Otitis Media Flashcards
Describe some congenital disorders of the auricle of the ear,
- Auricle arises from six Hillocks of His (1/2 branchial arch)
- Anotia- total absence
- Microtia –deformity
- canal atresia
- Ossicular chain anomalies • CHL/SNHL
- FN atypia
- Pre auricular sinus
- Collaural sinuses/fistula
Describe the structure of the External auditory canal.
Cartilagenous 1/3
• Thick skin
• Cerumen producing • Hair bearing
Bony 2/3
• Thin skin
• Non cerumen producing
• Non hair bearing
Management of Otitis Externa
- Bacterial\fungal
- Water precautions
- Aural toilet
- Topical drops
Describe the structure of the middle ear
- Picture the middle ear as a box
- Tegmen roof
- Floor is jugular bulb
- Anterior is Eustachian tube
- Posterior is mastoid/aditus ad antrum
What is the function of the Cochlea
- Organ of hearing • 2.5 turns
- Pitch
- Inner and Outer Hair cells
Three differentials for discharging ears
• Acute otitis media
• Chronic otitis media (persistent hole in tympanic membrane)
often painless
• Cholesteatoma often painless
How does acute otitis media present?
- Acute infection behind TM
- Follows URTI
- Usually children
What is the treatment for acute otitis media?
Conservative - Abx drops, monitor speech and language dev, otoventballoon
Hearing aid
Gromits
Complications of acute otitis media?
Complications can be serious; intracranial vs extracranial
Acute suppuration with infection spreading into the mastoid cavity leading to mastoiditis
Mastoiditis and AOM can lead to intracranial infection and death
Complications of middle war disease
mastoiditis
• Facial Nerve dysfunction
• The facial nerve runs through the middle ear and is vulnerable to damage from middle ear disease.
Tympanic Perforation
What is Cholesteatoma? What are the symptoms?
- Skin in the wrong place
- Failure of normal skin migratory pathways • Indolent tumour
- Erodes surrounding structures over time
- Hallmarks:
- Recurrent painless smelly discharge
- Hearing loss
Causes of Cholesteatoma
- Congenital
- Acquired
- Perforation, esp attic region
- Retraction pockets
- Crusts in this region can hide a cholesteatoma
- This may be the tip of the iceberg!
Cholesteatoma treatment
Surgery
Mastoidectomy
• Canal wall up vs canal wall down
Aims of surgery: 1 Safe ear
2 Dry ear
3 Hearing ear
Causes of Childhood deafness
- Glue ear
- Infections (transient)
- Congenital 1-2/1000 population • Syndromic
- Non syndromic
- Screening programme (NHSP)
Pathophysiology of Otitis Media with Effusion OME (Glue Ear)
Thick effusions accumulate behind ear drum
Secondary to prolonged negative pressure, eus
Resulting in Conductive Hearing Losstacian tube dysfunction and genetic predisposition
