mx of pinna haematoma?

A

drainage within 24h –> gauze and tight headband

25
Q

Surgical technique for pinna haematoma drainage?

A

Incision along helical rim of ear –> evacuate haematoma –> place dental roll on both sides of auricle –> tight mattress sutures through rolls and pinna

26
Q

Pinna lacerations things to consider?

A

All cartilage needs skin around it as skin provides blood flow

Optimal wound cleaning + tetanus boosters + AB prophylaxis

27
Q

Two types of Temporal bone fractures?

A

Longitudinal - hit on side of head –> conductive hearing loss

Transverse - hit on front of head –> sensorineural heaing loss and facial palsy

28
Q

Sign of basilar skull fracture?

A

“Battle sign” = crescent shape behind ear –> when the posterior auricular artery ruptures due to a basal skull fracture

29
Q

Mx of temporal bone fracture?

A

CT fine slice

Admit for observation

30
Q

Mx of Tympanic membrane perforation?

A

Uncomplicated TM perfs resolve themselves in 3 months - tell patient strictly no water in ear!

Compicated or non-healing ones require surgery –> myringoplasty where autologous graft used

31
Q

Most common cause of Otitis Externa?

A

Pseudonomas aeruginosa

32
Q

Who gets Otitis Externa most?

A

swimmers and humid environements

33
Q

Features of Otitis Externa?

A

Pain!

Swollen, erythematous ear canal

34
Q

Types of ear discharge?

A

White-yellow = bacterial

thick white grey w spore = fungal

clear grey = otitis media

35
Q

What scale for Otitis Externa severity?

A

Brighton Grading

36
Q

What is Brighton Grading scale?

A 
1 = tympanic membrane seen
2= partially obscured 
3= no tympanic membrane 
4= systemic involvement
37
Q

Mx of Otitis Externa?

A

Antibiotic and steroid drops

Painkillers

Aural toiletting

38
Q

Otitis externa with headaches is a sign of..?

A

Malignant Otitis Externa - where the OE extends into mastoid and temporal bones -urgent CT required –> debridement w IV antibiotics

Finals RP (11 decks)

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