Lecture 10 - Anatomy + Ear Conditions Flashcards
What is infection of the pinna called?
Perichondritis
What is the problem with perichonditis of the pinna?
Since its made of cartilage its heals poorly
What is the name of the condition where theres unilateral facial drooping and vesicles in the ear/pinna?
So a facial nerve palsy with red ear vesicles
Ramsay Hunt syndrome
What is Ramsay-Hunt syndrome?
When theres a facial nerve palsy leading to unilateral facial droop and there’s red ear vesicle
What is the stage that occurs before cauliflower ear?
Pinna haemotoma
What is a Pinna haemotoma?
When blood accumulates between teh cartilage of the pinna and the overlying perichondrium
What is perchondrium?
The layer that sits on top of cartilage
What is the pathology of a Pinna Haematoma?
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
How does a pinna haemotoma lead to cauliflower deformity if left untreated?
The necrosis/ischaemic damage to the cartilage leads to fibrosis/repair of the cartilage in an uncontrolled
How is pinna Haematoma treated preventing cauliflower deformity?
Drain ear
Prevent the reaccumlation of fluid by bringing the 2 layers (cartilage and perichondrium)
Go to the last slide, what is the condition in picture 1?
This is the external acoustic meatus, its been narrowed since its inflammed
Otitis externa (due to infection)
What is the normal cause of inflammation of the External Acoustic Meatus?
Infection
What are the 2 main bacterial infections that cause Acute Otitis Externa?
Staphylococcus aureus
Pseudomonas aeruginosa
What are the symptoms of Acute Otitis Externa?
Otalgia
Custard like discharge
Can have hearing loss depending on extent of inflammation
What are some risk factors for Acute Otitis Externa?
Injury to External acoustic meatus like itching
Swimming/warm weather
Skin problems like eczema
How is Acute Otitis Externa treated?
Ear drops (topical antibiotic)
+
Steroid depending on how inflammed it is
What is a potentially life threatening complication of Otitis Externa?
Necrotising Otitis Externa
What is Necrotising Otitis Externa?
Where the infection from otitis externa spreads to the the ossicles, temporal bone and skull base (OSTEOMYELITIS)
What are the symptoms of Necrotising Otitis Externa?
Severe Otalgia (CANT SLEEP)
Hearing loss
Can get Cranial nerve symptoms
What are the risk factors for Necrotising Otitis Externa?
Old
Male
Immunocomprimised
Diabetic
What investigations are often done if suspecting Necrotising Otitis Externa?
CT temporal bone to see how far osteomyelitis spread
How is Necrotising Otitis Externa treated?
IV antibiotics
Can be oral sometimes with ear drops
Lots of analgesia
What is a very common infection of the middle ear in children?
Acute otitis media
Why is Acute otitis media common in babies and young children to 4yrs?
Short Eustachian/pharyngotympanic tube which opens to large adenoids (bigger in young children)
What are some symptoms of Acute Otitis media (middle ear infection)?
Otalgia
Fever
Can have red tympanic membrane
Can have non specific signs in infants like pulling on ear
What is the treatment of Acute Otitis Media?
Usually resolves in 3 - 1week
Analgesia
Back up Abx prescription if doesn’t resolve
What are some potential complications of Acute Otitis Media (middle ear infection)?
Tympanic membrane perforation
Facial nerve involvement
Life threatening:
Mastoiditis
Meningitis
Sigmoid sinus thrombosis
Brain abscess (posterior cranial fossa)
How does Mastoiditis present?
Signs + symptoms of Acute Otitis Media
Unwell + pyrexia
Oedema around mastoid
No longer sharp angle behind ear (sticks out)
Pinna pushed down and forward
What is Otitis media with effusion/Glue ear?
NOT AN INFECTION
Where inflammatory fluid accumulates in the middle ear which affects the hearing
What is the pathology of of Glue Ear/Otitis media with effusion?
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
How does Otitis media with effusion/glue ear present?
Child well
Hearing loss
Who does otitis media with effusion/glue ear occur most in?
Infants + kids
Pharyngotympanic dysfunction more likely in kids
How is Otitis media with effusion (glue ear) managed?
Most spontaneously resolve after 2-3 months
If persists and impedes speech and language development at school Grommets are implanted
What are Grommets and how do they help with Otitis media with effusion (glue ear)?
The are a tympanostomy tube which basically acts as an extra Eustachian tube so that pressures can be equalised
What is a Cholesteatoma?
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
Why are Cholesteatomas very bad?
Grows into middle ear and beyond
What are the signs and symptoms of a Cholesteatoma?
Could smelling discharging ear
Progressive hearing loss (depends on extent of Cholesteatoma)
Other signs and symptoms depending on structures affected
What is the treatment for a Cholesteatoma?
Surgical treatment called a mastoidectomy
Which is risk to the facial nerve
What sign can be seen on the tympanic membrane indicating a Cholesteatoma?
Abnormalities at the attic/pars flaccida
What condition does this patient have?
4yr old
Hearing deteriorated over month
Otherwise well
Otitis media with effusion/glue ear
What condition does this patient have?
22yr old
3 day history of left ear otalgia
Itchy + otorrhoea
Acute otitis externa
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
Necrotising otitis externa
What structures can be affected in the inner ear?
Cochlea and/or vestibular apparatus
What is the term to describe age-related hearing loss?
Presbycusis
What is thought to be the mechanism for presbycusis (age related hearing loss)?
Sensorineural
Sterocilia degenerate (maybe due to noise or drugs like vancomycin)
Bilateral and gradual
How is Presbycusis treated?
Hearing aids
What is the condition where only vertigo is experienced?
Benign Paroxysmal Positional Vertigo (BPPV)
What part of the ear is affected in Benign Paroxysmal Positional Vertigo (BPPV)?
Semicircular canals which are part of the vestibular apparatus of the inner ear
How does Benign Paroxysmal Positional Vertigo present?
Episodes of short lived vertigo that occur with changing positions/movement of head
What causes Benign Paroxysmal Positional Vertigo (BPPV)?
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
How is Benign Paroxysmal Positional Vertigo (BPPV) diagnosed and treated?
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)
What is Menieres Disease?
Where the vestibular and cochlear apparatus are affected
Causes episodes of a triad of symptoms
What is the triad of symptoms indicating Menieres Disease?
Vertigo
Tinnitus
Hearing loss
Episodes
Usually unilateral
What is though to be the cause of Menieres Disease?
Thought that the endolymph sac is not draining enough of the fluid from the vestibulocochlear apparatus
What is another term for the inner ear?
Labyrinth
What is Acute Labyrinthitis?
Infection of all inner ear structures
What are the symptoms of Acute labyrinthitis?
Hearing loss
Tinnitus
Vomiting
Vertigo
What is acute vestibular neuronitis?
Infection of vestibular neurones
What are the symptoms of acute vestibular neuronitis?
Sudden onset vomiting and severe vertigo
Hearing fine and no tinnitus
What is a major risk factor for developing acute labyrinthitis and acute vestibular neuronitis?
Prior history of Upper repsiratory tract infection
What is suspected and what must be done immediately if a patient has sudden onset unilateral hearing loss?
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
What are the 2 types of hearing loss?
Conductive
Sensorineural
What can cause conductive hearing loss?
Pathology involving external or middle ear
Otosclerosis
Otitis media with effusion
Acute otitis media
Wax
What is Otosclerosis?
When theres a gradual conductive hearing loss over years
Where extra bony growths happen at the synovial joints of the ossicle bones reducing vibrations
How does Otosclerosis present?
Gradual hearing loss bilaterally (can be unilateral early on)
Normally well but tinnitus can occur
How is otosclerosis treated?
Hearing aids
Surgical replacement of ossicles (stapes replaced with prosthesis )
What is sensorineural hearing loss?
Pathology involving inner ear or CN VIII
What are some causes of sensorineural hearing loss?
Age related hearing loss (presbycusis)
Noise related hearing loss
Ménière’s disease
Ototoxic meds like vancomycin
Acoustic neuroma
Sudden sensorineural hearing loss
What is an acoustic neuroma?
Benign slow growing posterior cranial fossa tumour on the Schwann cells of CN VIII
What can be some signs and symptoms of an Acoustic neuroma?
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
How is an acoustic neuroma diagnosed?
MRI
How is an acoustic neuroma managed?
Observe since grows slow
Surgery
Or radiation
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
Cholesteatoma
What condition does this patient have?
65yrs old
Hearing loss in both ears
Gradual
Otherwise well and no symptoms
Presbycusis
