middle ear

Question 1

otomycosis

Answer 1

external ear fungal infection

Question 2

common organisms causing otomycosis?

Answer 2

aspergillous fumigatous
aspergillous niger
candida albicans

Question 3

what is the presenting complains in otomycosis?

Answer 3

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

Question 4

signs on examinaton of otomycosis?

Answer 4

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

Question 5

treatment of otomycosis (clinical care)

Answer 5

ear toilet - removesdischarge and debri
syringing
suction
mopping

Question 6

medical treatment of otomycosis

Answer 6

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

Question 7

how long do u give med treatment for otomycosis?

Answer 7

for a week even after apparent cure

should always be dry

Question 8

what does salcylic acid do?

Answer 8

remove superficial layer of epithelium with fungal mycelium

Question 9

what is malignant otitis externa?

Answer 9

inflammation
due to pseudomonas
common in dm

Question 10

prediaposing condition for malignant otitis externa

Answer 10

diabetes mellitus elderly and

immunosuppresive therapy

Question 11

what does the feature resemble malignant otitis externa

Answer 11

diffuse otitis externa

Question 12

features specific to otitis externa

Answer 12

excruciating pain
granulation in ear canal
facial paralysis

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

investigations done in otomycosis?

Answer 15

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

Question 16

what does gallium 67 in otomycosis indicate?

Answer 16

indicates soft tissue infection and repeated to check prognosis

Question 17

what is Meiners disease ?

Answer 17

endolymphatic hydrops

distention of endolymphatic system

Question 18

structures affected in meniers disease

Answer 18

scala media (cochlea)
saccule
utricle

Question 19

where is endolymph produced and absorbed?

Answer 19

produced by scala vestibuli

absorbed by endolymphatic sac

Question 20

what happenes when the scala media distends in meniers disease?

Answer 20

the reissners membrane bulges and herniates

Question 21

what happens to saccule in meniers?

Answer 21

saccule bulges and lies in stapes footplate

saccule and utricle outpuch and move near semicircular canal

Question 22

what are the aiteological factors that lead to meniers?

Answer 22

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

Question 23

age, sex of meniers disease?

Answer 23

30-60

males

Question 24

cardinal symptoms of meniers disease?

Answer 24

vertigo
fluctuating hearing loss
tinnitis
sense of fullness in ear

Question 25

describe the vertigo in meniers?

Answer 25

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

Question 26

warning signs of vertigo in meniers?

Answer 26

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

Question 27

what is TUILLIOS PHENOMINON?

Answer 27

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

Question 28

where else is TUILLIOS phenominon seen ?

Answer 28

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

Question 29

describe the character of hearing loss in meiners disease??

Answer 29

``` # 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( ```

Question 30

what is diplacusis?

Answer 30

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

Question 31

what is the type of tinnitis heard?

Answer 31

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

Question 32

nystagmus in meniers

Answer 32

only during accute attacks quick component towards unaffected ear

Question 33

signs on clinical exam of meniers

Answer 33

nystagmus during accute attacks nothing on otoscopy tunning fork abnorms

Question 34

tunning fork abnormalities in meniers

Answer 34

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