Otology Flashcards
What is included in the middle ear?
Tympanic membrane
Middle ear ossicles
Ventilated by Eustachian tube
What is included for history of otology?
Hearing loss
Tinnitus
Discharge
Otalgia
Dizziness
Facial weakness, headaches, skin conditions and allergies
What is used to examine the ear?
Otoscope
What are the 2 tuning fork tests?
Rinne’s test
Weber’s test
Describe management if ear wax is blocking
Removal is not essential
Removal if symptoms
Ear drops - olive/almond oil, NAHCO3 and saline
Syringe or micro suction if no improvement
Advice not to insert anything into the ear
Describe the types of foreign body
Inorganic - beads/plastic, inert and no damage to skin
Organic - cotton bud, nuts, cause irritation of skin and risk of otitis externa
What can penetrating injury cause?
Cause rupture of tympanic membrane
May damage the ossicles
What are the symptoms for foreign body?
Persistent unilateral discharge
Ear discharge
Bleeding is occasional
Hearing loss if penetrated
How can foreign body be removed?
Hawthorne wax hook, right angled hook, syringing and suction
What is the management for penetrating trauma by foreign body?
Do nothing
ENT review six weeks later
What are the symptoms for otitis externa?
Hearing loss, itch and pain
What is used for treatment for otitis externa?
Use Sofradex, Gentisone HC ear drops or Otomize spray
If tympanic membrane perforation or not visible then use Cilodex
What is the management of otitis externa if persists?
Arrange microbiology swabs and treat according to sensitivities
If unresponsive then refer to ENT nurse
What is used if otitis externa causes swelling?
Pop wick - puts drops in canal and antibiotics
What happens if otitis externa spreads to cause facial pinna cellulitis?
Infection is in cartilage
Oral antibiotics needed and referral to hospital
What is the management for fungal otitis externa?
Micro suction
Check for underlying perforation
Keep ears dry
Topical Clotimazole or Nystatin drops for 2 weeks
What can fungal otitis externa be caused by?
Aspergillus or Candida
Can be if wet environment - swimmers
Describe malignant otitis externa
Infection spread to skull base
Granulation tissue on external ear
Longstanding process and systemic upset
Cranial nerve deficits
Diabetic or immune suppressed patient
Describe necrotising otitis externa
Elderly diabetic or immune-suppressed
Topical treatment not working
Increased CRP and fasting blood sugar
Granulation tissue
Facial palsy/ cranial nerve deficits
What is the management for necrotising otitis externa?
Immediate referral
Systemic anti-pseudomonas antibiotics
Surgical debridement
Control of diabetes
What is exostoses?
Multiple body swellings
May need surgery to widen canal
History of water exposure
Presents with hearing loss
What is osteoma?
Benign tumour of the bone causing small swelling - solitary bony lesion
Monitor
Usually asymptomatic
How is chronic otitis media with perforation managed?
2 week course of Cilodex (ciprofloxacin and dexamethasone) ear drops 4 drops twice daily
If discharge in ear persists then refer to ENT
Describe tympanic retractions
Part of ear drum lies deeper in ear than normal due to vacuum as lack of ventilation from Eustachian tube
If asymptomatic then no treatment needed
What are the types of chronic otitis media?
Mucosal - active, inactive, or healed
Squamosal - retracted pockets and active
What is acute mastoiditis?
Complication of SOM
Can cause brain abscess so acute emergency
Drain pus and abscess
IV antibiotics and put in grommets
What is the diagnosis if dizziness lasts few seconds when turns head?
BPPPV
Positive on Dix Hallpike test
Needs Epley manoeuvre
What is the differential diagnosis for vertigo?
BPPV - seconds and positional
Meniere’s/ Vest migraine - minutes to hours
Vestibular neuritis - days
What is the treatment for Meniere’s Disease?
Betahistine - vasodilator
Stemetil PRN - anti-emetic
What are complications of otitis media?
Fluctuant peri-aural swelling, facial palsy, vertigo, severe headache, new onset of neurological symptoms
