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ENT > middle ear > Flashcards

middle ear Flashcards

learn about the conditions of middle er

1
Q

otomycosis

A

external ear fungal infection

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2
Q

common organisms causing otomycosis?

A

aspergillous fumigatous
aspergillous niger
candida albicans

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3
Q

what is the presenting complains in otomycosis?

A 
itching or ear
pain/discomfort
watery discharge of musty odur
ear block
fungal nass of colour ~ white brown black
looks like a wet filter paper
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4
Q

signs on examinaton of otomycosis?

A

niger ~black deposit
Fumigatous~ light blue
Candida~ white creamy

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5
Q

treatment of otomycosis (clinical care)

A

ear toilet - removesdischarge and debri
syringing
suction
mopping

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6
Q

medical treatment of otomycosis

A

Nystatin 100000 units/ml ~ candida
clotrimozole, pavidoiodine (broad spec) for others
keratolytic agents to remove debri - 2% salsylic acid

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7
Q

how long do u give med treatment for otomycosis?

A

for a week even after apparent cure

should always be dry

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8
Q

what does salcylic acid do?

A

remove superficial layer of epithelium with fungal mycelium

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9
Q

what is malignant otitis externa?

A

inflammation
due to pseudomonas
common in dm

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10
Q

prediaposing condition for malignant otitis externa

A

diabetes mellitus elderly and

immunosuppresive therapy

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11
Q

what does the feature resemble malignant otitis externa

A

diffuse otitis externa

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12
Q

features specific to otitis externa

A

excruciating pain
granulation in ear canal
facial paralysis

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13
Q

spread of otitis externa? and what does it result in?

A

to base of skull , jugular foramen
ant - tm joint
post - mastoid , petrous
results in multiple nerve palsy

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14
Q

how does a patient oresent in an opd with malignant otitis externa?

A

elderly patient with severe otalgia with granulation in the eac at the bone and cartilage junction.

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15
Q

investigations done in otomycosis?

A

CT bony distructionn
Gallium 67 - taken up by RE cells and monocytes
technitium99 bone scans

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16
Q

what does gallium 67 in otomycosis indicate?

A

indicates soft tissue infection and repeated to check prognosis

17
Q

what is Meiners disease ?

A

endolymphatic hydrops

distention of endolymphatic system

18
Q

structures affected in meniers disease

A

scala media (cochlea)
saccule
utricle

19
Q

where is endolymph produced and absorbed?

A

produced by scala vestibuli

absorbed by endolymphatic sac

20
Q

what happenes when the scala media distends in meniers disease?

A

the reissners membrane bulges and herniates

21
Q

what happens to saccule in meniers?

A

saccule bulges and lies in stapes footplate

saccule and utricle outpuch and move near semicircular canal

22
Q

what are the aiteological factors that lead to meniers?

A

increased sympathetic activity - anoxia of capillaries of the stria vascularis - inc permiability of endolymph- inc production.

increased production or decreased absorption of the endo lypmh

23
Q

age, sex of meniers disease?

A

30-60

males

24
Q

cardinal symptoms of meniers disease?

A

vertigo
fluctuating hearing loss
tinnitis
sense of fullness in ear

25
Q

describe the vertigo in meniers?

A 
TULLIOS PHENOMINON - Loud noises produce attack
#sudden in onset
#attacks in clusters
#spontanious remission for days months or years 
with -
nausea
vomiting
ataxia
nystagmus
26
Q

warning signs of vertigo in meniers?

A

no warning signs
sometimes change in character of tinnitis
change in ear fullness

27
Q

what is TUILLIOS PHENOMINON?

A

loud noise produce vertigo in meniers disease because enlarged saccule lies on the stapes footplate so vibrates more produce vertigo get it dumb dumb??

28
Q

where else is TUILLIOS phenominon seen ?

A

when there is three windows in the ear - when there is fenestration in the horizontal semi circular canal

29
Q

describe the character of hearing loss in meiners disease??

A 
# FLUCTUATING HEARING LOSS
# distortion of sound
#intolerance to loud sounds 
#preceeds or accompany vertigo
#improvement of hearing after the attack
#normal at remission
#after attack of vertigo hearing improves but the improvement scale decreases(
30
Q

what is diplacusis?

A

seen in meiners
one frequency normal in one ear
other earits in higher pitch

31
Q

what is the type of tinnitis heard?

A

low-pitch roaring, sometimes hissing
inc during acute attacks
persists through remission
change in character before attack as warning

32
Q

nystagmus in meniers

A

only during accute attacks
quick component
towards unaffected ear

33
Q

signs on clinical exam of meniers

A

nystagmus during accute attacks
nothing on otoscopy
tunning fork abnorms

34
Q

tunning fork abnormalities in meniers

A

SNHL
rinnies - positive
ABC - red in affected ear
webber - lat tobetter ear

ENT (1 decks)

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