ENT Pathology 2 - Acute otitis media, cholestaeatoma, mastoiditis, otitis externa, Dizziness, tinnitus,

Question 1

Earache, fever and signs of inflammation in a child Can have otorrhea What is this usually? What causes the otorrhea?

Answer 1

This is acute otitis media Otorrhea is caused by perforation of the tympanic membrane

Question 2

Is acute otitis media usually due to viral or bacteria?

Answer 2

Usually a viral cause

Question 3

What may be seen on otoscopy in acute otitis media?

Answer 3

Bulging red and inflamed tympanic membrane, can sometimes be perforated

Question 4

If tympanic membrane is perforated then swab can be obtained for culture What is the most common cause of bacteria causing AOM?

Answer 4

Haemophilus influenza

Question 5

In AOM, can prescribe antibiotics but delay the usage till after 4days to see if symptoms resolve What is the 1st line antibiotic? What is given if allergic?

Answer 5

1st line is amoxicillin 2nd line - clarithromycin Strep sore throat - penicillin or clarithromycin if allergic SInsusitis - penicillin or doxcycline if allergic Just some info

Question 6

. High cell turnover and abundant keratin production in the middle ear What is this?

Answer 6

Cholesteatoma

Question 7

What causes cholesteatoma?

Answer 7

Can be due to recurrent infections or blocked eustachian tube preventing the clearance of dead skin cells

Question 8

What are symptoms of cholesteatoma?

Answer 8

Pain, deafness, can lead to infection

Question 9

What is the required treatment for cholesteatoma?

Answer 9

Mastoid surgery (mastoidectomy)

Question 10

What is a potential side effect that can be caused by withholding antibiotics in AOM and leads to destruction of air cells in the bone next to the ear?

Answer 10

This is mastoiditis

Question 11

How can mastoiditis present?

Answer 11

Presents with a swelling/redness behind the ear causing the pinnna to stick forward Also a tenderness on the mastoid area behind the ear

Question 12

What is the other known name for swimmer’s ear?

Answer 12

Otitis externa

Question 13

How does otitis externa present?

Answer 13

Inflammation of the external ear/ear canal Can be a discharge coming and there is pain associated

Question 14

How does swimming increase the chances ootitis externa?

Answer 14

Swimming causes the ear to be moist giving good growing conditions for organisms

Question 15

What is the most common cause of otitis externa and what are other causes?

Answer 15

Most common cause - pseudomonas aerguinosa Other causes are staph aureus, aspergillus niger and candida (these two are fungal)

Question 16

What is the first line treatment of otitis externa?

Answer 16

Do not swab if mild or moderate Consider aural toilet If mild - prescribe acetic acid (2%) - (earcalm) If moderate - give Otomize® or Sofradex® Otomize -Neomycin/Dexamethasone/Acetic Acid (antibiotic, steroid, vinegar) Sofradex - Framycetin sulfate and gramicidin - different antibiotics

Question 17

If the aural toilet does not work a swab is taken, what is the treatment for the different organisms?

Answer 17

Pseudomonas aerguinosa - gentamicin drops Candida/aspergillus niger - topical clotrimazole

Question 18

In patients with perforated tympanic membranes, ototoxic drugs cannot be used, what is used instead?

Answer 18

Instead of gentamicin a flouroquinolone such as ciproflaxacin should be used

Question 19

What is a complicatin of otitis externa when it begins to erode into the bone?

Answer 19

Malignant otitis externa

Question 20

What are the main causes of benign paroxysmal positional vertigo?

Answer 20

Trauma, or idiopatic

Question 21

What is actually displaced to cause BPPV?

Answer 21

Otolith crystals in the utricle becomes dislodged and enter the semicircular canals, therefore making you feel dizzy as these are to do with balance

Question 22

Which semicircular canal is most commonly affected in BPPV?

Answer 22

The posterior semicircular canal

Question 23

Describe the features of BPPV?

Answer 23

Clear positional trigger No aural fullness, hearing loss or tinnitus Only lasts a few minutes

Question 24

In BPPV, when is the vertigo usually felt?

Answer 24

usually when turning in bed, looking left nd right at a junction

Question 25

What is used for diagnosis of BPPV? What is the treatment of BPPV?

Answer 25

Diagnosis - Hallpike test Teatment - Epley manoevure

Question 26

What is usually seen as a result of Hallpike test?

Answer 26

Classical nystagmus 30 seconds later (due to vestibuloocular reflex being dysfuntional)

Question 27

BPPV is often confused with vertebrobasilar insufficiency, what does diagnosis of VBI require?

Answer 27

Visual disturbane, vertigo and numbness

Question 28

• Ringing, hissing or buzzing suggests inner ear or central cause What is this ringing in the ears known as?

Answer 28

Known as tinnitus

Question 29

If the tinnitus is unilateral, what is carried out?

Answer 29

Carry out an MRI to exclude an acoustic neuroma (vestibular schwannoma)

Question 30

What is the treatment of tinnitus?

Answer 30

Use hearing aids to try stop the background ringing Cognitive behavioural therapy

Question 31

Which two causes of vertigo usually follow a viral infection? (eg an URTI)

Answer 31

Vestibular neuronitis or labrynthitis

Question 32

How can you differentiate between vistibular neuronitis and labrynthitis?

Answer 32

Labrynthitis can also present with associated hearing loss and tinnitus Vestibular neuronitits is vertigo on its own

Question 33

How long does the vertigo in vestibular neuronitis and labrynthiitis tend to last?

Answer 33

Tends to last days to weeks - both tend to be self limiting

Question 34

• History of recurrent, spontaneous, rotational vertigo w/ at least two episodes >20mins (often lasting hours) • Occurrence of worsening tinnitus on affected side • Occurrence of aural fullness on affected side What is this? What one other symptom is missing?

Answer 34

This is Meniere’s disease Vertgio that can last hours Associated tinnitus and aural fullness Requires also associated (sensorineural) hearing loss

Question 35

What is generally the first line treatment in the management of menieres disease?

Answer 35

Low salt diet and diuretics

Question 36

If there is an assciated nausea or vomiting during the meniere attacks, what can be prescribed?

Answer 36

Anti emetics eg prochlorperazine Can use betahistine as prophylaxis

Question 37

As gentamicin is ototxic, this can be given as an intratympanic injection to prevent the tinnitus by killing the labrynth If this fails and hearing is intact or inadequate what are the two surgery otpions?

Answer 37

Hearing intact - endolympahtic shunt Hearing inadequate - labrynthectomy

Question 38

Patient presents with a vertgio. Previously had an URTI. What are the two options? How to differentiate?

Answer 38

Labrynthitis or vestibular neuronitis Labrynthitis also has associated HL and tinnitus - vestibular neurontitis does not

Question 39

Patient presents with vertigo that lasts a really short amount of time. Usually comes on when moving head quickly or rolling over in bed. What is this?

Answer 39

This is BPPV

Question 40

Patient presents with vertigo lasting up to an hour. Ear is sore as it feels quite full and also vomits occasionally. What is this?

Answer 40

This is Meniere’s disease