ENT Pathology 2 - Acute otitis media, cholestaeatoma, mastoiditis, otitis externa, Dizziness, tinnitus, Flashcards
Earache, fever and signs of inflammation in a child Can have otorrhea What is this usually? What causes the otorrhea?
This is acute otitis media Otorrhea is caused by perforation of the tympanic membrane
Is acute otitis media usually due to viral or bacteria?
Usually a viral cause
What may be seen on otoscopy in acute otitis media?
Bulging red and inflamed tympanic membrane, can sometimes be perforated
If tympanic membrane is perforated then swab can be obtained for culture What is the most common cause of bacteria causing AOM?
Haemophilus influenza
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?
1st line is amoxicillin 2nd line - clarithromycin Strep sore throat - penicillin or clarithromycin if allergic SInsusitis - penicillin or doxcycline if allergic Just some info
. High cell turnover and abundant keratin production in the middle ear What is this?
Cholesteatoma
What causes cholesteatoma?
Can be due to recurrent infections or blocked eustachian tube preventing the clearance of dead skin cells
What are symptoms of cholesteatoma?
Pain, deafness, can lead to infection
What is the required treatment for cholesteatoma?
Mastoid surgery (mastoidectomy)
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?
This is mastoiditis
How can mastoiditis present?
Presents with a swelling/redness behind the ear causing the pinnna to stick forward Also a tenderness on the mastoid area behind the ear
What is the other known name for swimmer’s ear?
Otitis externa
How does otitis externa present?
Inflammation of the external ear/ear canal Can be a discharge coming and there is pain associated
How does swimming increase the chances ootitis externa?
Swimming causes the ear to be moist giving good growing conditions for organisms
What is the most common cause of otitis externa and what are other causes?
Most common cause - pseudomonas aerguinosa Other causes are staph aureus, aspergillus niger and candida (these two are fungal)
What is the first line treatment of otitis externa?
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
If the aural toilet does not work a swab is taken, what is the treatment for the different organisms?
Pseudomonas aerguinosa - gentamicin drops Candida/aspergillus niger - topical clotrimazole
In patients with perforated tympanic membranes, ototoxic drugs cannot be used, what is used instead?
Instead of gentamicin a flouroquinolone such as ciproflaxacin should be used
What is a complicatin of otitis externa when it begins to erode into the bone?
Malignant otitis externa
What are the main causes of benign paroxysmal positional vertigo?
Trauma, or idiopatic
What is actually displaced to cause BPPV?
Otolith crystals in the utricle becomes dislodged and enter the semicircular canals, therefore making you feel dizzy as these are to do with balance
Which semicircular canal is most commonly affected in BPPV?
The posterior semicircular canal
Describe the features of BPPV?
Clear positional trigger No aural fullness, hearing loss or tinnitus Only lasts a few minutes
In BPPV, when is the vertigo usually felt?
usually when turning in bed, looking left nd right at a junction
What is used for diagnosis of BPPV? What is the treatment of BPPV?
Diagnosis - Hallpike test Teatment - Epley manoevure
What is usually seen as a result of Hallpike test?
Classical nystagmus 30 seconds later (due to vestibuloocular reflex being dysfuntional)
BPPV is often confused with vertebrobasilar insufficiency, what does diagnosis of VBI require?
Visual disturbane, vertigo and numbness
• Ringing, hissing or buzzing suggests inner ear or central cause What is this ringing in the ears known as?
Known as tinnitus
If the tinnitus is unilateral, what is carried out?
Carry out an MRI to exclude an acoustic neuroma (vestibular schwannoma)
What is the treatment of tinnitus?
Use hearing aids to try stop the background ringing Cognitive behavioural therapy
Which two causes of vertigo usually follow a viral infection? (eg an URTI)
Vestibular neuronitis or labrynthitis
How can you differentiate between vistibular neuronitis and labrynthitis?
Labrynthitis can also present with associated hearing loss and tinnitus Vestibular neuronitits is vertigo on its own
How long does the vertigo in vestibular neuronitis and labrynthiitis tend to last?
Tends to last days to weeks - both tend to be self limiting
• 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?
This is Meniere’s disease Vertgio that can last hours Associated tinnitus and aural fullness Requires also associated (sensorineural) hearing loss
What is generally the first line treatment in the management of menieres disease?
Low salt diet and diuretics
If there is an assciated nausea or vomiting during the meniere attacks, what can be prescribed?
Anti emetics eg prochlorperazine Can use betahistine as prophylaxis
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?
Hearing intact - endolympahtic shunt Hearing inadequate - labrynthectomy
Patient presents with a vertgio. Previously had an URTI. What are the two options? How to differentiate?
Labrynthitis or vestibular neuronitis Labrynthitis also has associated HL and tinnitus - vestibular neurontitis does not
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?
This is BPPV
Patient presents with vertigo lasting up to an hour. Ear is sore as it feels quite full and also vomits occasionally. What is this?
This is Meniere’s disease
