Otology Flashcards
What makes up the outer ear?
Pinna + ear canal
What makes up the middle ear?
Timpanic membrane + middle ear ossicles + ad ventilated by Eustachian tube
What makes up the inner ear?
Semi-circular canals
Cochlea
What are important clinical findings in a history?
Hearing loss
Tinnitus
Discharge
Otalgia
Dizziness
Facial weakness, headaches, other ENT symptoms, skin conditions, allergies
What is used for an ear examination to look inside the ear?
Otoscope
Is removal always necessary with wax buildup?
No
When would you remove ear wax?
If symptoms, TM examination essential, H aid
What can be used to treat wax buildup?
Ear drops- olive/almond oil, NAHCO3, 0.9% saline
What should be used if no import net in earwax after treatment?
Irrigation
When is nurse led clinic used?
If known perforation, trauma, infection, surgery
What should you advise to prevent people from getting ear irritation?
Advise against inserting anything into the ear
Cotton buds
Matchsticks
Hair pins
Ear candling
Vacuuming
What are examples of inorganic foreign bodies?
Beads/ plastic material
Can inorganic foreign body cause damage to skin?
No, inert
What are examples of organic foreign bodies?
Cotton bud, nuts
What can organic foreign bodies cause?
Excoriation of skin
Risk of otitis externa
What can cause a penetrating injury in the ear?
Cotton buds, ear syringing, pellets injury
What can penetrating injury cause?
Rupture of tympanic membrane
May cause damage to the ossicles
What are the symptoms of a foreign body?
H/o of foreign body
Persistent unilateral discharge
Ear discharge
Bleeding- occasionally
Hearing loss- penetrating
What is the treatment of foreign bodies?
Foreign body removal
What are ways of removing a foreign body?
Hawthorne wax hook
Right angled hook
Syringing
Suction
What is the treatment of penetrating trauma?
Do nothing
ENT review six weeks later
What is the treatment for acute otitis externa?
Sofradex, gent is one HC ear drops or otomize spray
If tympanic membrane perforation present in acute otitis externa, what should be used?
Cilodex- pseudomonas
When does acute otitis externa get better?
Within a week
What should happen if AOE persisten after 2 weeks
Arrange microbiology swabs and treat according to sensitivities
If unresponsive refer to ENT nurse- Led clinic
When are oral antibiotic indicated in acute otitis externa?
If infection is spread to cause facial pinna cellulitis
What can cause fungal otitis externa?
Chronically wet ear
Uses a lot of antibiotics
How is fungal otitis externa treated?
Micro suction
Check for underlying perforation
Keep ears a dry
Topical clotrimazole or nystatin ear drops for 2 weeks
What patient is predisposed to malignant otitis externa?
Diabetic or immune suppressed patient
What kind of process is malignant otitis externa?
Long-standing
What can malignant otitis externa cause?
Granulation tissue
Systemic upset
Cranial nerve deficits
Who are at risk of necrotising otitis externa?
Elderly diabetic or immune suppressed patient
How does necrotising otitis externa present compared to other otitis externa infections?
Topical treatment not working
Increasing pain
How do you test for necrotising otitis externa?
Swab
Fasting blood sugar
CRP
What is a hallmark of necrotising otitis externa?
Granulation tissue in EAC
What can also present with necrotising otitis externa?
Facial palsy
Cranial nerve deficits
What is the management of necrotising otitis externa?
Immediate referral
Systemic anti-pseudonomonas antibiotics
Surgical debridement
Control of diabetes
What does a swimmer presenting with hearing loss likely have?
Exotoses
What does a 4yr old with fever and ear ache likely have?
Acute supportive otitis media
What is the typical treatment of acute supportive otitis media?
Give painkillers, wait for 2 to 3 days, if still symptomatic, give systemic antibiotics
What would you use to confirm the diagnosis of otitis media with effusion?
Audio gram
What kind of hearing loss would present in otitis media with effusion?
Low frequency conductive hearing loss
What kind of tympnetry would you get in otitis media with effusion?
Flat
What would a possible presentation of chronic mucoid +/- tympanic membrane perforation be?
Grommet insertion as a child
Ear discharge
Hearing loss
Conductive hearing loss
What is the first line treatment of chronic mucoid +/- tympanic membrane perforation?
Prescribe 2 week course of cilodex (ciproflaxacin with dexamethasone) ear drops
4 drops twice daily
What is the second line treatment of chronic mucoid?
If after 2 weeks ear discharge persists - send a swab and consider refer to ENT
If not fungal cilodex can be given for further 2 weeks while the patient is awaiting to be seen in ENT
What can be the complication of otitis media with cholestaetoma?
Can go into mastoid bone, eats away at ossicles, cause damage to balance organs
Can go into brain and hit visual nerve
what is the treatment of cholesteatoma?
Temporal mastoid surgery
What cannot be used to treat cholesteatoma?
Antibiotic drugs
What are the two types of progression of chronic otitis media?
Mucosal
Squamosal
What are the types of mucosal chronic otitis media?
Active (CSOM)
Inactive (permanent perforation)
Healed (adhesive OM)
What are the types of sqamosal chronic otitis media?
Retraction pockets (PT/PF/atelectatic ear)
Active (C+ discharge)
What is a complication of squamous otitis media?
Acute mastoiditis
what can happen if acute mastoiditis is left untreated?
Brain abscess
What is the step for managing accurate mastoiditis?
Acute emergency
Admit -> IV antib -> urgent CT -> Drain mastoid -> put in grommet
If brain abscess -> also needs drained
Wha are questions to ask with dizziness?
Is it positional
Does nausea come with dizzy episodes
Any recent hearing loss since episodes started
Manoeuvres to do - hallpikes and epleys in clinic
What is the treatment for Ménière’s disease?
Betahistine
Stemetil PRN — only
What is Bell’s palsy likely caused by?
Herpes simplex virus
How should you treat Bell’s palsy?
Steroids
Can have spontaneous self resolution
What is Ramsey hunt syndrome caused by?
Varicella zoster virus
How do you treat Ramsey hunt syndrome?
Give acyclovir
