ENT - ears Flashcards
Features of Acute Otitis media?
Severe pain and tympanic membrane inflammation (erythema), usually in children
Which part of ear is infected in Otitis Media?
Middle
Most common organism causing Acute Otitis Media?
S pneumoniae
all URTI organisms really
Viruses include RSV and rhinovirus
What is a sign of rupture?
ear pain that suddenly goes away then discharge
What nerve is important to test in middle ear infection?
Facial nerve
Management of Acute Otitis Media?
Painkillers first for 3 days and observe
Then amoxicillin if not improved
Main complication of Acute Otitis Media?
Mastoiditis - bulgy swelling behind ear, pushing ear forward
How to deal w Mastoiditis?
Admit, IV antibiotics, CT head if no improvement in 24h –> mastoidectomy definitive management
What are the two types of chronic otitis media?
Mucosal (i.e. supparative) - where tympanic membrane ruptures + chronic discharge
Squamous - where tympanic membrane is pushed back - assoc w choleastoma
Main feature of Chronic Mucosal Otitis Media?
Chronic discharge for over 6 weeks WITHOUT pain or fever
First Ix for ear pain?
Otoscopy
What are common causes of Chronic Mucosal Otitis Media?
Anything that can burst the ear:
Recurrent AOM
Trauma to ear
Previous ear surgery
What type of hearing loss is caused by Chronic Otitis Media?
Conductive
Investigation for suspected cholesteatoma?
CT scan of petrous temporal bone
Treatment for uncomplicated chronic mucosal otitis media?
- Aural toileting techniques
- Antibiotic and steroid drops
Who should be referred to ENT in chronic OM?
if symptoms >6 weeks or lots of debris
They must keep ear dry!
Two types of surgery for large perforated tympanic membrane?
Myringoplasty
Tympanoplasty
two types of squamous chronic OM?
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
What will be seen on otoscopy in Squamous chronic OM?
pearly waxy mass
Investigations for chronic OM?
otoscopy
pure-tone audiogram
If cholesteatoma suspected, CT of petrous temporal bone
Mx of choleasteatoma?
surgery
Common injuries following ear trauma?
Pinna Haematoma
Pinna laceration
Temporal bone fracture
Tympanic perforation
Who is pinna haematoma common in?
Boxers and rugby players
Mx of pinna haematoma?
drainage within 24h –> gauze and tight headband
Surgical technique for pinna haematoma drainage?
Incision along helical rim of ear –> evacuate haematoma –> place dental roll on both sides of auricle –> tight mattress sutures through rolls and pinna
Pinna lacerations things to consider?
All cartilage needs skin around it as skin provides blood flow
Optimal wound cleaning + tetanus boosters + AB prophylaxis
Two types of Temporal bone fractures?
Longitudinal - hit on side of head –> conductive hearing loss
Transverse - hit on front of head –> sensorineural heaing loss and facial palsy
Sign of basilar skull fracture?
“Battle sign” = crescent shape behind ear –> when the posterior auricular artery ruptures due to a basal skull fracture
Mx of temporal bone fracture?
CT fine slice
Admit for observation
Mx of Tympanic membrane perforation?
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
Most common cause of Otitis Externa?
Pseudonomas aeruginosa
Who gets Otitis Externa most?
swimmers and humid environements
Features of Otitis Externa?
Pain!
Swollen, erythematous ear canal
Types of ear discharge?
White-yellow = bacterial
thick white grey w spore = fungal
clear grey = otitis media
What scale for Otitis Externa severity?
Brighton Grading
What is Brighton Grading scale?
1 = tympanic membrane seen 2= partially obscured 3= no tympanic membrane 4= systemic involvement
Mx of Otitis Externa?
Antibiotic and steroid drops
Painkillers
Aural toiletting
Otitis externa with headaches is a sign of..?
Malignant Otitis Externa - where the OE extends into mastoid and temporal bones -urgent CT required –> debridement w IV antibiotics
