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ENT > Otitis Media > Flashcards

Otitis Media Flashcards

1
Q

What does otitis externa discharge look like?

A

Scanty discharge as there’re no mutinous glands
Blood can result from trauma to the canal
Liquid wax can sometimes leak out

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2
Q

What does middle ear disease discharge look like?

A

Mucous discharges are almost always middle ear disease
Serosanguinous discharge suggests a granular mucosa of chronic otitis media
An offensive discharge suggests cholestatoma

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3
Q

How can you test if nasal discharge is CSF?

A

Halo sign on filter paper
Raised glucose
B2 transferris is present

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4
Q

Describe the presentation of acute OM.

A

Rapid onset of pain, fever, irritability

Anorexia, vomiting often after viral URTI

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5
Q

What are common causative organisms of OM?

A

Pnumococcus
Haemorphilus
Moraxella

Also other streps/staphs

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6
Q

What causes pain in acute OM?

A

Bulging of the tympanic membrane causes pain which eases if the drum perforates

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7
Q

What is management in acute otitis media?

A

Optimise analgesia
Acute OM resolves in 60% without abx
Antibiotics if required (symptoms over 4 days)
Appropriate oral or topical antibiotics according to swab reutls
Clean EAC to remove infected material from meatus

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8
Q

When should antibiotics be prescribed immediately?

A 
Symptoms lasting more than 4 days
Systemically unwell
Immunocompromised
< 2 years old with bilateral OM
Perforation and/or discharge in the canal
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9
Q

What is antibiotic treatment for acute OM?

A

Amoxicillin for 5 days

erythromycin or clarithromycin if penicillin allergic

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10
Q

What are complications of acute OM?

A 
Mastoiditis
Petrositis
Labyrinthitis
Facial palsy
Meningitis
Intracrnail anscess
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11
Q

What is OME?

A

Occurs when an effusion is present after regression of the symptoms of OM.

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12
Q

What is chronic otitis media? Symptoms?
Benign?
Chronic serous OM?
Chronic suppurative OM?

A

Ear with a tympanic membrane perforation in the setting of recurrent or chronic infections.
- Hearing loss, otorrhoea, fullness, otalgia

Benign = dry tympanic membrane perforation without active infection

Chronic serous OM = continuous serous drainage - straw coloured

Chronic suppurative OM = persistent purulent drainage through a perforated tympanic membrane

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13
Q

What is management for chronic OM?

A

Topical/systemic antibiotics based on swab results
Aural cleaning
Water precautions
Careful follow-up
Surgery may be required - myringoplasy or mastoidectomy

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14
Q

What are complications of chronic OM?

A

Prolonged low middle ear pressure allows for development of retraction pocket of the pars tense or falcida.
As this enlarges, squamous epithelium builds up and can no longer escape from the neck of the sac, resulting in cholesteatoma

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15
Q

What is cholesteatoma? Main features?

A

Squamous epithelium that is trapped within the skull base causing local destruction.
10-20 years old
Note: not cholesterol nor a tumour - it is locally destructive around and beyond the pars flaccid

Foul smelling discharge
Hearing loss

Headache
Pain
Facial pralysis
Vertigo

Attic crust seen in uppermost part of eardrum

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16
Q

What is management of cholesteatoma?

A

Mastoid surgery is needed to make a safe dry ear by removing disease

17
Q

What is mastoiditis? Features?

A

Middle ear inflammation leads to destruction of air cells in mastoid bone ± abscess formation.

Otalgia: severe, behind ear
History of recurrent otitis media
Fever
Swelling, erythema, tenderness, over mastoid process
External ear may protrude forward
18
Q

What is management of mastoiditis?

A

CT

Admit for IV ab
Myringotomy ± definitive mastoidectomy

19
Q

What are risk factors for otitis media?

A 
URTI - autumn/winter
Bottle feeding
Passive smoking
Dummy
Presence of adenoids
Asthma
Malformations
GORD
20
Q

What is myringoplasty?

A

Repair of the tympanic membrane alone
Perforation in TM is patched using a graft
Acts as a scaffold for the tympanic membrane to grow across

21
Q

What is mastoidectomy?

A

For its with mastoiditis or advanced cholesteatoma
Mastoid surgery and tympanoplasty - surgical repair of tympanic membrane and ossicles - is used to eradicate the source of chronic infection, excise the cholesteatoma and reconstruct the hearing mechanism.Removal or mastoid air cells.

22
Q

What are causes of perforated tympanic membrane?

A

Infection
Barotrauma
Direct trauma

23
Q

What is management for perforated tympanic membrane?

A

No treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks.
It is advisable to avoid getting water in the ear during this time.

It is common practice to prescribe antibiotics to perforations which occur following an episode of acute otitis media.

Myringoplasty may be performed if the tympanic membrane does not heal by itself

ENT (22 decks)

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