Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Neurology + Special Senses > ENT - Otorrhoea > Flashcards

ENT - Otorrhoea Flashcards

1
Q

What does otorrhoea (discharing ear) often indicate?

A

Infection or inflammation of the

middle ear (otitis media) or outer ear (otitis externa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What symptoms commonly present with Otorrhoea?

A
  • Ear pain (otalgia)
  • Hearing loss
  • Tinnitus
  • Sometimes vestibular disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common features of otitis externa?

A

Features:

  • Ear pain (otalgia)
  • Otorrhoea (ear discharge)
  • Itch
  • Occasional pre / post auricular lymph node swelling

On otoscope:

  • Erythema
  • Swollen (ear canal is narrower than normal)
  • Tender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the common causes otitis externa?

A
  • Infection:
    • bacterial (staph. aureus, pseudomonas aeruginosa)
    • fungal (aspergillus niger - commonest ear fungal infection)
      • rarer than bacterial
      • symptoms = more itching than otalgia, otorrohea is rare
  • Seborrhoeic dermatitis (skin inflammation in areas of sebaceous glands)
  • Contact dermatitis (allergic and irritant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is otitis externa managed?

A

1st line:

  • SWAB FIRST!!
  • topical Abx OR combined topical Abx + corticosteroid
    • e.g. Sofradex (framycetin, dexamethasone and gramicidin)
    • some believe if tympanic membrane is perforated aminoglycosides (e.g. gentamicin, streptomycin, neomycin) are to be avoided due to otoxticity concerns
  • keep ear dry
  • remove excessive canal debris
  • ear wick (cylindrical sponge) - if canal is swollen extensively, aids administration of ear drops
  • oral analgesia - otitis externa can be very painful

2nd line:

  • oral Abx:
    • flucloxacillin - if no penicillin allergy
    • clarithromycin - if penicillin allergy
    • ciprofloxacin - if pseudomonas suspected
  • consider antifungal agent
  • consider contact dermatitis 2ndary to neomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 3 risk factors for developing otitis externa?

A
  1. Allowing water to enter ear
  2. Instrumentation of the ear canal e.g. cotton buds
  3. Skin conditions i.e. eczema or psoriasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is perichondritis?

A

Inflammation of the perichondrium (layer of connective tissue surrounding cartilage) - commonly used to refer to auricular perichondritis

  • Infection of the pinna
  • Often due to trauma, surgical wound or spread from local infections
  • Left untreated –> can cause pinna necrosis + deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is malignant otitis externa?

A

Rare form of otitis externa seen in immunocompromised patients. Infection begins in soft tissue of external auditory meatus –> progresses to bony ear canal –> progresses to temporal bone osteomyelitis

  • 90% cases found in diabetics
  • Pseudomonas aeruginosa = commonest organism
  • Diagnosis = CT scan
  • Management:
    • 6 weeks IV Abx that cover pseudomonal infections e.g. ciprofloxacin
    • Regular clinical assessment + bloods (CRP / ESR) and MR of skull base

Symptoms:

  • ear pain (otalgia) - severe, unrelenting, deep
  • purulent otorrhea
  • temporal headaches
  • possible facial nerve (CN VII) dysfunction
  • other CN may be involved
  • can cause sensorineural deafness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the possible complications of otitis externa?

A
  1. Facial cellulitis
  2. Otomycosis (fungal ear infection - often in immunosuppresed or after topical Abx)
  3. Canal stenosis w/ hearing loss
  4. Malignant otitis externa (w/ osteomyelitits of temporal bone)
  5. Sensorineural deafness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What questions might you want to cover in a ear discharge history?

A

SOCRATES each symptom:

  • Which ear?
  • Duration of discharge?
  • Character of discharge; thick, watery, offensive?
  • What precipitated it?
  • Other symptoms:
    • Ear pain (otalgia)?
    • Hearing loss (and how does this affect the patient)?
    • Balance issues?
    • Tinnitus?
  • What treatment have they had so far and has it responded?
  • What hobbies or sports are they involved in and do they get water in the ear e.g. swimming?
  • Have they had any surgery to the affected ear?
  • Do they have any other significant medical problems e.g. allergic chronic rhinosinusitis, asthma, diabetes?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 issues in this ear drum image?

A
  1. Inferior perforation of pars tensa
  2. Anterior tympanosclerosis (white calcium deposits caused by healing from previous ear infections)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 3 causes of tympanic membrane rupture?

A
  1. Recurrent infections
  2. Trauma e.g. barotrauma or foreign body
  3. Iatrogenic e.g. ear surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the 4 most common organisms involved in chronic otitis media?

A
  1. Pseudomonas aeruginosa
  2. Staph. aureus
  3. Streptococcus
  4. Anaerobic bacteria ie peptostreptococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is acute otitis media managed?

A

Generally, alike other self-limiting infections a no Abx / delayed Abx prescribing approach is suggested (policy for respiratory tract infections)

Prescribe Abx immediately IF:

  1. Symptoms lasting > 4 days / not improving
  2. Systemically unwell but not requiring admission
  3. Immunocompromised
  4. High risk of complications 2ndary to significant heart, lung, kidney, liver, or neuromuscular disease
  5. Children < 2 yrs old with bilateral otitis media
  6. Otitis media with perforation and/or discharge in the canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long should an episode of acute otitis media last?

A

~ 4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the management options for a perforated tympanic membrane?

A
  • No treatment (majority of cases) - membrane will heal in ~6-8 weeks
    • Don’t get ear wet!!
  • Combined topical Abx + corticosteroid (7-10 days) - if associated with active infection:
    1. Sofradex (framycetin, dexamethasone and gramicidin)
    2. Gentisone H/C (gentamicin and hydrocortisone)
    3. Otomise (dexamethasone, neomycin and acetic acid)
    4. Ciprofloxacin drops (covers pseudomonas)
  • Myringoplasty (ear drum repair) - freshen edges of perforation + place graft underneath as scaffold for membrane to grow
17
Q

What is a Cholesteatoma?

A

Cholesteatoma = non-cancerous growth of squamous epithelium that is ‘trapped’, often in a deep retraction of tympanic membrane

  • Involves accumulation of keratin within the retraction (normally skin cells migrate out of the ear canal as they are refreshed - but the retraction causes build up –> kertain cyst)
  • Epidemiology:
    • commonest age = 10-20 yrs
    • cleft palate = 100 fold risk
  • Features:
    • Otorrhoea - foul-smelling, non-resolving discharge, resistant to Abx
    • Hearing loss
    • Can have tinnitus
    • Depending on local invasion: dizziness (erosion of semicircular canal), facial nerve palsy (weakness, altered taste), deafness (erosion of ossicles)
    • Not likely painful
  • Otoscopy:
    • ‘attic crust’ - keratin cyst in the uppermost tympanic membrane w/ or wo/ perforation
  • Management:
    • Refer to ENT for surgical removal
18
Q

What can cause a Cholesteotoma?

A
  1. Otitis media - commonly precipitates cholesteotoma
  2. Eustachian tube dysfunction - can promote invagination of tympanic membrane, due to chronic -ve pressure in middle ear
  3. Otological surgery (iatrogenic)
  4. Trauma (barotrauma)
19
Q

What is a Glomus jugulare?

A

A vascular tumour that presents as a ‘red mass’ behind an intact tympanic membrane

  • Pt may complain of ‘pulsatile tinnitus’
20
Q

What measures should be taken in a patient presenting with a cholesteotoma?

A
  1. Pure tone audiogram
    • Determines degree of hearing loss
    • Enables pre / post surgery hearing assessment (see if hearing was improved or if surgery caused deafness)
  2. Topical Abx + steroid - helps if infection is present
  3. Close inspection + cleaning under microscope
    • pars flaccida (also called the attic) is often ignored and only the pars tensa is inspected, missing pathology in the attic area
21
Q

What is the definitive treatment for a cholesteatoma?

A

Mastoidectomy

  1. Involves opening the mastoid air cells, removing the cholesteatoma from the middle ear
  2. Reconstruction of ossicles + tympanic membrane
22
Q

Name some of the complications of any major middle ear surgery?

A
  • Infection
  • Bleeding
  • No improvement in hearing
  • Complete loss of hearing, called a dead ear (if the inner ear is damaged)
  • Tinnitus
  • Vertigo
  • Facial nerve palsy
  • Altered taste (chorda tympani nerve damage)
  • Recurrence of disease needing revision surgery
23
Q

Describe the following types of otitis media.

  • Acute otitis media (AOM)
  • Recurrent acute otitis media (RAOM)
  • Chronic otitis media (COM)
  • Otitis media with effusion
A
  • Acute otitis media (AOM)
    • acute inflammation of middle ear with systemic upset (AOM is often precipitated by a URTI)
    • otolgia, fever, cough, nasal discharge
  • Recurrent acute otitis media (RAOM)
    • > 4 episodes of AOM in a 6-month period
  • Chronic otitis media (COM)
    • inflammation of middle ear for > 3-months. There are 2 types:
      • Mucosal COM - inner cells of tympanic membrane
        • Active - wet perforation (i.e. with middle ear infection)
        • Inactive - dry perforation
      • Squamous COM - outer cells of tympanic membrane
        • Active - cholesteatoma
        • Inactive - shallow self-cleaning retraction of membrane
  • Otitis media with effusion
    • inflammation (not infection) of middle ear + effusion –> conductive hearing loss
24
Q

What are the intra-temporal and extra-temporal complications of COM?

A

Intra-temporal complications:

  1. Vertigo - inflammation spreads to vestibular apparatus
  2. Hearing loss - COM can cause either conductive (dmg to ossicles / tympanic membrane) or sensorineural (cochlea inflammation) hearing loss
  3. Acute otitis externa - discharge causing skin irritation
  4. Facial weakness - erosion of thin bony canal exposes CN VII

Extra-temporal complications:

  1. Meningitis - erosion through tegmen (roof of middle ear) to expose the dura
  2. Subdural abscess - same as above, infection spreads from extradural to subdural
  3. Temporal lobe abscess
  4. Sigmoid sinus thrombosis
25
Q

What does this image show?

A

Active squamous chronic otitis media

  • There is a deep retraction in the pars flaccida with accumulation keratin around it
  • Pars tensa looks normal
26
Q

What does this image show?

A

Inactive mucosal chronic otitis media

  • There is an inactive (no pus) subtotal perforation of the right ear
27
Q

What does this image show?

A

Active mucosal chronic otitis media

  • There is a large central perforation with mucopurulent secretions present in the middle ear

Year 4 - Neurology + Special Senses (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions