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Ent > Ext Ear Disease .. TM ... AOM.. SOM... CSOM ... UNSAFE CSOM > Flashcards

Ext Ear Disease .. TM ... AOM.. SOM... CSOM ... UNSAFE CSOM Flashcards

1
Q

Causative org of foll conditions.

  1. Cauliflower ear
  2. Perichondritis
  3. furuncle
  4. malignant otitis externa
  5. Base of skull osteomyelitis
  6. Bullous myringopathy
  7. Ramsay hunt syndrome
A
  1. Trauma
  2. Pseudomonas
  3. Staph
  4. Pseudomonas
  5. Pseudomonas
  6. strep pneumonia, influenza virus, mycoplasma
  7. VZV
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2
Q

Tx of fibrous cauliflower ear

A

No rx required..

Rx only for cosmetic problem

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3
Q

Test for early diagnosis of malignant otitis externa ?

Test for resolution confirmation of infection ?

A
  1. Bone scan ( technitium 99 )
  2. ESR ( mc used )
    Gallium/ indium
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4
Q

Severe pain in ear which increases with jaw movement
Tragus sign positive

What is dx ?
What is rx for ur dx ?

A

Dx.. fruncle / folliculitis

Rx.. coamoxiclav ( staph)

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5
Q

Elderly diabetic patient with ear pain..
On examination granulation is seen with necrosis …
Bx taken – came negative for mitotic bodies

State your dx and complications related to this dx.

A

Malignant otitis externa

Cx… 1. Osteomyelitis of base of skull ( thru fissure of santorini)
2. CN 7(mc) 9,10,11 involvement

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6
Q

Otomycosis causative org and app ?

A
  1. Aspergillus niger ( wet paper app)

2. Candida (cotton wool appearance)

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7
Q

In Ramsay hunt synd there is activation of ________ organism in ______.

A
  1. VZV

2. Geniculate ganglion

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8
Q

Ear wax composition

A

Ceruminous secretion + desquamated epithelium

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9
Q

what are Contraindication for wax removal ?

A
  1. TM PERFORATION
  2. Battery stuck as a foreign body
  3. Vegetative foreign body
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10
Q

Mx of traumatic TM PERFORATION ?

A

Keep the ear dry
If any infection give antibiotics (local and systemic)
TM heals by 3 months

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11
Q

Which layer of TM does not heal ?

A

Fibrous layer

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12
Q

Tympanosclerosis occurs following ______

A
  1. SOM
  2. CSOM
  3. TM PERFORATION HEALING
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13
Q

TM is adherent to promontory

State the stage of sabe pars tensa retraction

A

Stage 4

Adhesive otitis media

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14
Q

Sickling of maleolar folds seen in _____

A

Stage 1 of TM retraction

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15
Q

MC organism to cause Acute otitis media ?

A

Strep pneumoniae

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16
Q

Why eustachian tube is infected in
A) children
B) adult

A

A) ET is wider and smaller

B) FORCEFULL SNEEZING IN PHARYNGITIS OR SINUSITIS

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17
Q

3 year old child brought with severe pain in right ear with H/O sore throat. He will be having all except

A.. Hyperemic TM ( CART WHEEL SIGN)
B.. Bulging of TM
C… Tx is Tymoanoplasty
D… AB is preferred course.

A

C

Tymoanoplasty is done is safe CSOM where there is ossicular dislocation along with TM PERFORATION.

Ab is preferred when there is less / minimal bulging and no imminent danger of perforation.

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18
Q

Light house sign characteristics of

A

Acute otitis media

Aka light house sign

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19
Q

Types of incision in myringotomy

A

Radial and curvilinear

Curvilinear is preferred in postero inferior quadrant.

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20
Q

Postero superiro incision in myringotomy in contraindicated due to risk to damage to following structure

A

Chorda tympani
Facial nerve
Incudostapedial joint
Oval window

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21
Q

Acute necrotising otitis media

Caused by _______

A

B hemolytic streptococcus

22
Q
  1. Subtotal perforation occurs in ANOM
  2. Annulus is eroded in Marginal perforation

True or false

A
  1. False

2. True

23
Q

Causes of SEROUS OTITIS MEDIA

A

SOM - STERILE FLUID COLLECTION

CAUSES

DECREASE DRAINAGE -

  1. Bilateral hypertrophy of adenoid
  2. ET dysfunction in cleft palate
  3. Unilateral nasopharyngeal carcinoma

Increase production
1. Allergic conditions

24
Q

State dx

25 year old male presented with

  1. DULL TM
  2. NON BULGING TM
  3. PROMINENT LATERAL PROCESS OF MALEUS
  4. B TYPE Of TYMPANOGRAM
A

SEROUS OTITIS MEDIA

Fluid is collected but not under pressure and non infected .

Retracted tm features like shortened malleus, prominent lateral process, come light distortion can be seen.

No infection means no hyperemia means dull TM

25
Q

Tx of SEROUS OTITIS MEDIA

A
  1. Antiallergins
  2. Decongestant
  3. Steroidal nasal spray
    !
    ! 3 months of tx if no response
    !
    √
    Surgery
  4. adenoidectomy + myringotomy
  5. Grommet insertion
26
Q

Incision for grommet insertion is made on ?

A
  1. Radial incision on anteroinferior part

2. Incision on anterosuperior part ( bear can technique)

27
Q

T tube grommet stays in ear for how long

A

2 years

28
Q

Long term grommet indication

A
  1. Adhesive otitis media

2. Atelectasis

29
Q

Tx of safe csom

A

Antibiotics × 6 weeks

When ear is dry

Sx—-. Mryingoplasty. }
. }. Tymoanoplasty
Ossiculoplasty }

30
Q

Most common ossicle to get necrosed

A

Lenticular process of incus

31
Q

Which grafts are used for repairing TM

A
  1. Temporalis fascia
  2. Perichondrium of ear
  3. Fat
32
Q

State and define types of Tymoanoplasty

A

Type 1… Graft over malleus ( simple myringoplasty)

Type 2…. Graft over incus

Type 3….Graft over stapes head ( myringostapediopexy)

Type 4… Maintain phase difference

Type 5… Fenestration operation

33
Q

Types of myringoplasty

Which is preferred

A

Underlay ( preferred)
Graft under malleus and under annulus

Overlay
Graft under malleus and over annulus

34
Q

Unsafe csom can spread to

A

Medially inner ear

Superiorly brain

Posteriorly mastoid

Further posteriorly sigmoid sinus

35
Q

What is cholesteatoma

A

It the the keratin flakes due to startified squamous keritinizing epithelium

Normally present only in EAC

Abnormal in middle ear or temporal bone - cholesteatoma

36
Q

Keratin accumulation in EAC

A

Keratosis obturans

37
Q

1° cholesteatoma is due to

2° cholesteatoma is due to

A

1° retraction of pars flaccida in prussak space / attic

2° marginal perforation of TM

38
Q

Explain

Haberman theory

Wittmack theory

Sade theory

Ruedis theory

A

Haberman - 2° cholesteatoma

Wittmack - 1 cholesteatoma

Sade theory - due to repeated infection of ET –> metaplasia

Ruedis theory - due to basal cell hyperplasia of TM

39
Q

Management of UNSAFE CSOM

A

Surgery

  1. Canal intact surgery
  2. Canal wall down surgery - Radical mastoidectomy
    - modified radical M….
40
Q

Which type of incision in MRM for tx of UNSAFE CSOM

A

Wilde’s incision

Post auricular incision

41
Q

Boundaries of trautmam triangle

A

Anteriorly by inner ear

Superiorly by superior. Petrosal sinus

Posteriorly by sigmoid sinus

42
Q

Discharge from the ear is when cleaned reappear again

This sign is called ______ and it is suggestive of ______

A

Reservoir sign

Suggestive of mastoiditis

43
Q

Superior spread of infection from mastoiditis results in ?

A

Zygomatic abscess

44
Q

Which of the foll is not a complications of mastoiditis

  1. Lucs abscess
  2. Post auricular abscess
  3. Bezolds abscess
  4. Trautmam abscess
A

Trautmam abcsess

45
Q

Non tender edema of mastoid suggestive of

A

Sigmoid vien thrombosis

Thrombus passed in mastoid emissiory vein

46
Q

Tender edema of mastoid suggestive of

A

Mastoiditis

47
Q

Which is most common intracranial complication of unsafe csom

A

Meningitis

48
Q

Gradenigos triad ……

A

Persistence of discharge after MRM
5 nerve involvement ( retro orbital pain)
6 nerve palsy ( lateral rectus palsy - diplopia(

49
Q

Explain Crowe Beck sign

Explain Toby ayer test

A

Crowe Beck sign —

If there if IJV Thrombosis of one side , on oressing the IJV of the normal side … ICP increases… Which can be seen by Pailledema

Toby ayer.

Inccraese ICP can be seen by lumber puncture

50
Q

CECT mri result of lateral vein thrombosis

A

Empty traingle sign

Delta sign

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