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Middle Ear TM External Ear Flashcards

AOM csom ASOM TM and external ear ds

1
Q

Boxer’s ear occurs due to

Immediate treatment

A

Hematoma of pinna

I&D

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2
Q

Perichondritis is caused by

It can be treated by

A

Infection by pseudomonas
T/T
Ciprofloxacin
Caftazidime

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3
Q

On pressing tragus pt complain of pain
Pain also increase on jaw and pinna movement
Diagnosis can be

A

Furuncle

Localised otitis externa

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4
Q

Edematous eac
Painful movement of jaw and pinna
Infection by pseudomonas
Diag

A

Diffuse otitis externa

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5
Q

Diffuse otitis externa is aka

A

Swimmer’s ear /tropical ear

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6
Q

Examination finding of malignant otitis externa

A

Granulation
Necrosis
7, 9,10,11 nerve involved

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7
Q

Malignant otitis externa Infection occurs in individual which are-

A

Diabetes
Steroids
Immunosuppressive drugs

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8
Q

Earliest nerve to be involved in malignant otitis externa

A

Facial nerve

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9
Q

Skull base osteomyelitis occurs following -

A

Malignant otitis externa spreads through fissures of santorini causes osteomyelitis of skull bone

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10
Q

Investigation for early diagnosis of malignant otitis externa

A

Bone scan

Technetium 99m scan increased uptake due to osteoclastic activity

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11
Q

Test for checking resolution of malignant otitis externa following treatment

A

Gallium)/indium scan (taken up by inflammatory cells)

ESR

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12
Q

Wet newspaper appearance along with pain itching is seen in

A

Otomycosis- aspergillus niger

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13
Q

Herpes zoster infection in ear leads to vesicles formation in the distribution of nerve
Which nerve is inv mc

A

Auriculotemporal nerve

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14
Q

Herpes zoster infection association with facial nerve palsy

A

Ramsay hunt syndrome

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15
Q

Freys syndrome occurs due to

A

Aberrant innervation of secretomotor fibres with auriculotemporal nerve due to injury to auriculotemporal nerve following parotidectomy

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16
Q

Syringing should be done with following instructions

A

Water at body temp
Posterosuperior direction
At moderate pressure

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17
Q

What will happen if water is not at body temp during syringing

A

Vertigo

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18
Q

What will happen if water is injected at high pressure

A

Perforation of TM

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19
Q

If foreign body is lodged - how to remove a
Battery
Live insects
Vegetative fb

A

Battery never put water inside ear
Live insects kill with oil and then syringe
Vegetative fb remove by ear hook as it can swell by syringing

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20
Q

Abnormal epithelial migration leading to collection of keratin in eac

A

Kerstosis obturans

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21
Q

A young pt with b/l chl widening of eac thereby facial nerve palsy

A

Keratosis obturans

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22
Q

TM is made of how many layers

A

3 layers
Epithelial
Fibrous
Endothelial

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23
Q

A pt suffering from traumatic injury which leads to tm perforation what will be the mgt

A

Keep ear dry
Keep ear free fron infection
TM heals by itself in 3 months
If not myringoplasty has to be done

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24
Q

Can TM heal completely following traumatic perforation

A

Only 2 layers heal

Fibrous layer will not heal

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25
acute infection of TM with bloodstained discharge on rupture
Myringitis bullosa
26
Myringitis bullosa is caused by
S pneumoniae
27
Chronic myringitis occurs due to
Pseudomonas | Multiple granulation on tm
28
Retraction of TM occurs due to
Negative pressure in middle ear following eustachian tube obstruction
29
Which part gets retracted in acute conditions &chronic conditions
Pars tensa | Pars flaccida
30
Sade staging is for
Retraction of pars tensa
31
Sade stage 1
Pulling of handle of malleus Cone of light becomes absent -dull TM Sickling of malleolar folds Prominence of lateral fold
32
Stage 3 sade
Collapse of middle ear space atelectasis | Tm touches promontory
33
Adhesive otitis media occurs in which stage
Sade stage 4 | TM adherent to promontory
34
Acute otitis media is caused by
Streptococcus pneumoniae
35
First stage of aom
Pharyngitis leading to tubal blockade, me pressure negative and tm gets retracted
36
Second stage of AOM
Hyperemia of middle ear mucosa | Cartwheel, very red TM
37
Rupture of TM leads to flow of pus from me to eac | This is known as
Pulsatile Otorrhea or lighthouse sign
38
Mgt of impending rupture of tm when it is bulged in asom
Myringotomy
39
Asom with ruptured membrane | How to manage
Give antibiotics and wait for 3 month to heal | If healing doesn't occur -myringoplasty
40
Incision given in myringotomy | Why incision not preferred in posterosuperior Quadrant?
J shaped curvilinear incision in postero inferior quadrant | Incudostapedial joint oval window present in posterosuperior quadrant
41
Marginal perforation is seen in
Acute necrotizing otitis media
42
ANOM is caused by
Beta hemolytic strep
43
Chalky deposition in TM is known as
Tympanosclerosis
44
Chalky deposition in TM is known as
Tympanosclerosis
45
Pt with foul smelling ear discharge and multiple tm perforation painless with pale granulation On audiometry 50-55 sB hearing loss Diagnosis and treatment
TB ear | ATT
46
B/L hypertrophy of adenoid leads to obstruction of eustachian tube. Pt complains of painless bilateral fluctuating hearing loss Diagnosis
Serous otitis media -collection of fluid in middle ear | Mcc adenoid hypertrophy
47
Why is SOM painless and fluctuating hearing loss condition
Because fluid in middle ear is under no pressure and seasonal change of adenoid leads to fluctuating hearing loss
48
Unilateral painless hearing loss in adults suspect
Nasopharyngeal carcinoma
49
Features of TM in SOM
``` Dull Retracted TM Fluid level seen Air bubble present Bluish TM ```
50
Glue ear is seen in | It is due to
Glue ear is seen in Long standing cases of SOM | Due to precipitation of fluid inside TM
51
Tuning fork test in SOM Will suggest
Rinne negative BC>AC weber lateralised to affected ear CHL
52
Tympanometry and Stapedial Reflex in SOM
Type B tympanometry ME pressure negative and compliance reduced Stapedial reflex absent
53
What is management of SOM
For 3 months medical mgt Anti allergics Decongestant Steroid nasal spray no response Surgical mgt
54
What is grommet | What incision and in which area is preferred to place grommet on TM
Grommet is ventilation tube | Radial incision in anteroinferior quadrant is given to mimin ET
55
Is there a special technique if som is glue ear ie thick fluid in middle ear which is difficult to remove by anteroinferior incision
Beer can technique Another incision at anterosuperior quadrant is given Air enters middle ear through superior incision and pushes fluid through lower opening
56
During descent how to relieve decreased pressure in middle ear?
Opening of ET by actively chewing swallowing valsalva
57
During descent what if eustachian tube is blockes and pressure diff is more than 90mm H2O
Increase ict leads to increase pressure in inner ear and ruptured secondary TM In blood vessels pressure increase exudation of fluid in middle ear pain and TM ruptured hemotympanum
58
CSOM is characterized by what condition of TM
Permanent abnormality of tympanic membrane
59
Types of CSOM
Mucosal earlier k a safe CSOM | Squamosal unsafe CSOM
60
How to define mucosal csom
Permanent central perforation of pars tensa more than 3months following asom, trauma
61
Define squamosal CSOM
Any permanent abnormality on TM leading to migration ofsquamosal epithelium from eac into middle ear
62
Why is mucosal csom aka tubotympanic csom
Infection from et leads to middle ear infection
63
What is active and inactive csom
If discharging it is active | If non discharging it is inactive
64
Causative organism of csom
Aerobic pseudomonas | Anaerobic Bacteroides
65
Clinical features of CSOM mucosal
Ear discharge for more than 3months | Hearing loss 10-40 dB
66
Types of myringoplasty
Underlay graft placed under 3 layers of TM | Overlay graft placed over fibrous layer of TM under malleus
67
Most common ossicle to get necrosed in mucosal csom
Lenticular/Long process of incus
68
Hearing loss upto 50dB in mucosal csom can be due to | How to treat
Ossicular necrosis disrupts ossicular pathway Myringoplasty and ossciculoplasty ie TYMPANOPLASTY
69
Wullstein classification of tympanoplasty
``` Type 1 to 5 1 graft over malleus 2 graft over incus 3 graft over stapes head 4 oval window left open rest middle ear covered by graft 5 fenestration operation in otosclerosis ```
70
Myringostapediopexy or columella tympanoplasty is done by
Graft placed over stapes head | Type 3 tympanoplasty
71
Which type of tympanoplasty not done anymore
Type 5 fenestration operation | Because can cause vertigo
72
Classification of tympanoplasty based in presence of handle of malleus and stapes head
Austine kartush classification
73
Kartush addition in austine kartush classification
Type E ossicular head fixation and Type F stapes fixation
74
Type A to D of Austine Kartush classification
A only incus is absent M+S+ B incus and stapes absent M+S- C incus and malleus absentM-S+ D none ossicle presentM-S-
75
How to treat when none of ossicle present after necrosis in mucosal csom
Total ossicular replacement prosthesis | TORP
76
What is cholestaetoma
Presence of stratified squamous epithelium in middle ear
77
What change in TM causes cholesteatoma
Marginal perforation where annulus is eroded Causes migration of epithelium to middle ear Keratin accumulation Macrophage activation and transformation into osteoclast Bone erosion
78
Haberman theory is for
Secondary cholesteatoma | Following acute necrotizing o m migration of epithelium from marginal perforation
79
What is primary cholesteatoma
Migration of squamous epithelium from EAC into middle ear without TM perforation
80
What is active cholesteatoma
When any part of retraction pocket not seen
81
Most common site of retraction of TM
Pars flaccida/ Prussak space/ Attic
82
Levenson criteria for congenital cholesteatoma
Pars tensa and flaccida should be normal No history of perforation No history of surgery
83
MC site of primary cholesteatoma
Seen in pars flaccida
84
MC site of congenital cholesteatoma
Anterior part of ME
85
MC site of secondary cholesteatoma
In posterosuperior part
86
Surgical incision made in treatment of cholesteatoma
Post aural (Wildes incision) Pinna retracted from self retaining mastoid retractor It helps in achieving hemostasis
87
Surgical landmark for drilling mastoid
Mac evans triangle
88
Canal wall down procedure when reconstruction of posterior wall is done after removing disease part
Modified radical mastoidectomy

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