L2 Otology and Lateral Skill Pathology Flashcards by Jenni Meehan

“Battle sign – sign of base of scull fracture
Really hard to get this fractured – significant velocity
Rarely occur as an isolated injury NB Cspine, intracranial – multitrauma till proven otherwise
“

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Outer ear: Trauma. What to look out for?

“Examine for
Head injury,
Base of skull fracture,
TM perforation,
CSF otorrhoea,
Facial nerve function,
Hearing,
Vertigo
- Cut wounds and lacerations: Cover
underlying cartilage
- Auricular Hematoma: Aspiration or I&D
with compression dressing
“

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What are the causes of Otitis externa?

Water exposure, scratching, skin conditions

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What are the symptoms of otitis externa?

Pain on moving the pinna, discharge, itch

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What are the signs of otitis externa?

red, oedematous skin, debris, TM mobile, intact

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What are the 3 most common pathogens of otitis externa?

“Pseudomonas aeruginosa
Staph
Fungi (Otomycosis)”

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What is the treatment of otitis externa?

“Local
topical antibiotic/ steroid
canal toilet
wick “

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What are the complications of otitis externa?

“Ear canal stenosis
Perichondritis
Necrotising otitis externa “

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Whats perichondritis?

infection of the tissue lining your ear canal

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Whats necrotizing otitis externa?

“a severe infection of the ear canal with frequent bone erosion and local complications. NOE is a rare pathology.

Osteomyelitis and spread of infection along lateral skull base in pts with DM/immunocomprimised”

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What are the most common pathogens of necrotizing otitis externa?

“Pseudomonas aeruginosa
Rarely Staph, Aspergillus, Proteus
“

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What are the symptoms and signs of NOE?

“Severe Otalgia
Granulation tissue in EAC
Cranial nerve palsies
“

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How do you diagnose NOE?

“CRP, ESR, FBC, Ear swab
CT Scan, MRI scan
“

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What is ET Dysfunction in the middle ear?

“Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the middle ear result in symptoms

Symptoms include aural fullness, ears popping, a feeling of pressure in the affected ear(s), a feeling that the affected ear(s) is clogged, crackling, ear pain, tinnitus, autophony, and muffled hearing”

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Acute otitis media pathogens?

“Viral
bacterial; s. pneumonia, h. influenza, m. catarrhalis”

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Most common age of acute otitis media?

3 months - 3 years

Signs and symptoms of acute otitis media?

“pain, pyrexia, hearing loss
red bulging tympanic membrane with middle ear fluid
ear discharge improves the symptoms
decreased TM movement on pneumatic otoscopy “

What is the treatment of acute otitis media?

“ANTIBIOTIC GUIDELINES!!!

NICE Guidelines April 2019
Conservative:
In healthy children > 2 yrs consider observation x 72 h with analgesic and antipyretic
Medical:
Consider in children <2yrs, otorrhoea, signs and symptoms of systemic disease, high risk for complications
add antibiotics:
1st line: amoxicillin 80-90mg/kg/day
2nd line (worsening symptoms after 2-3 days): co-amoxiclav
PCN allergy: clarithromycin, erythromycin
Surgical:
for recurrent acute otitis media, consider grommet placement
3 or more in 6 months
4 or more in 12 months

”

Complications of acute otitis media?

“Extracranial:
Tympanosclerosis
TM perforation
- Often will heal on its own in 2 weeks
- Occasionally associated with chronic otorrhoea
Hearing Loss
Mastoiditis & subperiosteal abscess
- Fluid in the mastoid bone air cells becomes infected and invades bony structures
Facial nerve paralysis 1%
Petrositis (Gradenigo’s syndrome)
Labyrinthitis
Chronic suppurative otitis media

Intracranial:
Meningitis
Extradural abscess
Subdural abscess
Brain abscess
Sigmoid sinus thrombophlebitis
Otitic Hydrocephalus
“

Acute otitis media complications - Mastoiditis. What is it? CF? Dx? Tx?

“Empyema in mastoid, sub-periostial abscess
Clinical features
Fever, ear pain, protruding pinna
Erythema of skin, tenderness +/- fluctuance over mastoid
Diagnosis
Contrasted CT of temporal bone may indicate abscess
Treatment
Initially IV antibiotics, then possible mastoidectomy and grommet
“

Pinna Cellulitis:

Staphylococcus, Streptococcus, Pseudomonas

Erysipelas:

Group A β-hemolytic Streptococci

Relapsing polychondritis:

Autoimmune disease, treated with steroids

Where does ear wax come from

Secreted from sebaceous and ceruminous glands in EAC

Constents : Lipids, Lyzozymes, Desquamous debris

Natural Migration pattern

Normal Ear Hygiene

Wax impaction Treatment
Syringing – Contra Indications
Microsuction

Middle Ear: ET Dysfunction - what are the predisposing factors?

Predisposing factors Craniofacial anomalies e.g. Cleft palate Immuundefiencies Adenoidal enlargement Nasal allergy Parental smoking Bottle feeding Day care attendance

Presence of fluid in the middle ear, without signs or symptoms of infection?

Middle Ear: Otitis Media with Effusion (Glue ear) Presence of fluid in the middle ear, without signs or symptoms of infection Peak at 2yrs and 5yrs Otoscopy: dull TM, fluid level, immobile Commonest cause of hearing loss in children May cause a 30-40 dB conductive hearing loss Antibiotics are not indicated Refer to ENT if present > 3 months for possible grommet

What is the treatment of glue ear?

Conservative Hearing aid Down Syndrome, cleft palate Medical Auto inflation Surgical Grommets NICE guideline (Dec 2018): Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL

What do grommets do?

Prevent negative middle ear pressure Last ~ 9 months approx then extrude on their own Inserted in the Anterior inferior quadrant Indications OME Recurrent AOM Complications of AOM Complications Discharge (50%) Residual tympanic membrane perforation (1-2%) Tympanosclerosis (40%)

what does glue ear in an adult suggest?

If of recent origin and unilateral, should prompt nasopharyngeal examination (with scope) to assess for pathology blocking the eustachian tube Rule out early nasopharyngeal carcinoma

Patient presences with a discharging ear, hearing loss for 12 weeks without pain?

Middle Ear: Chronic Suppurative Otitis Media(CSOM) without cholesteotoma Discharging ear >3/12 in the presence of tympanic membrane perforation Usually as a result of acute otitis media Symptoms – otorrhoea, hearing loss (otalgia usually not a feature) Pathogenes: P. aeruginosa, S aureus, Proteus Treatment Topical Non ototoxic antiobiotics – steroids drops Surgical repair of tympanic membrane

white cottage cheese like discharge?

otitis externa

mucoid discharge?

otitis media with perforation

blood stained Clear fluid - CSF discharge

Trauma, Granulation tissue, Neoplasm

Foul smelling otorrhoea

Cholesteatoma

Middle Ear: Chronic Suppurative Otitis Media(CSOM) with Cholesteatoma what is it?

Benign keratinizing squamous cell epithelium in the middle ear Acquired Cholesteatoma theory - Retraction pocket becomes skin bag Congenital Cholesteatoma – embryonic squamous epithelium trapped in the middle ear Common presenting symptoms Foul-smelling chronic ear drainage (Tx with antibiotic drops) Hearing loss due to ossicular damage