Infective Ear Conditions

Question 1

what are the causes of otitis media?

Answer 1

• Usually viral
• Also Strep pneumoniae, H-influenza, moxerella catarhars
• Chronic – pseudomonas, aeruginosa
• Follows URTI

Question 2

what are the risk factors to developing Otitis Media?

Answer 2

UTRI, bottle fed, passive smoking, gastric reflux, presence of adenoids, asthma, malformations, low socioeconomic

Question 3

what is the pathophysiology of otitis media?

Answer 3

inflammation of the inner ear

Question 4

what are the investigations for otitis media?

Answer 4

• Audiometry – OAE, distraction testing, COR, PTA

* Tympanometry

Question 5

what are the complications of otitis media?

Answer 5

• Acute mastoiditis
• Facial paralysis
• Labyrinthitis
• Thrombosis of the lateral venous sinus

Question 6

what are the cause of acute otitis media?

Answer 6

Post viral

Question 7

what are the cause of chronic otitis media?

Answer 7

Multiple episodes

of AOM, crowded living, day-care, congenital cranial deformities

Question 8

what are the cause of otitis media with effusion?

Answer 8

URTI, oversized adenoids, narrow nasopharyngeal dimension, bacterial biofilms on adenoids.

Question 9

what is the immune cell involved in acute otitis media?

Answer 9

macrophages

Question 10

what is the pathophysiology of chronic otitis media?

Answer 10

Prolonged inflammatory response results in ulceration, oedema, perforation, polyps

Question 11

what is the pathophysiology of Otitis Media with Effusion?

Answer 11

Fluid accumulation in the middle ear + mastoid cells

Due to negative pressure creates a vacuum

Question 12

what are the clinical features of acute otitis media?

Answer 12

Rapid onset pain, fever +/- irritability, anorexia or vomiting
Easing of pain if rupture (discharge)
URTI symptoms
TM Early – clear
TM late – bulges, blister

Question 13

what are the clinical features of chronic otitis media?

Answer 13

Hearing loss, otorrhea, fullness, otalgia

Question 14

what are the clinical features of otitis media with effusion?

Answer 14

Hearing impairment, poor listening/speech, balance problems
Young kids – impact of education + development – bilateral
Adults – unilateral, ear pain, tinnitus, fullness

Question 15

what is the management of acute otitis media?

Answer 15

Most self-resolving
Optimise analegisa
Antibiotics – give none or delay, if no improvement in 4 days, 1st Amoxicillin, 2nd Erythromycin

Question 16

what is the management of chronic otitis media?

Answer 16

Antibiotics
Aural Cleaning
Topical Steroids
Surgery – myringoplasty, mastoidectomy

Question 17

what is the management of otitis media with effusion?

Answer 17

Observe (self resolving)
Auto inflation
Surgery
1st Line - grommets (last 6mths-4yrs)
2nd Line - adenoidectomy

Question 18

what are the risk factors to developing otitis media with effusion?

Answer 18

More common in DS, cleft palate, inter, atopy, passive smoking, primary ciliary dyskinesia

Question 19

what are the clinical features of benign COM?

Answer 19

dry TM perforation -ve active infection

Question 20

what are the clinical features of chronic serous COM?

Answer 20

continuous serous drainage through perforated TM

Question 21

what is a safe tympanic membrane perforation?

Answer 21

perforation in centre

Question 22

what is a unsafe tympanic membrane perforation?

Answer 22

perforation in periphery

Question 23

what does the tympanic membrane look like in otitis media with effusion?

Answer 23

retracted or bulging, dull, grey, yellow, may be bubbles or a fluid level, loss of light reflex

Question 24

what is a cholesteatoma?

Answer 24

Non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction

Question 25

where do cholesteatomas occur?

Answer 25

middle ear

Question 26

what is the histology of cholesteatoma?

Answer 26

squamous, high cell turnover + keratinisation | normal lining is cuboidal or columnar glandular epithelium

Question 27

what are the two types of cholesteatoma?

Answer 27

acquired | congenital

Question 28

what are the features of acquired cholesteatoma?

Answer 28

o Keratin accumulates in the pouch of the tympanic membrane o “attic” invagination form retraction pockets o Result of perforation

Question 29

what are the features of congenital cholesteatoma?

Answer 29

o Epidermal keratin filled cysts | o Found medial to tympanic membrane (intact)

Question 30

what are the clinical features of cholesteatoma?

Answer 30

• Foul smelling discharge +/ deafness, headache, pain, facial paralysis (invades nerve) and vertigo (invades middle ear), cerebellopontine angle syndrome

Question 31

how are cholesteatomas diagnosed?

Answer 31

* CT, MRI, Diffusion weighted MRI | * Otoscope – attic crust – seen in uppermost part of the ear drum

Question 32

what is the management of cholesteatoma?

Answer 32

mastoidectomy = URGENT REFERAL

Question 33

what is otitis externa?

Answer 33

Inflammation of the outer ear canal

Question 34

what are the types of otitis externa?

Answer 34

o Localised – associated with infection of hair follicle o Acute – rapid onset o Chronic – (acute lasting > 6 weeks)

Question 35

what are the bacterial causes of otitis externa?

Answer 35

staph aureus, pseudomonas aeruginosa – multi-microbial disorder

Question 36

what are the fungal causes of otitis externa?

Answer 36

aspergillus niger (immunocompromised = diabetes), candida albicans

Question 37

what are the causes of otitis externa?

Answer 37

bacterial fungal allergies and autoimmune

Question 38

what are the risk factors to otitis externa?

Answer 38

swimming, trauma (finger nails), hearing aids, skin problems (eczema, psoriasis), absence of cerebrum, high humidity, retained water in canal, increased temperature, external auditory exostosis

Question 39

what is the pathophysiology of otitis externa?

Answer 39

Once infection established, an inflammatory response occurs – oedema, pus, spread

Question 40

what are the clinical features of otitis externa?

Answer 40

* Redness and swelling * itchy * sore and painful * Discharge or increased ear wax * Canal blockage – hearing affected * Pre-auricular lymphadenopathy

Question 41

what is the management of mild otitis externa?

Answer 41

cleaning EAC, hydrocortisone cream and Ear Calm Spray

Question 42

what is the management of moderate otitis externa?

Answer 42

Swab, clean, topical antibiotic+/- steroid drops (otosporin, sofradex, genitsone)

Question 43

what is the management of severe otitis externa?

Answer 43

thin ear wick e.g. aluminium acetate

Question 44

what is the complication of malignant otitis externa?

Answer 44

Extension of otitis externa into bone surrounding ear canal (mastoid + temporal) Eventually evolve in the skull and meninges

Question 45

what are the risk factors to developing malignant otitis externa?

Answer 45

diabetes + radiotherapy

Question 46

what are the clinical features of malignant otitis externa?

Answer 46

pain and headache (more severe than findings suggest) | granulation tissue at bone cartilage junction, exposed bone in canal, facial nerve palsy

Question 47

what are the investigations for malignant otitis externa?

Answer 47

plasma viscosity + CRP, radiological imaging + biopsy + culture

Question 48

what is the management of malignant otitis externa?

Answer 48

antibiotics