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5. Trauma and Accident > ENT emergencies > Flashcards

ENT emergencies Flashcards

1
Q

What is mastoiditis?

A

Mastoiditis is acute inflammation of the mastoid periosteum and air cells occurring when AOM infection spreads out from the middle ear.

Now quite rare

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2
Q

What are the types of otitis media?

A

Acute Otitis Media
Otitis with effusion
Mastoiditis
Cholesteatoma

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3
Q

What is Acute Otitis Media?

A

AOM is acute inflammation of the middle ear and may be caused by bacteria or viruses. A subtype of AOM is acute suppurative OM, characterised by the presence of pus in the middle ear. In around 5% the eardrum perforates.

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4
Q

What is Otitis with effusion?

A

OME is a chronic inflammatory condition without acute inflammation, which often follows a slowly resolving AOM.

There is an effusion of glue-like fluid behind an intact tympanic membrane in the absence of signs and symptoms of acute inflammation.

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5
Q

What is cholesteatoma?

A

Cholesteatoma occurs when keratinising squamous epithelium (skin) is present in the middle ear as a result of tympanic membrane retraction.

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6
Q

What is the most common organism causing mastoiditis?

A

Streptococcus pneumoniae

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7
Q

What are the signs and symptoms of mastoiditis?

A

History of acute or recurrent episodes of otitis media.
Intense otalgia and pain behind the ear.
Fevere

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8
Q

How would you manage mastoiditis?

A

The usual initial therapy is high-dose, broad-spectrum intravenous (IV) antibiotics, given for at least 1-2 days (eg, with a third-generation cephalosporin).

Oral antibiotics are usually used after this, starting on IV treatment after 48 hours without fever and continuing for at least 1-2 weeks.

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9
Q

What is the Rinne & Weber test?

A

Test for lateralisation and conductive and sensorineural hearing loss

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10
Q

What are the signs and symptoms of acute otitis media?

A

Pain (younger children may pull at the ear).
Malaise.
Irritability, crying, poor feeding, restlessness.
Fever.

fever
A red, yellow or cloudy tympanic membrane.
Bulging of the tympanic membrane.

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11
Q

How would you manage acute otitis media?

A

Admit those severely unwell (five day amoxicillin)

Otherwise: NSAIDs

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12
Q

What is the most common cause of hearing impairment in children?

A

Otitis media with effusion (OME)

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13
Q

How does otitis media with effusion present?

A

Mishearing, difficulty with communication in a group, listening to the TV at excessively high volumes or needing things to be repeated.
Lack of concentration, withdrawal.
Impaired speech and language development.

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14
Q

How would you manage otitis media with effusion?

A

No pharmaceuticals
Will usually self-resolve in a year
Hearing aids
Surgery

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15
Q

What are the types of cholesteatoma?

A
  1. Congenital
  2. Primary acquired (80% of cases)
  3. Secondary acquired
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16
Q

How does cholesteatoma present?

A

Symptoms and signs vary according to the size of the cholesteatoma. Small lesions are associated with a progressive conductive hearing loss but, as the lesion grows and erodes into adjacent structures, there may be additional features such as vertigo, headache and facial nerve palsy

Frequent or unremitting painless otorrhoea which may be foul-smelling.
Recurrent otitis, poorly responsive to antibiotic treatment.
Progressive, unilateral conductive hearing loss.

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17
Q

What is otorrhoea?

A

Discharge from the ear

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18
Q

How would you manage cholesteatoma?

A

Surgery

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19
Q

What are risk factors for otitis externa?

A 
Hot and humid climates.
Swimming.
Older age.
Immunocompromise (eg, HIV).
Diabetes mellitus.
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20
Q

What usually causes infections of the outer ear?

A

Infection of the outer ear is usually bacterial (90%) or fungal (10%).

Most cases involve multiple organisms, with the majority involving Staphylococcus aureus and/or P. aeruginosa.

Fungal infection usually follows prolonged treatment with antibiotics, with or without steroids

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21
Q

How does otitis externa usually present?

A

The main symptoms are pain and itching. There may also be discharge and hearing loss.

In more severe cases there can be fever, discharge and oedema

22
Q

How does otitis externa usually present on otoscopy?

A

Findings on otoscopy are:

  1. Ear canal with erythema, oedema and exudate.
  2. Mobile tympanic membrane.
  3. Pain with movement of the tragus or auricle.
  4. Pre-auricular lymphadenopathy.
23
Q

What is Swimmer’s ear?

A

Acute otitis externa

The term is often used to refer to acute otitis externa brought on by water remaining in the ear after swimming, creating a perfect medium for bacterial growth.

24
Q

How would you manage otitis externa?

A

Topical drops (Acetic acid)

Removal of debris

If there is cellulitis or cervical lymphadenopathy, oral antibiotics are indicated.

25
Q

What is chondritis?

A

Inflammation of cartilage

26
Q

What is vertigo?

A

Vertigo is a type of dizziness and refers to a false sensation that oneself or the surroundings are moving or spinning (usually accompanied by nausea and loss of balance) that is a result of a mismatch between vestibular, visual and somatosensory systems

27
Q

What are causes of peripheral vertigo?

A

Vestibular neuritis and labyrinthitis.
Benign paroxysmal positional vertigo (BPPV).
Vertebrobasilar ischaemia.
Eustachian tube dysfunction (causes mild vertigo).
Ménière’s disease.
Chronic otitis media.

28
Q

What is Ménière’s Disease?

A

This is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. If the cause is known, the condition is more properly called Ménière’s syndrome.

In Ménière’s disease there is a progressive distension of the membranous labyrinth, which is called ‘endolymphatic hydrops’. This may injure the vestibular system, causing vertigo; or the cochlea, causing hearing loss.

29
Q

What are causes for Ménière’s Disease?

A 
Allergy
Autoimmunity 
Genetics
Metabolic disturbances 
Vascular factors
Viral infections
30
Q

What is the clinical presentation of Ménière’s Disease?

A

Core symptoms are vertigo, tinnitus and fluctuating hearing loss with a sensation of aural pressure

The hallmark of the disease is its fluctuating and episodic pattern of symptoms:

  1. Acute attacks typically last minutes-hours, often 2-3 hours.
  2. Acute episodes may occur in clusters of about 6-11 per year.
  3. Remission of symptoms may last several months.
31
Q

How would you diagnose Ménière’s Disease?

A

Vertigo - at least two spontaneous episodes lasting at least 20 minutes within a single attack of Ménière’s disease.

Tinnitus and/or perception of aural fullness.

Hearing loss confirmed by audiometry to be sensorineural in nature.

32
Q

How would you manage Ménière’s Disease?

A

Vertigo and nausea can be alleviated by prochlorperazine, cinnarizine, cyclizine, or promethazine.

Intramuscular steroid injection followed by a tapering dose of oral steroids has also been recommended.

Lifestyle measures may be helpful. Low-salt diet and avoiding caffeine, chocolate, alcohol and tobacco are often advised

Consider a trial of betahistine (initially 16 mg three times a day) to reduce the frequency and severity of attacks

33
Q

What is acoustic neuroma?

A

Acoustic neuromas are tumours of the vestibulocochlear nerve (eighth cranial nerve), arising from the Schwann cells of the nerve sheath. Most arise from the vestibular portion and only a few arise from the cochlear (auditory) division

Benign and slow-growing

34
Q

How does acoustic neuroma present?

A

Classic presentation of acoustic neuroma confined to the internal auditory canal, involves unilateral progressive hearing loss, vestibular dysfunction and tinnitus.

As the tumour spreads, there is an increase in hearing loss and disequilibrium, and symptoms due to compression of other structures may occur

35
Q

How would you manage acoustic neuroma?

A

For patients with small neuromas and good preserved hearing, the most appropriate course of action may be to watch and wait with serial scans to monitor growth.

Otherwise surgery

36
Q

What is Auricular haematoma?

A

Cauliflower ear is an irreversible condition that occurs when the external portion of the ear is hit and develops a blood clot or other collection of fluid under the perichondrium. This separates the cartilage from the overlying perichondrium that supplies its nutrients, causing it to die and resulting in the formation of fibrous tissue in the overlying skin.

37
Q

How does auricular haematoma present?

A

People presenting with possible auricular haematoma often have additional injuries

The ear itself is often tense, fluctuant, and tender with throbbing pain

38
Q

What causes auricular haematoma?

A

The most common cause of cauliflower ear is blunt trauma to the ear leading to a hematoma which, if left untreated, eventually heals to give the distinct appearance of cauliflower ear

Often in rugby, martial arts or boxing

39
Q

What does the outer ear include?

A
  1. Pinna
  2. Ear canal
  3. Eardrum
40
Q

What does the middle ear include?

A

The middle ear is an air-filled compartment. Inside it are three of the smallest bones in the body, called malleus, incus and stapes. These bones are connected to each other.

The last in the group, stapes, also makes contact with the internal (inner) ear. The air space of the middle ear connects to the back of the nose by the Eustachian tube.

41
Q

What does the inner ear include?

A

The cochlea - a snail-shaped chamber filled with fluid. It is lined with special hair cells. These cells transform sound waves into electrical signals. These signals are then passed by nerves to the brain.

The vestibular system, which helps with balance. The vestibular system is made up of a network of tubes, called the semicircular canals, plus the vestibule. The vestibular system detects movement instead of sound.

42
Q

How do you differentiate between otitis media and externa?

A

OM: very rare in adults, common in preschool children

OE: in adults and common in those who swim or have skin conditions. May present with discharge

43
Q

How do you remove ear wax?

A

Warmed olive oil or sodium bicarbonate ear drops (available from a pharmacy) applied three times a day usually help within a few days

44
Q

What is a perforated eardrum and how does it present?

A

A perforated eardrum is a hole or tear that has developed in the eardrum. It can affect hearing. The extent of hearing loss can vary greatly.

For example, tiny perforations may only cause minimal loss of hearing. Larger perforations may affect hearing more severely.

With a perforation, you are at greater risk of developing an ear infection

45
Q

How would you manage a perforated tympanic membrane?

A

6-8 weeks

Occasionally, a perforated eardrum gets infected and needs antibiotics

A small operation is an option to treat a perforated drum that does not heal by itself.

46
Q

What is tinnitus?

A

Tinnitus is a noise such as a ringing or buzzing that you can hear, but the noise does not come from outside your ear.

47
Q

How would you manage tinnitus?

A

Treat the underlying cause

If age-related; no cure

48
Q

What does the Eustachian tube do?

A

Responsible for equalising ear pressure and draining fluid from the middle ear, the part of the ear behind the eardrum.

The eustachian tubes are usually closed except for when you chew, swallow, or yawn.

49
Q

What is eustachian tube dysfunction?

A

These passageways are small in size and can get plugged for a variety of reasons. Blocked eustachian tubes can cause pain, hearing difficulties, and a feeling of fullness in the ears. Such a phenomenon is referred to as eustachian tube dysfunction (ETD).

50
Q

What are the symptoms of eustachian tube dysfunction?

A

Fullness in the ears
Changes to hearing
Tinnitus
Pain

51
Q

What causes eustachian tube dysfunction?

A

Allergies
Common cold
Sinus infections
Altitude

52
Q

How would you manage eustachian tube dysfunction?

A

Often, no treatment is needed

Decongestant if it’s due to a cold

5. Trauma and Accident (9 decks)

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