middle ear Flashcards
learn about the conditions of middle er
otomycosis
external ear fungal infection
common organisms causing otomycosis?
aspergillous fumigatous
aspergillous niger
candida albicans
what is the presenting complains in otomycosis?
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
signs on examinaton of otomycosis?
niger ~black deposit
Fumigatous~ light blue
Candida~ white creamy
treatment of otomycosis (clinical care)
ear toilet - removesdischarge and debri
syringing
suction
mopping
medical treatment of otomycosis
Nystatin 100000 units/ml ~ candida
clotrimozole, pavidoiodine (broad spec) for others
keratolytic agents to remove debri - 2% salsylic acid
how long do u give med treatment for otomycosis?
for a week even after apparent cure
should always be dry
what does salcylic acid do?
remove superficial layer of epithelium with fungal mycelium
what is malignant otitis externa?
inflammation
due to pseudomonas
common in dm
prediaposing condition for malignant otitis externa
diabetes mellitus elderly and
immunosuppresive therapy
what does the feature resemble malignant otitis externa
diffuse otitis externa
features specific to otitis externa
excruciating pain
granulation in ear canal
facial paralysis
spread of otitis externa? and what does it result in?
to base of skull , jugular foramen
ant - tm joint
post - mastoid , petrous
results in multiple nerve palsy
how does a patient oresent in an opd with malignant otitis externa?
elderly patient with severe otalgia with granulation in the eac at the bone and cartilage junction.
investigations done in otomycosis?
CT bony distructionn
Gallium 67 - taken up by RE cells and monocytes
technitium99 bone scans
what does gallium 67 in otomycosis indicate?
indicates soft tissue infection and repeated to check prognosis
what is Meiners disease ?
endolymphatic hydrops
distention of endolymphatic system
structures affected in meniers disease
scala media (cochlea)
saccule
utricle
where is endolymph produced and absorbed?
produced by scala vestibuli
absorbed by endolymphatic sac
what happenes when the scala media distends in meniers disease?
the reissners membrane bulges and herniates
what happens to saccule in meniers?
saccule bulges and lies in stapes footplate
saccule and utricle outpuch and move near semicircular canal
what are the aiteological factors that lead to meniers?
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
age, sex of meniers disease?
30-60
males
cardinal symptoms of meniers disease?
vertigo
fluctuating hearing loss
tinnitis
sense of fullness in ear
describe the vertigo in meniers?
TULLIOS PHENOMINON - Loud noises produce attack #sudden in onset #attacks in clusters #spontanious remission for days months or years with - nausea vomiting ataxia nystagmus
warning signs of vertigo in meniers?
no warning signs
sometimes change in character of tinnitis
change in ear fullness
what is TUILLIOS PHENOMINON?
loud noise produce vertigo in meniers disease because enlarged saccule lies on the stapes footplate so vibrates more produce vertigo get it dumb dumb??
where else is TUILLIOS phenominon seen ?
when there is three windows in the ear - when there is fenestration in the horizontal semi circular canal
describe the character of hearing loss in meiners disease??
# 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(
what is diplacusis?
seen in meiners
one frequency normal in one ear
other earits in higher pitch
what is the type of tinnitis heard?
low-pitch roaring, sometimes hissing
inc during acute attacks
persists through remission
change in character before attack as warning
nystagmus in meniers
only during accute attacks
quick component
towards unaffected ear
signs on clinical exam of meniers
nystagmus during accute attacks
nothing on otoscopy
tunning fork abnorms
tunning fork abnormalities in meniers
SNHL
rinnies - positive
ABC - red in affected ear
webber - lat tobetter ear
