Ext Ear Disease .. TM ... AOM.. SOM... CSOM ... UNSAFE CSOM Flashcards
Causative org of foll conditions.
- Cauliflower ear
- Perichondritis
- furuncle
- malignant otitis externa
- Base of skull osteomyelitis
- Bullous myringopathy
- Ramsay hunt syndrome
- Trauma
- Pseudomonas
- Staph
- Pseudomonas
- Pseudomonas
- strep pneumonia, influenza virus, mycoplasma
- VZV
Tx of fibrous cauliflower ear
No rx required..
Rx only for cosmetic problem
Test for early diagnosis of malignant otitis externa ?
Test for resolution confirmation of infection ?
- Bone scan ( technitium 99 )
- ESR ( mc used )
Gallium/ indium
Severe pain in ear which increases with jaw movement
Tragus sign positive
What is dx ?
What is rx for ur dx ?
Dx.. fruncle / folliculitis
Rx.. coamoxiclav ( staph)
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.
Malignant otitis externa
Cx… 1. Osteomyelitis of base of skull ( thru fissure of santorini)
2. CN 7(mc) 9,10,11 involvement
Otomycosis causative org and app ?
- Aspergillus niger ( wet paper app)
2. Candida (cotton wool appearance)
In Ramsay hunt synd there is activation of ________ organism in ______.
- VZV
2. Geniculate ganglion
Ear wax composition
Ceruminous secretion + desquamated epithelium
what are Contraindication for wax removal ?
- TM PERFORATION
- Battery stuck as a foreign body
- Vegetative foreign body
Mx of traumatic TM PERFORATION ?
Keep the ear dry
If any infection give antibiotics (local and systemic)
TM heals by 3 months
Which layer of TM does not heal ?
Fibrous layer
Tympanosclerosis occurs following ______
- SOM
- CSOM
- TM PERFORATION HEALING
TM is adherent to promontory
State the stage of sabe pars tensa retraction
Stage 4
Adhesive otitis media
Sickling of maleolar folds seen in _____
Stage 1 of TM retraction
MC organism to cause Acute otitis media ?
Strep pneumoniae
Why eustachian tube is infected in
A) children
B) adult
A) ET is wider and smaller
B) FORCEFULL SNEEZING IN PHARYNGITIS OR SINUSITIS
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.
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.
Light house sign characteristics of
Acute otitis media
Aka light house sign
Types of incision in myringotomy
Radial and curvilinear
Curvilinear is preferred in postero inferior quadrant.
Postero superiro incision in myringotomy in contraindicated due to risk to damage to following structure
Chorda tympani
Facial nerve
Incudostapedial joint
Oval window
Acute necrotising otitis media
Caused by _______
B hemolytic streptococcus
- Subtotal perforation occurs in ANOM
- Annulus is eroded in Marginal perforation
True or false
- False
2. True
Causes of SEROUS OTITIS MEDIA
SOM - STERILE FLUID COLLECTION
CAUSES
DECREASE DRAINAGE -
- Bilateral hypertrophy of adenoid
- ET dysfunction in cleft palate
- Unilateral nasopharyngeal carcinoma
Increase production
1. Allergic conditions
State dx
25 year old male presented with
- DULL TM
- NON BULGING TM
- PROMINENT LATERAL PROCESS OF MALEUS
- B TYPE Of TYMPANOGRAM
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
Tx of SEROUS OTITIS MEDIA
- Antiallergins
- Decongestant
- Steroidal nasal spray
!
! 3 months of tx if no response
!
√
Surgery - adenoidectomy + myringotomy
- Grommet insertion
Incision for grommet insertion is made on ?
- Radial incision on anteroinferior part
2. Incision on anterosuperior part ( bear can technique)
T tube grommet stays in ear for how long
2 years
Long term grommet indication
- Adhesive otitis media
2. Atelectasis
Tx of safe csom
Antibiotics × 6 weeks
When ear is dry
Sx—-. Mryingoplasty. }
. }. Tymoanoplasty
Ossiculoplasty }
Most common ossicle to get necrosed
Lenticular process of incus
Which grafts are used for repairing TM
- Temporalis fascia
- Perichondrium of ear
- Fat
State and define types of Tymoanoplasty
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
Types of myringoplasty
Which is preferred
Underlay ( preferred)
Graft under malleus and under annulus
Overlay
Graft under malleus and over annulus
Unsafe csom can spread to
Medially inner ear
Superiorly brain
Posteriorly mastoid
Further posteriorly sigmoid sinus
What is cholesteatoma
It the the keratin flakes due to startified squamous keritinizing epithelium
Normally present only in EAC
Abnormal in middle ear or temporal bone - cholesteatoma
Keratin accumulation in EAC
Keratosis obturans
1° cholesteatoma is due to
2° cholesteatoma is due to
1° retraction of pars flaccida in prussak space / attic
2° marginal perforation of TM
Explain
Haberman theory
Wittmack theory
Sade theory
Ruedis theory
Haberman - 2° cholesteatoma
Wittmack - 1 cholesteatoma
Sade theory - due to repeated infection of ET –> metaplasia
Ruedis theory - due to basal cell hyperplasia of TM
Management of UNSAFE CSOM
Surgery
- Canal intact surgery
- Canal wall down surgery - Radical mastoidectomy
- modified radical M….
Which type of incision in MRM for tx of UNSAFE CSOM
Wilde’s incision
Post auricular incision
Boundaries of trautmam triangle
Anteriorly by inner ear
Superiorly by superior. Petrosal sinus
Posteriorly by sigmoid sinus
Discharge from the ear is when cleaned reappear again
This sign is called ______ and it is suggestive of ______
Reservoir sign
Suggestive of mastoiditis
Superior spread of infection from mastoiditis results in ?
Zygomatic abscess
Which of the foll is not a complications of mastoiditis
- Lucs abscess
- Post auricular abscess
- Bezolds abscess
- Trautmam abscess
Trautmam abcsess
Non tender edema of mastoid suggestive of
Sigmoid vien thrombosis
Thrombus passed in mastoid emissiory vein
Tender edema of mastoid suggestive of
Mastoiditis
Which is most common intracranial complication of unsafe csom
Meningitis
Gradenigos triad ……
Persistence of discharge after MRM
5 nerve involvement ( retro orbital pain)
6 nerve palsy ( lateral rectus palsy - diplopia(
Explain Crowe Beck sign
Explain Toby ayer test
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
CECT mri result of lateral vein thrombosis
Empty traingle sign
Delta sign
