Important ENT presentations Flashcards
Otitis externa
Inflammation of the outer ear.
Commonly caused by bacterial infection of the ear canal, e.g. Streptococci, Staphylococci, Pseudomonas, and fungi.
Heat, humidity, swimming, and any irritants causing pruritus can all predispose a patient to otitis externa.
Often occurs in patients with eczema, seborrhoeic dermatitis, or psoriasis due to scratching.
Symptoms can vary from irritation to severe pain ± discharge.
Pressure on the tragus or movement of the auricle may cause pain.
Malignant otitis externa: very aggressive form caused by a spreading osteomyelitis of the temporal bone (usually Pseudomonas pyocaneus).
Furunculosis
An infection of hair follicles in the auditory canal.
Presents with severe throbbing pain exacerbated by jaw movement with pyrexia and often precedes rupture of an abscess.
Otitis media and glue ear: overview
Inflammation of the middle ear, usually following a URTI.
In the early stages, the eardrum becomes retracted as the eustachian tube is blocked, resulting in an inflammatory middle ear exudate.
If there is infection, pus builds up causing the middle ear pressure to rise and this is seen on otoscope as bulging of the eardrum.
The eardrum may eventually rupture if untreated.
Otitis media and glue ear: complications
Inflammation in the mastoid air cells (mastoiditis). Labyrinthitis. Facial nerve palsy. Extradural abscess. Meningitis. Lateral sinus thrombosis. Cerebellar and temporal lobe abscess.
Otitis media and glue ear: chronic suppurative otitis media
Associated with a central persistent perforation of the pars tensa.
The resulting otorrhoea is usually mucoid and profuse in active infection.
Otitis media and glue ear: glue ear
Otitis media with effusion.
Commonest cause of acquired conductive hearing loss in children (peaks at 3-6 years).
Higher incidence in patients with cleft palate and Down’s syndrome.
Aetiology is usually eustachian tube dysfunction with thinning of the drum.
Cholesteatoma
Destructive disease consisting of overgrowth of stratified squamous epithelial tissue in the middle ear and mastoid causing erosion of local structures and the introduction of infection.
When infected, there may be a foul-smelling discharge.
Bone destruction and marked hearing loss can occur.
May be complicated by meningitis, cerebral abscesses, and VII palsy.
Ménière’s disease
Endolymphatic hydrops.
Distension of the membranous labyrinthine spaces.
Exact cause not known.
Symptoms: attacks of vertigo with prostration, nausea, vomiting, a fluctuating sensorineural hearing loss at low frequencies, tinnitus, and aural fullness or pressure in the ear.
Attacks tend to occur in clusters with quiescent periods between.
Each attack only lasts a few hours and the patient usually has normal balance between.
Over years, the hearing gradually deteriorates in the affected ear.
Vestibular neuronitis
Typically associated with sudden vertigo, vomiting, and prostration.
The symptoms are exacerbated by head movement.
Often follows a viral illness in the young or a vascular lesion in the elderly.
No deafness or tinnitus.
Vertigo lasts for several days, but complete recovery of balance can take months, or may never be achieved.
Otosclerosis
A localised disease of bone which affects the capsule of the inner ear.
Vascular, spongy bone replaces normal bone around the oval window and may fix the footplate of the stapes.
Both ears are affected in >50% of patients.
Otoscopic examination is usually normal.
There may be progressive conductive deafness manifesting after the 20s, possibly with tinnitus and rarely vertigo.
Pregnancy and lactation aggravate the condition.
There is often a strong FHx.
Benign positional vertigo
Attacks of sudden-onset rotational vertigo provoked by lying flat or turning over in bed.
Caused by crystalline debris in the posterior semicircular canal.
Can follow an upper respiratory tract infection or head injury, but often there may be no preceding illness.
Hallpike’s manoeuvre is diagnostic.
If diagnosed, the person should have an Epley manoeuvre which is often curative.
This repositions the debris in the posterior semicircular canal into the utricle.
Labyrinthitis
Localised infection of the labyrinth apparatus.
Difficult to distinguish clinically from vestibular neuritis, unless there is hearing loss due to cochlear involvement.
Acoustic neuromas
Benign tumours of the vestibular element of cranial nerve VIII.
Usually present in middle age and occur more frequently in females.
Bilateral neuromas occur in 5% of patients.
The early symptoms are unilateral or markedly asymmetric, progressive sensorineural hearing loss and tinnitus.
Vertigo is rare but patients with large tumours may have ataxia.
Presbyacusis (senile deafness)
Progressive loss of hair cells in the cochlea with age, resulting in a loss of acuity for high-frequency sounds.
It usually becomes clinically noticeable from the age of 60-65 years.
The degree of loss and age of onset are variable.
Hearing is most affected in the presence of background noise.
Glomus jugulare tumour
A highly vascular tumour arising from ‘glomus jugulare’ tissue lying in the bulb of the internal jugular vein or the mucosa of the middle ear.
Usually presents with a hearing loss or pulsatile tinnitus.
Examination may show a deep red mass behind the eardrum.
Occasionally associated with other tumours such as phaeochromocytomas, or carotid body tumours.
