Otalgia Flashcards
What is otalgia
Ear pain
What does chronic otitis media include (3)
Otitis media with effusion, cholesteatoma, perforation
What is otitis externa
Inflammation of the outer ear canal
Name 3 bacterial causes for otitis externa
Staph aureus
Proteus spp
Pseudomonas
Name 2 fungal causes of otitis externa
Aspergillus Niger
Candida albicans
Name some common triggers for otitis externa
Water exposure, cotton buds, skin conditions
Clinical presentation of otitis media
Redness and swelling of ear canal
Discharge, increased amounts of wax
Buildup can lead to hearing being affected
How do we manage otitis externa
TOPICAL
ear drops
What is acute otitis media
Inflammation of the middle ear
Who usually gets acute otitis media
Infants and children
What is acute otitis media commonly associated with
URTIs
Most common bacteria associated with acute otitis media
Strep pneumo
H influenzae
Moraxella catarrhalis
Strep pyogenes
How does infection extend in acute otitis media
From the throat to the ear via the Eustachian tube
Symptoms of acute otitis media
Ear pain, fever, irritability, possibly hearing loss
Clinical signs of acute otitis media
Inflammation
Middle ear effusion
Opaque tympanic membrane - bulging may be present
Mobility of tympanic membrane impaired
When can you investigate acute otitis media
When the eardrum perforates you can take a swab
Management of acute otitis media
80% resolve in 4 days
Amoxicillin or erythromycin if needed
Complications of acute otitis media
Subperiosteal abscess
Sensorineural hearing loss
Vertigo
Facial palsy
Brain abscess / meningitis
Venus sinus thrombosis
What is malignant otitis externa
Invasive infection of the bone surrounding the ear canal
What bones may be affected in malignant otitis externa
Mastoid, temporal
Most common cause of malignant otitis externa
Pseudomonas
Risk factors for malignant otitis externa
Diabetes, radiotherapy to the head and neck
What usually precedes malignant otitis externa
Otitis externa
Symptoms of malignant otitis externa
Pain and headache that is more severe than clinical signs would suggest
Clinical signs of malignant otitis externa
Granulation tissue at bone-cartilage junction of ear canal
Exposed bone
Facial nerve palsy
Investigations for malignant otitis externa
Plasma viscosity, CRP
radiological imaging
Biopsy and culture
Complication of untreated malignant otitis externa
Osteomyelitis progressively involves the skull and meninges
DEATH
Management of malignant otitis externa
Cleaning and debridement, topical antibiotics of the ear canal
Long term systemic antibiotics
Surgery if necessary
Name the 6 Ts of referred pain in the ear
Teeth, tonsils, throat, tongue, tumour, trauma
What is acute mastoiditis
Infection of the mastoid air cells
What is acute mastoiditis a complication of
Acute otitis media
Name 2 common causes of acute mastoiditis
Strep pneumo, h. Influenzae
Clinical presentation of acute mastoiditis
Pain, tenderness and swelling behind the ear
Investigation of acute mastoiditis
CT, MRI
Management of acute mastoiditis
IV antibiotics
Some require surgical drainage
Complication of acute mastoiditis
Mastoid process can get infected, spread to the middle cranial fossa and into the brain causing meningitis
What causes referred pain from the auriclo-temporal branch of the mandibular nerve (CN V3) to the ear
Lower mandibular pathology: dental
TMJ lesions
Inflammation on the anterior 2/3 of the tongue
Tooth grinding
Salivary gland disease
What causes referred pain from the sensory branch of the facial nerve to the ear
Geniculate herpes + Ramsay hunt syndrome are related to palsy
Sphenoid or ethmoid sinus pathology
Nasal pathology
What causes referred pain from the tympanic branch of the Glossopharyngeal nerve to the ear
Tonsillitis or Quincy
Post-tonsillectomy
Carcinoma of the posterior 1/3 of the tongue or tonsils
Neuralgia of the nerve
What causes referred pain from the auricular branch of the vagus nerve to the ear
Foreign body in piriform fossa
Carcinoma of the piriform fossa, larynx
Piriform abscess
Post-cricoid carcinoma
Where does the greater occipital nerve arise from
Dorsal rami of C2 and C3
Where does the lesser occipital nerve originate from
Ventral ramus of C2
Where does the greater auricular nerve arise from
Ventral rami of C2 and C3
What causes referred pain from the greater auricular nerve to the ear
Cervical neuritis
What causes referred pain from the lesser occipital nerve to the ear
Cervical spondylosis
Cervical neuritis
Herpes zoster
