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-
Otitis media with effusion-
GLUE EAR
Presents with hearing loss and recurrent ear infections.
Retracted TM with altered colour- yellow/blue/amber, opaque.
Resolves spontaneously within 12 wks.
May need grommets.
Other medications i.e. Abx, antihistamines not recommended.
Acute sinusitis-
<12 weeks but usually 10 days.
Nasal obstruction/nasal discharge, with facial pain worse on leaning forward. If bacterial also get temp and discoloured nasal discharge.
RF- Nasal obstruction (septal deviation/polyps), swmming, diving, infections (strep, H.I, Rhinovirus).
Investigate with anterior rhinoscopy.
Acute sinusitis management-
Intranasal decongestants
Intranasal corticosteroids
If >10 days and non resolving then give phenoxymethylpenicillin. If systemic effects then co-amoxiclav.
Refer if >3 episodes needing Abx in 1 year, persisting after treatment, atypical bacteria, immunocomp, suspected allergy.
Chronic sinusitis-
> 12 weeks
Nasal discharge/obstruction with facial pain.
Red flags- unilateral symptoms, epitaxis or >3 months and not resolved with treatment compliance.
Investigate with anterior rhinoscopy.
Chronic sinusitis management-
Red flags need referring + suspect allergy, child with recurrent pneumonia/OM, reduced QoL.
Intranasal saline irrigation
Avoid allergen, stop smoking, stop diving etc.
Intranasal corticosteroids- fluticasone.
Thyroid nodules-
Investigate with USS and TFTs.
Manage with removal/follow up, US guided fine needle aspiration to diagnose papillary carcinoma.
Acute labyrinthitis-
Onset 40-70yrs old.
Symptoms; acute onset vertigo, SN HL, tinnitus, N+V.
Types- Suppurative- bacterial cause which invades surrounding structures therefore severe SN HL and vertigo.
Serous- viral cause localised to the labyrinth therefore less severe SN HL and vertigo.
Investigate with H+E, audiometry, CT, R+W, BM to rule our hypoG.
Acute labyrinthitis management-
Symptomatic relief, keep hydrated.
Can consider promethazine or cyclazine.
Allergic rhinitis (Hayfever)-
Investigate with skin prick test, IgE.
Manage with; removal/avoid allergen, nasal decongestants, nasal saline irrigation, antihistamines.
Mild/moderate/intermittent- oral/intranasal AH.
Moderate/severe/persistent- intranasal corticosteroids.
If really severe or reduced QoL then oral prednisolone.
Nasal polyps-
Benign growth of the paranasal sinus mucosa.
PNS has pseudostratified ciliated epithelia.
Investigate with anterior rhinoscopy, nasal endoscopy, CT, if unilateral then biopsy on CT.
Nasal polyps management-
Shrink with intranasal corticosteroids, polipectomy, nasal saline irrigation, doxycycline if needed.
Cervical lymphadenopathy-
Malignancy
If bilateral then consider tonsillitis; sore throat, exudate, swollen tonsils, headache, fever etc.
Treat with penicillin or erythromycin if allergy.
Also check Virchows.
BPPV-
> 55yrs old
10-20 second recurrent vertigo episodes, gradual onset, associated nausea, caused by change in head movement.
Investigate with symptoms and Dix-Hillpike manouvere.
BPPV management-
Medication not really useful
Patient should rest during attacks
Patient education and reassurance
Epley manoeuvre.
Nasal septal deviation-
Obstructive breathing
Dry mucosa therefore increase bleeds
Loud breathing in sleep
Recurring sinus infection
Vestibular migraine-
Sudden onset headache, phonophobia, visual disturbances , vertigo, hearing loss.
Manage by avoiding triggers i.e. dehydration, keep symptom diary.
Vestibulopathy-
Dizzy, imbalance, nausea, visual problems.
Treat with vestibular sedatives, vestibular rehab therapy, Epley manoeuvre if BPPV.
Stridor-
Blockage at the level of supra/infra or glottis, trachea.
Concerning if sound reduces, can reduce air entry and lung work.
Causes in children- croup, acute epiglottitis, inhaled foreign body.
Sore throat-
Tonsillitis- Headache, abdo pain N+V. Tonsillar swelling, tonsillar exudate, anterior CL.
Pharyngitis- sometimes headache, abdo pain, N+V. Pharyngeal exudate, CL.
Investigate with
