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Y2 - Head N Neck > Lecture 10 - Anatomy + Ear Conditions > Flashcards

Lecture 10 - Anatomy + Ear Conditions Flashcards

1
Q

What is infection of the pinna called?

A

Perichondritis

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2
Q

What is the problem with perichonditis of the pinna?

A

Since its made of cartilage its heals poorly

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3
Q

What is the name of the condition where theres unilateral facial drooping and vesicles in the ear/pinna?

A

So a facial nerve palsy with red ear vesicles

Ramsay Hunt syndrome

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4
Q

What is Ramsay-Hunt syndrome?

A

When theres a facial nerve palsy leading to unilateral facial droop and there’s red ear vesicle

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5
Q

What is the stage that occurs before cauliflower ear?

A

Pinna haemotoma

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6
Q

What is a Pinna haemotoma?

A

When blood accumulates between teh cartilage of the pinna and the overlying perichondrium

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7
Q

What is perchondrium?

A

The layer that sits on top of cartilage

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8
Q

What is the pathology of a Pinna Haematoma?

A

Blunt trauma leads to shearing of perichondrium from the cartilage
Cartilage relies on the perichondrium for its blood supply
Leads to its necrosis
Also pressure necrosis from the build up of blood between the cartilage and perichondrium

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9
Q

How does a pinna haemotoma lead to cauliflower deformity if left untreated?

A

The necrosis/ischaemic damage to the cartilage leads to fibrosis/repair of the cartilage in an uncontrolled

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10
Q

How is pinna Haematoma treated preventing cauliflower deformity?

A

Drain ear
Prevent the reaccumlation of fluid by bringing the 2 layers (cartilage and perichondrium)

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11
Q

Go to the last slide, what is the condition in picture 1?

A

This is the external acoustic meatus, its been narrowed since its inflammed

Otitis externa (due to infection)

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12
Q

What is the normal cause of inflammation of the External Acoustic Meatus?

A

Infection

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13
Q

What are the 2 main bacterial infections that cause Acute Otitis Externa?

A

Staphylococcus aureus
Pseudomonas aeruginosa

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14
Q

What are the symptoms of Acute Otitis Externa?

A

Otalgia
Custard like discharge
Can have hearing loss depending on extent of inflammation

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15
Q

What are some risk factors for Acute Otitis Externa?

A

Injury to External acoustic meatus like itching

Swimming/warm weather

Skin problems like eczema

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16
Q

How is Acute Otitis Externa treated?

A

Ear drops (topical antibiotic)
+
Steroid depending on how inflammed it is

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17
Q

What is a potentially life threatening complication of Otitis Externa?

A

Necrotising Otitis Externa

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18
Q

What is Necrotising Otitis Externa?

A

Where the infection from otitis externa spreads to the the ossicles, temporal bone and skull base (OSTEOMYELITIS)

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19
Q

What are the symptoms of Necrotising Otitis Externa?

A

Severe Otalgia (CANT SLEEP)
Hearing loss
Can get Cranial nerve symptoms

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20
Q

What are the risk factors for Necrotising Otitis Externa?

A

Old
Male
Immunocomprimised
Diabetic

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21
Q

What investigations are often done if suspecting Necrotising Otitis Externa?

A

CT temporal bone to see how far osteomyelitis spread

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22
Q

How is Necrotising Otitis Externa treated?

A

IV antibiotics
Can be oral sometimes with ear drops

Lots of analgesia

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23
Q

What is a very common infection of the middle ear in children?

A

Acute otitis media

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24
Q

Why is Acute otitis media common in babies and young children to 4yrs?

A

Short Eustachian/pharyngotympanic tube which opens to large adenoids (bigger in young children)

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25
Q

What are some symptoms of Acute Otitis media (middle ear infection)?

A

Otalgia
Fever
Can have red tympanic membrane
Can have non specific signs in infants like pulling on ear

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26
Q

What is the treatment of Acute Otitis Media?

A

Usually resolves in 3 - 1week
Analgesia

Back up Abx prescription if doesn’t resolve

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27
Q

What are some potential complications of Acute Otitis Media (middle ear infection)?

A

Tympanic membrane perforation
Facial nerve involvement

Life threatening:
Mastoiditis
Meningitis
Sigmoid sinus thrombosis
Brain abscess (posterior cranial fossa)

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28
Q

How does Mastoiditis present?

A

Signs + symptoms of Acute Otitis Media
Unwell + pyrexia

Oedema around mastoid
No longer sharp angle behind ear (sticks out)
Pinna pushed down and forward

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29
Q

What is Otitis media with effusion/Glue ear?

A

NOT AN INFECTION

Where inflammatory fluid accumulates in the middle ear which affects the hearing

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30
Q

What is the pathology of of Glue Ear/Otitis media with effusion?

A

Dysfunction of the pharyngotympanic tube leads to increased -ve pressure in the middle ear drawing TM inwards, leads to inflammatory fluid accumulating
This decreases the mobility of the TM and ossicles causing hearing loss

31
Q

How does Otitis media with effusion/glue ear present?

A

Child well
Hearing loss

32
Q

Who does otitis media with effusion/glue ear occur most in?

A

Infants + kids

Pharyngotympanic dysfunction more likely in kids

33
Q

How is Otitis media with effusion (glue ear) managed?

A

Most spontaneously resolve after 2-3 months

If persists and impedes speech and language development at school Grommets are implanted

34
Q

What are Grommets and how do they help with Otitis media with effusion (glue ear)?

A

The are a tympanostomy tube which basically acts as an extra Eustachian tube so that pressures can be equalised

35
Q

What is a Cholesteatoma?

A

When the pars flaccida gets pulled inwards meaning dead skin gets stuck here

This dead skin then eats through anything it comes into contact with

Its no a tumour and has nothing to do with cholesterol

36
Q

Why are Cholesteatomas very bad?

A

Grows into middle ear and beyond

37
Q

What are the signs and symptoms of a Cholesteatoma?

A

Could smelling discharging ear
Progressive hearing loss (depends on extent of Cholesteatoma)
Other signs and symptoms depending on structures affected

38
Q

What is the treatment for a Cholesteatoma?

A

Surgical treatment called a mastoidectomy

Which is risk to the facial nerve

39
Q

What sign can be seen on the tympanic membrane indicating a Cholesteatoma?

A

Abnormalities at the attic/pars flaccida

40
Q

What condition does this patient have?

4yr old
Hearing deteriorated over month
Otherwise well

A

Otitis media with effusion/glue ear

41
Q

What condition does this patient have?

22yr old
3 day history of left ear otalgia
Itchy + otorrhoea

A

Acute otitis externa

42
Q

What condition does this patient have?

72yr old
Severe otalgia + otorrhoea for last 2-3 weeks which is worsening
Otalgia preventing sleep
Over counter analgesia not working
Type 2 DM

A

Necrotising otitis externa

43
Q

What structures can be affected in the inner ear?

A

Cochlea and/or vestibular apparatus

44
Q

What is the term to describe age-related hearing loss?

A

Presbycusis

45
Q

What is thought to be the mechanism for presbycusis (age related hearing loss)?

A

Sensorineural

Sterocilia degenerate (maybe due to noise or drugs like vancomycin)

Bilateral and gradual

46
Q

How is Presbycusis treated?

A

Hearing aids

47
Q

What is the condition where only vertigo is experienced?

A

Benign Paroxysmal Positional Vertigo (BPPV)

48
Q

What part of the ear is affected in Benign Paroxysmal Positional Vertigo (BPPV)?

A

Semicircular canals which are part of the vestibular apparatus of the inner ear

49
Q

How does Benign Paroxysmal Positional Vertigo present?

A

Episodes of short lived vertigo that occur with changing positions/movement of head

50
Q

What causes Benign Paroxysmal Positional Vertigo (BPPV)?

A

Otoliths that normally reside in the utricle and saccule move into the semicircular canals
So movemtn of the head moves these crystals which leads to the fluid moving causing your brain to think you’re moving

51
Q

How is Benign Paroxysmal Positional Vertigo (BPPV) diagnosed and treated?

A

Head moved to trigger the vertigo episode (Dix-Hallpike manoeuvre)

Head moved to move the crystals back into the utricle and saccule from the semi circular canals (Epley manoeuvre)

52
Q

What is Menieres Disease?

A

Where the vestibular and cochlear apparatus are affected

Causes episodes of a triad of symptoms

53
Q

What is the triad of symptoms indicating Menieres Disease?

A

Vertigo
Tinnitus
Hearing loss

Episodes
Usually unilateral

54
Q

What is though to be the cause of Menieres Disease?

A

Thought that the endolymph sac is not draining enough of the fluid from the vestibulocochlear apparatus

55
Q

What is another term for the inner ear?

A

Labyrinth

56
Q

What is Acute Labyrinthitis?

A

Infection of all inner ear structures

57
Q

What are the symptoms of Acute labyrinthitis?

A

Hearing loss
Tinnitus
Vomiting
Vertigo

58
Q

What is acute vestibular neuronitis?

A

Infection of vestibular neurones

59
Q

What are the symptoms of acute vestibular neuronitis?

A

Sudden onset vomiting and severe vertigo

Hearing fine and no tinnitus

60
Q

What is a major risk factor for developing acute labyrinthitis and acute vestibular neuronitis?

A

Prior history of Upper repsiratory tract infection

61
Q

What is suspected and what must be done immediately if a patient has sudden onset unilateral hearing loss?

A

Sudden sensorineural hearing loss (SSNHL)

Refer to ENT specialist or Emergency department

Since earlier identified and treated with steroids more likely for hearing to improve

62
Q

What are the 2 types of hearing loss?

A

Conductive
Sensorineural

63
Q

What can cause conductive hearing loss?

A

Pathology involving external or middle ear

Otosclerosis
Otitis media with effusion
Acute otitis media
Wax

64
Q

What is Otosclerosis?

A

When theres a gradual conductive hearing loss over years

Where extra bony growths happen at the synovial joints of the ossicle bones reducing vibrations

65
Q

How does Otosclerosis present?

A

Gradual hearing loss bilaterally (can be unilateral early on)

Normally well but tinnitus can occur

66
Q

How is otosclerosis treated?

A

Hearing aids

Surgical replacement of ossicles (stapes replaced with prosthesis )

67
Q

What is sensorineural hearing loss?

A

Pathology involving inner ear or CN VIII

68
Q

What are some causes of sensorineural hearing loss?

A

Age related hearing loss (presbycusis)
Noise related hearing loss
Ménière’s disease
Ototoxic meds like vancomycin

Acoustic neuroma
Sudden sensorineural hearing loss

69
Q

What is an acoustic neuroma?

A

Benign slow growing posterior cranial fossa tumour on the Schwann cells of CN VIII

70
Q

What can be some signs and symptoms of an Acoustic neuroma?

A

Unilateral hearing loss
Tinnitus + vertigo (vestibulocochlear)
Numbness, pain or weakness down one half of face (Trigeminal + facial nerve)

Since it can compress different structures around here

Can also compress brainstem and cerebellum

71
Q

How is an acoustic neuroma diagnosed?

A

MRI

72
Q

How is an acoustic neuroma managed?

A

Observe since grows slow
Surgery
Or radiation

73
Q

What condition does this patient have?

55yrs old
1month smelly discharge from ear
Hearing loss in same ear
No pain
Other wise well
Ear problems as kid and needed grommets

A

Cholesteatoma

74
Q

What condition does this patient have?

65yrs old
Hearing loss in both ears
Gradual
Otherwise well and no symptoms

A

Presbycusis

Y2 - Head N Neck (24 decks)

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