H&N WEEK 6

Question 1

what are auricular haematomas

Answer 1

collection of blood within the cartilaginous auricle which typically results from blunt trauma during sports

Question 2

management of auricular haematomas

Answer 2

incision and drainage
pressure dressing
antibiotics

complication could be “cauliflower ear”

Question 3

management of foreign bodies in ear

Answer 3

removal
urgency :
- button battery - within hour
- organic - within days
- inorganic - within weeks

mainly occurs in children

Question 4

otitis externa

Answer 4

inflammation of external auditory meatus

Question 5

management of otitis externa

Answer 5

topical
antibiotic/steroid ear drops
+/- suction under microscope - may be needed

prevention - no water or cotton buds - contributing factors

Question 6

presentation of otitis externa

Answer 6

pain
discharge
itching
and/or hearing loss

Question 7

malignant otitis externa

Answer 7

osteomyelitis of temporal bone
rare but serious

Question 8

presentation of malignant otitis externa

Answer 8

severe pain in elderly diabetic
granulations in external auditory meatus
+/- cranial nerve palsies - may spread throughout skull base

Question 9

management of malignant otitis externa

Answer 9

antibiotics for weeks or months - long term
ciprofloxacin - pseudomonas
few patients may need surgery

Question 10

otitis media with effusion

Answer 10

sterile fluid in middle ear
“glue ear” - middle ear secretes mucus - sometimes has gluey consistency

Question 11

presentation of otitis media with effusion (glue ear)

Answer 11

hearing loss - conductive
speech delay

Question 12

management of otitis media with effusion

Answer 12

observation for 3 months
otovent balloon - child blows up with nose - push air into eustachian tube into middle ear and open eustachiant tube and prevent build up of glue ear
grommet - plastic tube in ear drum - middle ear ventilates through

Question 13

acute suppurative otitis media

Answer 13

pus in middle ear

Question 14

presentation of acute suppurative otitis media

Answer 14

otalgia +/- otorrhea
increased pain
discharge when eardrum bursts
resolution of pain

Question 15

management of acute suppurative otitis media

Answer 15

observation
+/- antibiotics

Question 16

tympanosclerosis

Answer 16

calicification in tympanic membrane +/- middle ear

Question 17

presentation of tympanosclerosis

Answer 17

usually asymptomatic

Question 18

management of tympanosclerosis

Answer 18

usually none

Question 19

chronic suppurative otitis media

Answer 19

perforated tympanic membrane
cholesteatoma (skin in middle ear +/- mastoid bone)

Question 20

cholesteatoma

Answer 20

abnormal collection of skin cells deep inside your ear
within temporal bone
rare
if left untreated can damage delicate structures inside ear essential for hearing and balance
can lead to long term discharge from ear

Question 21

complications of chronic suppurative otitis media

Answer 21

“dead ear”
facial palsy - facial nerve runs through middle ear
meningitis
brain abscess

Question 22

causes of perforation of tympanic membrane

Answer 22

infection - acute suppurative otitis media
trauma -slap on ear
grommet

Question 23

presentation of perforation of tympanic membrane

Answer 23

recurrent infections
hearing loss

Question 24

management of perforation of tympanic membrane

Answer 24

water precautions
+/- mringoplasty

Question 25

causes of cholesteatoma

Answer 25

eustachian tube dysfunction
impaired skin migration

Question 26

presentation of cholesteatoma

Answer 26

persistent offensive otorrhea

Question 27

management of cholesteatoma

Answer 27

mastoidectomy

Question 28

otosclerosis : presentation

Answer 28

conductive hearing loss - some path you can see
normal tympanic membrane

Question 29

pathology : otosclerosis

Answer 29

fixation of stapes by extra bone
deposition of new bone where footplate of stapes fits into oval window
reduces movement of stapes footplate causing a conductive hearing loss

Question 30

management : otosclerosis

Answer 30

hearing aid
stapedectomy

Question 31

facial nerve palsy : clinical features

Answer 31

lower motor neuron facial palsy (forehead involved)

Question 32

differential diagnosis of facial nerve palsy

Answer 32

intratemporal eg cholesteatoma
extratemporal eg parotid tumour
idiopathic = Bell’s palsy - diagnosis of exclusion - thought to be viral

Question 33

management : facial nerve palsy

Answer 33

treat underlying cause (if possible)
steroids
eye care

Question 34

3 parts of middle ear

Answer 34

malleus (hammer)
incus (anvil)
stapes (stirrup)

Question 35

middle ear function

Answer 35

amplify sound collected by outer ear
transforms acoustic energy from medium of air to medium of fluid
lever action of ossicular chain

Question 36

what is main indication for repair of small perforation

Answer 36

recurrent infections

Question 37

structure of cochlea

Question 38

hearing mechanism in cochlea

Answer 38

filled with a fluid that moves in response to the vibrations from the oval window
as fluid moves, 25000 nerve endings are set into motion
these transform the vibrations into electrical impulses that then travel along CN VIII (auditory) to the brain