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ENT > Otalgia > Flashcards

Otalgia Flashcards

1
Q

What are the causes of otalgia?

A 
Otitis externa/media
Furunculosis
Malignant/necrotising otitis externa
Barotrauma
TMJ dysfunction
Referred pain
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2
Q

What are the causes of otitis externa?

A 
Excess canal moisture (most common)
Trauma
High humidity
Absence of wax (from self-cleaning)
Narrow ear canal
Hearing aids
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3
Q

What are the most common organisms causing otitis externa?

A

Pseudomonas (main organism)

Staph aureus

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4
Q

What is the main differential for otitis externa?

A

Contact dermatitis

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5
Q

What are some of the symptoms of otitis externa?

A

Discharge
Itch
Pain
Tragal tenderness

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6
Q

What are the symptoms and signs of mild otitis externa?

A

Scaly skin
Some erythema
Normal diameter of external auditory canal

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7
Q

What is the treatment for mild otitis externa?

A

Clean the external auditory canal
Keep ears water-free
Hydrocortisone cream to pinna/acetic acid spray

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8
Q

What is the function of acetic acid spray?

A

Has antibacterial and antifungal properties

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9
Q

What are the signs/symptoms of moderate otitis externa?

A

Painful ear
Narrowed ear canal
Smelly creamy discharge

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10
Q

What is the treatment for moderate otitis externa?

A

Swab for microscopy
Clean the canal
Topical antibiotics +/- steroid drops for up to 7 days

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11
Q

Which topical antibiotics are contraindicated in patients with a perforated TM/grommets and why?

A

Aminoglycosides

Ototoxicity

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12
Q

Why should ear drops not be used for more than 7 days? How is this treated?

A

Troublesome fungal infections

Treated with clotrimazole

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13
Q

What is the treatment for pinna cellulitis?

A

Immediate antibiotics and refer

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14
Q

What are the signs/symptoms of severe otitis externa?

A

Complete occlusion of the external auditory canal

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15
Q

What is the treatment for severe external otitis externa?

A

Insertion of an ear wick (may require ENT referral)

After a few days the ear canal should open up enough for ear cleaning

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16
Q

What should you be wary of when treating otitis externa?

A

Persistent unilateral otitis externa in diabetics/immunosuppressed/elderly - at increased risk of malignant/necrotising otitis externa
Resistant to treatment - can be a sign of malignancy like SCC - do a biopsy

17
Q

What is furnuculosis?

A

Very painful staphylococcal abscess arising in a hair follicle within the ear canal

18
Q

What is the treatment for furunculosis?

A

Consider lancing

if there is pinna cellulitis start antibiotics (e.g. flucloxacillin)

19
Q

What is a predisposing factor to furunculosis?

A

Diabetes

20
Q

What is malignant/necrotising otitis externa?

A

An aggressive life-threatening infection of the external ear that can lead to temporal bone destruction and base-of-skull osteomyelitis

21
Q

What is the biggest risk factor for malignant otitis externa?

A

90% of patients with this have diabetes

22
Q

What are the most common organisms causing malignant otitis externa?

A 
Pseudomonas aerginosa
(Though Proteus and Klebsiella can also cause this)
23
Q

What is the treatment for for malignant otitis externa?

A

Surgical debridement
Systemic antibiotics
Specific immunoglobulins

24
Q

What is barotrauma?

A

The pressure in the middle ear is not equalised due to occlusion of the Eustachian tube causing damage

25
Q

In what situations is barotrauma most likely to occur?

A

Descent in an aircraft

Diving

26
Q

What are the symptoms of barotrauma?

A

Initially severe pain as the drum becomes indrawn

Secondary effusion may occur as transudate/haemotympanum

27
Q

How can barotrauma be prevented?

A

Not flying with an URTI
Decongestants into nose
Repeated yawns/swallows/jaw movements

28
Q

What is the treatment for barotrauma?

A

Supportive if simple
Effusions usually clear spontaneoulsy
Most perforations heal

29
Q

What causes TMJ dysfunction?

A

Teeth grinding
Joint derangement
Stress (may become a chronic pain syndrome)

30
Q

What are the symptoms of TMJ dysfunction?

A

Earache
Facial pain
Joint clicking/popping

31
Q

What are the signs of TMJ dysfunction?

A

Joint tenderness exacerbated by lateral movements of the open jaw
Trigger points in the pterygoids

32
Q

What is the treatment for TMJ dysfunction?

A

Most self-resolve
Reassure and explain
Simple analgesia

33
Q

What is the specialist treatment for TMJ dysfunction?

A

Dental occlusion therapy
Physiotherapy
CBT
Surgery (rarely needed)

34
Q

What is the function of cleaning the external auditory canal when treating otitis externa?

A

Facilitates the application and effectiveness of topical treatments

35
Q

What are the options for cleaning the ear canal?

A

Gentle syringing/irrigation
Dry mopping
Microsuction

36
Q

Referred pain to the ear can arise from disease processes in the areas of the sensory nerves supplying the ear. Describe the different nerves that can be affected and how.

A

CN V (auriculotemporal nerve branch) - dental disease & TMJ dysfunction
CN VII (geniculate ganglion) - geniculate herpes (Ramsay Hunt Syndrome)
CN IX - glossopharyngeal neuralgia (rare cause of otalgia) - from talking/swallowing
CN IX & X - tympanic branch of glossopharyngeal and auricular branch of vagus - tongue, larynx, throat - cancer, tonsillitis, tonsillectomy, quinsy
C2, C3 - great auricular nerve - soft tissue injury in neck, cervical spondylosis/arthritis

ENT (2 decks)

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