Otology Flashcards
What are the common presenting symptoms in Otology cases?
- Deafness
- Tinnitus
- Dizziness (vertigo)
- Discharge
- Otalgia
- Facial Nerve:
- > Drooping of the face
- > Facial paralysis
- > Weakened facial muscles
- > Facial Twitches
- > Excessive salivation
- > Dry eyes
- > Changes in taste
What are the standard ear examination techniques in Otology cases?
- Otoscope
- Tuning Fork tests
- Whispered voice testing
- Nystagmus
- Facial (CN VII) nerve
What is the first line investigation for Nystagmus?
- Videonystagmography (VNG)
What are the most common disorders in Otology cases?
External ear:
- Otitis Externa
Middle ear:
- Acute Otitis Media
- Otitis Media w Effusion (“glue ear”)
- Chronic Suppurative Otitis Media (CSOM)
- Tympanosclerosis
- Otosclerosis
Inner ear:
- Presbyacusis
- Noise-induced Deafness
- Acoustic Neuroma
- Meniere’s Disease
What are the most common emergencies in Otology cases?
- Foreign Body
- Malignant/Severe Otitis Externa
- Auricular Haematoma
- Bell’s Palsy
- Complications of CSOM (ie. in CNS)
What is the management of Auricular Haematoma?
- Incision and drainage
- Pressure dressage
- Abx.
- if left unmanaged, can lead to cauliflower ear…*
What is the management of Foreign Body in the ear?
- Removal
Urgency: button battery > organic > inorganic
What is the management of Otitis Externa in the ear?
- inflammation of external auditory meatus*
- Abx./steroid drops +/- suction under microscope
- Prevention: no water or cotton buds
What is the presentation of “Malignant” Otitis Externa?
- Severe ear pain in elderly diabetic
- Granulations in external auditory meatus
- +/- cranial nerve palsies
What is the management of “Malignant” Otitis Externa?
- Abx. for weeks or months
What is the pathology of “Malignant” Otitis Externa?
- Osteomyelitis of Temporal bone
What is the pathology of Otitis Media w Effusion? (“glue ear”)
- Sterile fluid in the middle ear
What is the presentation of Otitis Media w Effusion? (“glue ear”)
- Hearing loss
- Speech delay
What is the management of Otitis Media w Effusion? (“glue ear”)
1 - Observation for 3 months
2 - Otovent
3 - Grommet
What is the Acute Suppurative Otitis Media?
- Pus in the middle ear
What is the presentation of Acute Suppurative Otitis Media?
- Otalgia +/- Otorrhoea
What is the management of Acute Suppurative Otitis Media?
- Observation +/- antibiotics
What is the pathology of Tympanosclerosis?
- Calcification in Tympanic membrane +/- middle ear
What is the presentation of Tympanosclerosis?
- Usually asymptomatic
What is the management of Tympanosclerosis?
- Usually none
* usually only treat if there is hearing loss*
What is the pathology of Chronic Suppurative Otitis Media (CSOM)?
- Perforated Tympanic membrane
- > “burst ear drum”
or
- Cholesteatoma
(skin in middle ear +/- mastoid bone)
What are the complications of Chronic Suppurative Otitis Media (CSOM)?
- “Dead ear”
- Facial palsy
- Meningitis
- Brain abscess
What are the causes of perforation of the Tympanic membrane? (or “burst” ear drum)
- Infection
- Trauma
- Grommet
What is the clinical presentation of perforation of Tympanic membrane? (or “burst” ear drum)
- Recurrent infections
- Hearing loss
What is the management of perforation of Tympanic membrane? (or “burst” ear drum)
- Water precautions
- +/- myringoplasty (not essential tho!)
What are the causes of Cholesteatoma?
- Eustachian tube dysfunction
- Impaired skin migration
What is the clinical presentation of Cholesteatoma?
- Persistent, offensive (smelly) otorrhoea
RED FLAG SYMPTOM!!
What is the management of Cholesteatoma?
- Mastoidectomy
What is the pathology of Otosclerosis?
- Fixation of stapes by extra bone
What are the clinical features of Otosclerosis?
- Conductive hearing loss
- Normal tympanic membrane
What is the management of Otosclerosis?
- Hearing aid
or
- Stapedectomy
What are the clinical features of Facial Nerve (CN VII) palsy?
- Lower motor neurone Facial palsy
What are the causes of Facial Nerve (CN VII) palsy?
- Intratemporal ie. Cholesteatoma
- Extratemporal ie. Parotid tumour
- Idiopathic = Bell’s palsy
What is the management of Facial Nerve (CN VII) palsy?
- Treat underlying cause (if possible)
- Steroids (Bell’s palsy)
- Eye care
