Lec2 Flashcards
Symptoms of ear diseases ?
1- deafness
2- tinnitus
3- vertigo
4- discharge ( amount- odor-consistency- colour )
5- otalgia
6- headache
7- eye symptoms
8- facial paralysis
9- swelling
10- deformity
Examination methods ?
1- external examination : inspection, palpation to pre auricular , auricle and post auricular area
2- otoscopy
3- examination of drum mobility
( if ET is opened or closed)
- valsalva method : otoscopic examination when blowing the nose while its closed
- seiglization : using seigle ‘s pneumatic otoscope ( otoscope with pump )
4- tuning fork test : rennie , weber test detecting the type of HL
5- microscope to magnify the view
Talk about rinne test
(5)
1- using 512 hz ( equally felt , heard)
2- comparing ac, bc in one ear to denote type of HL not the degree of hearing
3- it gives valuable results if HL excedes 25 dB
4- strike the tuning fork with your elbow or non metallic material , put it parallel with 1 cm distance with the meatus , then put it on mastoid , ask the patient which is louder ?
5- result ;-
Rinne + : normal ( ac > bc) (من الامراض القليلة ال+ يعني طبيعي )
Rinne - :( bc > ac ) CHL
Reduced rinne + : ( ac > bc but both are reduced) SNHL (في مشكلة ف المصدر نفسه )
False rinne - : ( the sound is heard by other ear not the examined which has SEVERE SNHL( unilateral ) when the fork is placed on mastoid)
Talk about weber test ?
(3)
1- comparison of bc between the 2 ears
2- the fork is either replaced on forehead , chin or central incisor( midline ) , asking the patient
3- result ;-
Equal : normal
Lateralised to one side
In CHL : lateralised to conductive one ( due to masking of noise )
In SNHL : lateralised to normal one or better hearing
Talk about schwabachs test
(3)
1- comparison of bc between parient , examiner ( regarding examiner is normal )
2- striking it , one time for examiner hearing a sound for period of time then one time for patient then see if it takes the same duration
3-result ;-
Duration of sound is equal on mastoid : normal
Duration is shorter : SNHL
Duration is longer : CHL
Classifications of external ear diseases
1- congenital
2- traumatic
3- inflammatory
4- neoplastic
Embryo of external ear ?
The auricle is developed from mesenchymal proliferations of 1st, 2 nd branchial arches
EAC is developed from 1st branchial cleft
Congenital anomalies of external ear and their treatments
1- defect in size
- anotia ( no auricle) ( 1st,2nd)
- microtia ( 1st)
- macrotia
Treatment : plastic surgery before schoo age
2- defect in shape
- bat ear ( protruding ) ( if the angle is > 30)
Treatment: plastic surgery before schoo age
3- accessory auricle
Small caritlage anterior to auricle
Treatment : surgical removal if it is large
4- pre auricular cyst , sinus
- located at the root of auricle
- presented with cystic swelling , repeated infection , discharge
Treatment : surgical removal
5- congenital aural ( meatal ) atresia
(5)
- decanalization of EAC ( 1st arch )
- usually accompanied with ME hypoplasia, ossiclar fixation and rarely any inner ear anomalies
- clinial picture : anotia or microtia may present
Deafness ( CHL ) rarely mixed if there is inner ear anomalies
- investigations
• ERA ( evoked response audiometry ) ( to see cochlea is functioning or not )
• CT ( pre operative ) : to know length of atresia , ME , inner ear
- treatment
• hearing aid until the age of surgery ( before school age ) if its bilateral
• plastic surgery if microtia or anotia
• meatoplasty
Traumatic diseases ?
1- aural hematoma
(5)
- collection of blood between perichondriam ,cartilage
- aetiology : blunt trauma as box ( boxers ear )
- clincal picture: cystic swelling ( paniful not tenderness )
- complications : perichondritis due 2ndry bacterial infection , necrosis of cartilage ~> fibrosis ~> cauliflower ear
- treatment :
Antibiotics
Analgesics
Incision, evacution with application of bendage ( prevent recollection of it ) with debridment
2- FB
(5)
1- type of patient : child or mentally retarded adult
2- type of FB : animate
Inanimate ~> vegetable
~> novegetables : cotton , papper
3- clinical picture
-history of FB insertion
- irritation , noise with animate FB
- deafness ( CHL )
4- complications
Injury
Infection
5- treatment
Animate : kill it by oil drops then ear wash
Inanimate
Vegetables: local cleaning hook or suction ( no water as it swells )
No vegetables: local cleaning by water ,hook or suction
( if child is not co operative give general anesthesia )
Inflammatory diseases
1- perichondritis
(5)
- inflammation of perichondrium, cartilage
- aetiology :
Infected hematoma
Squeezing foruncle
Infected surgical wound
- clinical picture
Hottness , tenderness, redness , swelling - complications
Necrosis of cartilage ~> fibrosis ~> cauliflower ear - treatment
Antibiotics local , systemic
Analgesics
Incision and drainge with debridement
2- otitis externa
Otitis externa
Def and types
Inflammation of EAC due viral , fungal , bacterial infection
• Viral
- herpes simplex : in fever forming vesicles
- herpes zoster :
•chickenpox virus forming painful vesicles
•RAMSAY HUNT SYNDROME : herpes zoster oticus Chracterized by 4 things
* vesicles
* painful
* facial paralysis
*vertigo & SNHL
( the last 2 as the virus is neurotropic )
•Treatment :
Analgesics
Acyclovir : local and systemic
- bollus myringitis :
- bollue filled with serous fluid or blood attached to EAC or skin layer of drum
- treatment
- analgesics
- antibiotics local and systemic to prevent 2ndry infection
• fungal
(5)
- otomycosis
- caustive organism: asprigellis niger + candida albicans
- symptoms:
Itching ( hyphae attahced to skin )
Deafness ( CHL )
- signs
Fungal mass looking like a wet newspaper ( white masses with black spot)
- treatment
• local cleaning with ear wash but suction is preferred
•antifungal ear drops
Nystitin
Salsalyic acid ( aspirin) 2% ( keratolytic ) + alcohol 70 % ( fungicidal )
• packing of EAC with antifungal cream on gauze ( resistent )
Bacterial otitis externa
1- localized ( foruncle )
(6) الشاذ
- aetiology: staph aureus
- predisposing factors
* sugar ( diabetes)
* scratching
* swimming in contaminated pool
* seborrhea
* sweating
- sympotoms
Pain + with mastication ( TMJ presses on EAC)
Discharge : scanty - purulent- cheesy
Deafness ( CHL ) - signs
Tenderness + with pulling auricle or pressing the tragus
Internal swelling : reddish on outer 1/3
External swelling : enlarged tender pre and post auricular LN
-investigations
• blood sugar test if recurrent
- treatment
General
Antibiotics & analgesics
Local
•Local cleaning with suction ( no water)
•10%Glycerin icythyol ear drop ( glycerin is hygroscopic , acythyol is counter irritant)
• packing the EAC with cream containg steroid & antibiotics
• incision and drainage if there is abscess
2- diffuse
(5)
- predispoing factors
*sugar ( diabetes)
* scratching
* swimming in contaminated pool
* seborrhea
* sweating
- sympotoms
Pain + with mastication ( TMJ presses on EAC)
Discharge : scanty - purulent
Deafness ( CHL ) - signs
Tenderness + with pulling auricle or pressing the tragus
Internal swelling : reddish odematous diffuse
External swelling : enlarged tender pre and post auricular LN - investigations
• blood sugar test ( if recurrent)
• culture and sensitivity - treatment
General
Antibiotics &analgesics
Local
•Local cleaning with suction ( no water )
•8% Alamonium asetate ear drop ( astringent ) ( antioedmic)
•Packing of EAC with cream containg steroid & antibiotcs
3- malignant
(10)
- skull base osteomylitis
- necrotizing otitis externa
- caustive organism: pseudomonas aureginosa
- it starts with EAC inflammation ( cellulitis ) then involved to skull base ( osteomyelitis)
- predisposing factors : diabetes
- symptoms:
Pain + mastication ( but the pain is severe , prolonged , well seated )
Discharge : scanty purulent
Deafness ( CHL ) - signs :
Tenderness + pulling the ear or pressing on tragus
Internal swelling : red odematous diffuse
External swelling : pre and post auricular LN
Granulations at the bony junction area ( due hyper activity - extenisons ( due to osteomyelitis)
• facial palsy ( stylomastoid foramen )
•parotid swelling
• 4 lower cranial nerves ( jugular foramen )
• trigrminal facial pain if it is involved to petrous apex - investigations (5)
• fasting blood sugar test
• culture and sensitivity ~> pseudomonas
• CT BONE
• gallium and tecntium bone scan ( very specific )
• biopsy from granulations to exclude tumour - treatment (5)
-hospitalisation and control of diabetes - sytemic antibiotics : quinolones as ciprofloxacin ( pseudomonas)
- local antibiotics : ciprofloxasin
- local ear cleaning with suction ( no water )
-debridement sometimes
Neoplastic otits externa
• auricle
Benign
Papilloma , navus ( skin )
Chondroma ( cartilage)
Malignant
Squamus cell carcinoma
Basal cell carcinoma ( rodent ulcer)
•EAC
Benign
Exostosis ( osteoma )
Malignant
Squamous Cell carcinoma
Talk about ear wax?
(5)
1- wax formed by ceruminous , sebecaous glands in outer 1/3
2- usually removed by epithelial migration , mastication
3- symptoms
It impacted ( usually after bathing or swimming )
Deafness ( CHL )
tinnitus
4- maybe dark brown ( hard old) or yellow ( softened new)
5- ear wash , if it is hardened use glycerin bicarbonate or h2o2 ( faster)
Talk about ear wash ?
(5)
1- indications ( RECO )
Removal of foreign body ( not impact not vegtable)
Excessive wax
Caloric test ( testing the vestibular part ) ( vertigo )
Otomycosis ( suction is preffered)
2- contraindications
Bacterial or viral otitis externa
Impact or vegetable FB
perforated drum ( traumatic or pathological )
3- technique
- should be seated with towel covering him
- syringe must have warm water ( around 37) to avoid vertigo
- nozzle and the ear must be moved postero superior to avoid the drum
- EAC is cleaned and dried with alcohol afterwards
4- complications ( 2i and 2 s)
Infection
Injury
Stimulation of inner ear ~> vertigo
Stimulation of vagus ~> cough reflex , vago vagal attack
5- manifestation of drum rupture
- sudden pain
- bleeding
- deafness , tinnitus
- fluid trickling in the throat
