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Ent > Middle Ear TM External Ear > Flashcards

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
Q

acute infection of TM with bloodstained discharge on rupture

A

Myringitis bullosa

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26
Q

Myringitis bullosa is caused by

A

S pneumoniae

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27
Q

Chronic myringitis occurs due to

A

Pseudomonas

Multiple granulation on tm

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28
Q

Retraction of TM occurs due to

A

Negative pressure in middle ear following eustachian tube obstruction

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29
Q

Which part gets retracted in acute conditions &chronic conditions

A

Pars tensa

Pars flaccida

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30
Q

Sade staging is for

A

Retraction of pars tensa

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31
Q

Sade stage 1

A

Pulling of handle of malleus
Cone of light becomes absent -dull TM
Sickling of malleolar folds
Prominence of lateral fold

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32
Q

Stage 3 sade

A

Collapse of middle ear space atelectasis

Tm touches promontory

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33
Q

Adhesive otitis media occurs in which stage

A

Sade stage 4

TM adherent to promontory

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34
Q

Acute otitis media is caused by

A

Streptococcus pneumoniae

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35
Q

First stage of aom

A

Pharyngitis leading to tubal blockade, me pressure negative and tm gets retracted

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36
Q

Second stage of AOM

A

Hyperemia of middle ear mucosa

Cartwheel, very red TM

37
Q

Rupture of TM leads to flow of pus from me to eac

This is known as

A

Pulsatile Otorrhea or lighthouse sign

38
Q

Mgt of impending rupture of tm when it is bulged in asom

A

Myringotomy

39
Q

Asom with ruptured membrane

How to manage

A

Give antibiotics and wait for 3 month to heal

If healing doesn’t occur -myringoplasty

40
Q

Incision given in myringotomy

Why incision not preferred in posterosuperior Quadrant?

A

J shaped curvilinear incision in postero inferior quadrant

Incudostapedial joint oval window present in posterosuperior quadrant

41
Q

Marginal perforation is seen in

A

Acute necrotizing otitis media

42
Q

ANOM is caused by

A

Beta hemolytic strep

43
Q

Chalky deposition in TM is known as

A

Tympanosclerosis

44
Q

Chalky deposition in TM is known as

A

Tympanosclerosis

45
Q

Pt with foul smelling ear discharge and multiple tm perforation painless with pale granulation
On audiometry 50-55 sB hearing loss
Diagnosis and treatment

A

TB ear

ATT

46
Q

B/L hypertrophy of adenoid leads to obstruction of eustachian tube. Pt complains of painless bilateral fluctuating hearing loss
Diagnosis

A

Serous otitis media -collection of fluid in middle ear

Mcc adenoid hypertrophy

47
Q

Why is SOM painless and fluctuating hearing loss condition

A

Because fluid in middle ear is under no pressure and seasonal change of adenoid leads to fluctuating hearing loss

48
Q

Unilateral painless hearing loss in adults suspect

A

Nasopharyngeal carcinoma

49
Q

Features of TM in SOM

A 
Dull 
Retracted TM 
Fluid level seen 
Air bubble present
Bluish TM
50
Q

Glue ear is seen in

It is due to

A

Glue ear is seen in Long standing cases of SOM

Due to precipitation of fluid inside TM

51
Q

Tuning fork test in SOM Will suggest

A

Rinne negative BC>AC
weber lateralised to affected ear
CHL

52
Q

Tympanometry and Stapedial Reflex in SOM

A

Type B tympanometry
ME pressure negative and compliance reduced
Stapedial reflex absent

53
Q

What is management of SOM

A

For 3 months medical mgt
Anti allergics
Decongestant
Steroid nasal spray no response

Surgical mgt

54
Q

What is grommet

What incision and in which area is preferred to place grommet on TM

A

Grommet is ventilation tube

Radial incision in anteroinferior quadrant is given to mimin ET

55
Q

Is there a special technique if som is glue ear ie thick fluid in middle ear which is difficult to remove by anteroinferior incision

A

Beer can technique
Another incision at anterosuperior quadrant is given
Air enters middle ear through superior incision and pushes fluid through lower opening

56
Q

During descent how to relieve decreased pressure in middle ear?

A

Opening of ET by actively chewing swallowing valsalva

57
Q

During descent what if eustachian tube is blockes and pressure diff is more than 90mm H2O

A

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
Q

CSOM is characterized by what condition of TM

A

Permanent abnormality of tympanic membrane

59
Q

Types of CSOM

A

Mucosal earlier k a safe CSOM

Squamosal unsafe CSOM

60
Q

How to define mucosal csom

A

Permanent central perforation of pars tensa more than 3months following asom, trauma

61
Q

Define squamosal CSOM

A

Any permanent abnormality on TM leading to migration ofsquamosal epithelium from eac into middle ear

62
Q

Why is mucosal csom aka tubotympanic csom

A

Infection from et leads to middle ear infection

63
Q

What is active and inactive csom

A

If discharging it is active

If non discharging it is inactive

64
Q

Causative organism of csom

A

Aerobic pseudomonas

Anaerobic Bacteroides

65
Q

Clinical features of CSOM mucosal

A

Ear discharge for more than 3months

Hearing loss 10-40 dB

66
Q

Types of myringoplasty

A

Underlay graft placed under 3 layers of TM

Overlay graft placed over fibrous layer of TM under malleus

67
Q

Most common ossicle to get necrosed in mucosal csom

A

Lenticular/Long process of incus

68
Q

Hearing loss upto 50dB in mucosal csom can be due to

How to treat

A

Ossicular necrosis disrupts ossicular pathway

Myringoplasty and ossciculoplasty ie TYMPANOPLASTY

69
Q

Wullstein classification of tympanoplasty

A 
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
Q

Myringostapediopexy or columella tympanoplasty is done by

A

Graft placed over stapes head

Type 3 tympanoplasty

71
Q

Which type of tympanoplasty not done anymore

A

Type 5 fenestration operation

Because can cause vertigo

72
Q

Classification of tympanoplasty based in presence of handle of malleus and stapes head

A

Austine kartush classification

73
Q

Kartush addition in austine kartush classification

A

Type E ossicular head fixation
and
Type F stapes fixation

74
Q

Type A to D of Austine Kartush classification

A

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
Q

How to treat when none of ossicle present after necrosis in mucosal csom

A

Total ossicular replacement prosthesis

TORP

76
Q

What is cholestaetoma

A

Presence of stratified squamous epithelium in middle ear

77
Q

What change in TM causes cholesteatoma

A

Marginal perforation where annulus is eroded
Causes migration of epithelium to middle ear
Keratin accumulation
Macrophage activation and transformation into osteoclast
Bone erosion

78
Q

Haberman theory is for

A

Secondary cholesteatoma

Following acute necrotizing o m migration of epithelium from marginal perforation

79
Q

What is primary cholesteatoma

A

Migration of squamous epithelium from EAC into middle ear without TM perforation

80
Q

What is active cholesteatoma

A

When any part of retraction pocket not seen

81
Q

Most common site of retraction of TM

A

Pars flaccida/
Prussak space/
Attic

82
Q

Levenson criteria for congenital cholesteatoma

A

Pars tensa and flaccida should be normal
No history of perforation
No history of surgery

83
Q

MC site of primary cholesteatoma

A

Seen in pars flaccida

84
Q

MC site of congenital cholesteatoma

A

Anterior part of ME

85
Q

MC site of secondary cholesteatoma

A

In posterosuperior part

86
Q

Surgical incision made in treatment of cholesteatoma

A

Post aural (Wildes incision)
Pinna retracted from self retaining mastoid retractor
It helps in achieving hemostasis

87
Q

Surgical landmark for drilling mastoid

A

Mac evans triangle

88
Q

Canal wall down procedure when reconstruction of posterior wall is done after removing disease part

A

Modified radical mastoidectomy

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