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Head And Neck > Otology > Flashcards

Otology Flashcards

1
Q

What makes up the outer ear?

A

Pinna + ear canal

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2
Q

What makes up the middle ear?

A

Timpanic membrane + middle ear ossicles + ad ventilated by Eustachian tube

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3
Q

What makes up the inner ear?

A

Semi-circular canals
Cochlea

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4
Q

What are important clinical findings in a history?

A

Hearing loss
Tinnitus
Discharge
Otalgia
Dizziness
Facial weakness, headaches, other ENT symptoms, skin conditions, allergies

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5
Q

What is used for an ear examination to look inside the ear?

A

Otoscope

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6
Q

Is removal always necessary with wax buildup?

A

No

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7
Q

When would you remove ear wax?

A

If symptoms, TM examination essential, H aid

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8
Q

What can be used to treat wax buildup?

A

Ear drops- olive/almond oil, NAHCO3, 0.9% saline

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9
Q

What should be used if no import net in earwax after treatment?

A

Irrigation

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10
Q

When is nurse led clinic used?

A

If known perforation, trauma, infection, surgery

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11
Q

What should you advise to prevent people from getting ear irritation?

A

Advise against inserting anything into the ear
Cotton buds
Matchsticks
Hair pins
Ear candling
Vacuuming

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12
Q

What are examples of inorganic foreign bodies?

A

Beads/ plastic material

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13
Q

Can inorganic foreign body cause damage to skin?

A

No, inert

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14
Q

What are examples of organic foreign bodies?

A

Cotton bud, nuts

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15
Q

What can organic foreign bodies cause?

A

Excoriation of skin
Risk of otitis externa

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16
Q

What can cause a penetrating injury in the ear?

A

Cotton buds, ear syringing, pellets injury

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17
Q

What can penetrating injury cause?

A

Rupture of tympanic membrane
May cause damage to the ossicles

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18
Q

What are the symptoms of a foreign body?

A

H/o of foreign body
Persistent unilateral discharge
Ear discharge
Bleeding- occasionally
Hearing loss- penetrating

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19
Q

What is the treatment of foreign bodies?

A

Foreign body removal

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20
Q

What are ways of removing a foreign body?

A

Hawthorne wax hook
Right angled hook
Syringing
Suction

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21
Q

What is the treatment of penetrating trauma?

A

Do nothing
ENT review six weeks later

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22
Q

What is the treatment for acute otitis externa?

A

Sofradex, gent is one HC ear drops or otomize spray

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23
Q

If tympanic membrane perforation present in acute otitis externa, what should be used?

A

Cilodex- pseudomonas

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24
Q

When does acute otitis externa get better?

A

Within a week

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25
Q

What should happen if AOE persisten after 2 weeks

A

Arrange microbiology swabs and treat according to sensitivities
If unresponsive refer to ENT nurse- Led clinic

26
Q

When are oral antibiotic indicated in acute otitis externa?

A

If infection is spread to cause facial pinna cellulitis

27
Q

What can cause fungal otitis externa?

A

Chronically wet ear
Uses a lot of antibiotics

28
Q

How is fungal otitis externa treated?

A

Micro suction
Check for underlying perforation
Keep ears a dry
Topical clotrimazole or nystatin ear drops for 2 weeks

29
Q

What patient is predisposed to malignant otitis externa?

A

Diabetic or immune suppressed patient

30
Q

What kind of process is malignant otitis externa?

A

Long-standing

31
Q

What can malignant otitis externa cause?

A

Granulation tissue
Systemic upset
Cranial nerve deficits

32
Q

Who are at risk of necrotising otitis externa?

A

Elderly diabetic or immune suppressed patient

33
Q

How does necrotising otitis externa present compared to other otitis externa infections?

A

Topical treatment not working
Increasing pain

34
Q

How do you test for necrotising otitis externa?

A

Swab
Fasting blood sugar
CRP

35
Q

What is a hallmark of necrotising otitis externa?

A

Granulation tissue in EAC

36
Q

What can also present with necrotising otitis externa?

A

Facial palsy
Cranial nerve deficits

37
Q

What is the management of necrotising otitis externa?

A

Immediate referral
Systemic anti-pseudonomonas antibiotics
Surgical debridement
Control of diabetes

38
Q

What does a swimmer presenting with hearing loss likely have?

A

Exotoses

39
Q

What does a 4yr old with fever and ear ache likely have?

A

Acute supportive otitis media

40
Q

What is the typical treatment of acute supportive otitis media?

A

Give painkillers, wait for 2 to 3 days, if still symptomatic, give systemic antibiotics

41
Q

What would you use to confirm the diagnosis of otitis media with effusion?

A

Audio gram

42
Q

What kind of hearing loss would present in otitis media with effusion?

A

Low frequency conductive hearing loss

43
Q

What kind of tympnetry would you get in otitis media with effusion?

A

Flat

44
Q

What would a possible presentation of chronic mucoid +/- tympanic membrane perforation be?

A

Grommet insertion as a child
Ear discharge
Hearing loss
Conductive hearing loss

45
Q

What is the first line treatment of chronic mucoid +/- tympanic membrane perforation?

A

Prescribe 2 week course of cilodex (ciproflaxacin with dexamethasone) ear drops
4 drops twice daily

46
Q

What is the second line treatment of chronic mucoid?

A

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

47
Q

What can be the complication of otitis media with cholestaetoma?

A

Can go into mastoid bone, eats away at ossicles, cause damage to balance organs
Can go into brain and hit visual nerve

48
Q

what is the treatment of cholesteatoma?

A

Temporal mastoid surgery

49
Q

What cannot be used to treat cholesteatoma?

A

Antibiotic drugs

50
Q

What are the two types of progression of chronic otitis media?

A

Mucosal
Squamosal

51
Q

What are the types of mucosal chronic otitis media?

A

Active (CSOM)
Inactive (permanent perforation)
Healed (adhesive OM)

52
Q

What are the types of sqamosal chronic otitis media?

A

Retraction pockets (PT/PF/atelectatic ear)
Active (C+ discharge)

53
Q

What is a complication of squamous otitis media?

A

Acute mastoiditis

54
Q

what can happen if acute mastoiditis is left untreated?

A

Brain abscess

55
Q

What is the step for managing accurate mastoiditis?

A

Acute emergency
Admit -> IV antib -> urgent CT -> Drain mastoid -> put in grommet
If brain abscess -> also needs drained

56
Q

Wha are questions to ask with dizziness?

A

Is it positional
Does nausea come with dizzy episodes
Any recent hearing loss since episodes started
Manoeuvres to do - hallpikes and epleys in clinic

57
Q

What is the treatment for Ménière’s disease?

A

Betahistine
Stemetil PRN — only

58
Q

What is Bell’s palsy likely caused by?

A

Herpes simplex virus

59
Q

How should you treat Bell’s palsy?

A

Steroids
Can have spontaneous self resolution

60
Q

What is Ramsey hunt syndrome caused by?

A

Varicella zoster virus

61
Q

How do you treat Ramsey hunt syndrome?

A

Give acyclovir

Head And Neck (9 decks)

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