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CMED - ENT > L2 Otology and Lateral Skill Pathology > Flashcards

L2 Otology and Lateral Skill Pathology Flashcards

1
Q
A

“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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2
Q

Outer ear: Trauma. What to look out for?

A

“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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3
Q

What are the causes of Otitis externa?

A

Water exposure, scratching, skin conditions

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4
Q

What are the symptoms of otitis externa?

A

Pain on moving the pinna, discharge, itch

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5
Q

What are the signs of otitis externa?

A

red, oedematous skin, debris, TM mobile, intact

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6
Q

What are the 3 most common pathogens of otitis externa?

A

“Pseudomonas aeruginosa
Staph
Fungi (Otomycosis)”

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7
Q

What is the treatment of otitis externa?

A

“Local
topical antibiotic/ steroid
canal toilet
wick “

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8
Q

What are the complications of otitis externa?

A

“Ear canal stenosis
Perichondritis
Necrotising otitis externa “

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9
Q

Whats perichondritis?

A

infection of the tissue lining your ear canal

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10
Q

Whats necrotizing otitis externa?

A

“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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11
Q

What are the most common pathogens of necrotizing otitis externa?

A

“Pseudomonas aeruginosa
Rarely Staph, Aspergillus, Proteus
“

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12
Q

What are the symptoms and signs of NOE?

A

“Severe Otalgia
Granulation tissue in EAC
Cranial nerve palsies
“

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13
Q

How do you diagnose NOE?

A

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

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14
Q

What is ET Dysfunction in the middle ear?

A

“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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15
Q

Acute otitis media pathogens?

A

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

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16
Q

Most common age of acute otitis media?

A

3 months - 3 years

17
Q

Signs and symptoms of acute otitis media?

A

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

18
Q

What is the treatment of acute otitis media?

A

“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

”

19
Q

Complications of acute otitis media?

A

“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
“

20
Q

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

A

“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
“

21
Q

Pinna Cellulitis:

A

Staphylococcus, Streptococcus, Pseudomonas

22
Q

Erysipelas:

A

Group A β-hemolytic Streptococci

23
Q

Relapsing polychondritis:

A

Autoimmune disease, treated with steroids

24
Q

Where does ear wax come from

A

Secreted from sebaceous and ceruminous glands in EAC

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

25
Q

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

A

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

26
Q

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

A

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

27
Q

What is the treatment of glue ear?

A

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

28
Q

What do grommets do?

A

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%)

29
Q

what does glue ear in an adult suggest?

A

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

30
Q

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

A

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

31
Q

white cottage cheese like discharge?

A

otitis externa

32
Q

mucoid discharge?

A

otitis media with perforation

33
Q

blood stained
Clear fluid - CSF
discharge

A

Trauma, Granulation tissue, Neoplasm

34
Q

Foul smelling otorrhoea

A

Cholesteatoma

35
Q

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

A

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

CMED - ENT (3 decks)

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