Otology Flashcards
Hearing loss differentials-
Impacted ear wax Cholesteatoma Malignancy Presbycusis Congenital hearing loss Foreign body AOM OE
Red flags of ear
Acute sensorineural hearing loss
Acute discharge
Redness/swelling of mastoid
Otitis externa
Inflammation of the external canal commonly due to infection (staph.a) but also non infectious (dermatitis)
Localised to a hair follicle or diffuse.
Malignant otitis externa (benign) but can be fatal as can erode into the bone.
Treat with:
Ear drops- ciprofloxacin.
If not settling then oral flucloxacillin, or macrolide if allergy for 5-7days.
Give appropriate analgesia
Noise related hearing loss
Sensorineural hearing loss
Associated with TINNITUS
No cure just reduce loud noise exposure.
Ménière’s disease characteristic symptoms-
Vertigo (20 mins to 12hrs, need at least 2 sporadic episodes)
Fullness of the ear
Tinnitus
Sensorineural hearing loss (fluctuating)
Ménière’s disease management-
ENT referral for confirmation of diagnosis.
Self care, reassurance of vertigo resolving, low salt diet.
Treat vertigo with prochlorperazine buccal/IM 1-2wks.
Reduce attack severity and frequency with betahistine and vestibular exercises. If non resolving then ENT referral.
Vertigo will resolve whilst other symptoms persist.
Presbycusis
Progressive bilateral sensorineural hearing loss.
No cure, manage with hearing aids, reassurance
Acute otitis media
Complications include hearing loss and recurrent infection.
More serious but rare include mastoiditis, meningitis and facial nerve paralysis.
Preceded by viral URTI or has a bacterial cause; h.influenza, strep.pneumonia
Management includes
Pain and fever relief
5-7 days amoxicillin if severe systemic effects or at high risk of complications
Not responding to Abx, consider tympanocentesis.
Should avoid passive/active smoking to avoid reinfection.
Chronic suppurative otitis media with wet perforation
Complication of AOM
Can lead to extra cranial facial paralysis, mastoiditis or intracranial cerebral abscess, meningitis.
Symptoms include ottorrhoea w/o pain/fever, possible hearing loss.
Manage by not taking a swab, not treating in primary care, refer to secondary care for Abx treatment.
Dry tympanic perforation
Caused commonly by infection.
Symptoms include otalgia with perforation, otorrhoea and potential hearing loss.
Should resolve within 2 months.
Avoid water in the war and if prior to AOM then prescribe Abx.
If non resolving then potential myringoplasty.
Congenital hearing loss
Genetics, Down’s syndrome, Treacher Colins syndrome, trauma during birth, mother infected by syphilis, rubella.
Investigate with: HRCT Genetic testing Audiometry Neonatal hearing screen
Mastoiditis-
Very dangerous can lead to intracranial infection.
Key features include; mastoid tenderness/red/inflamed, bulging/perforated TM, fever, cervical lymphadenopathy at affected side.
Common organism in unnvaccinated children- H.I, vaccinated- Strep.pyogenes/pneumoniae, adults- strep.pn, staph.a.
Complications include conductive or sensorineural HL, facial nerve damage, vertigo, meningitis.
Mastoiditis-
Investigations
Management
Investigate bloods, renal, contrast CT, blood cultrues.
IV Abx ceftriaxone.
If penicillin allergic then IV vancomycin.
If progressing then drain surgically by myringotomy+grommet or mastoidectomy.
Cholesteatoma-
Foul smelling, persistent discharge with hearing loss. Local invasion can cause facial nerve damage, vertigo, altered taste.
Complication- Erode nearby bone.
Semi urgent ENT referral.
Will investigate with a CT.
Needs to be surgically excised.
Referred ear pain-
Perform otoscopy and cranial nerve examinations.
Otalgia w/o ear pathology- need to rule out H+N malignancy.
Trigeminal nerve
- Dental issues - TMJ disorders - Neuralgia
Facial nerve
- Bells palsy
Glossopharyngeal nerve
- Pharyngitis/ tonsillitis - Tumours
Vagus nerve
- Myocardial ischaemia
C2, C3
- Cervical spine arthritis-
