Otology Flashcards
What specific questions in the history should be asked in otology? (7)
Deafness Tinittus Vertigo Otorrhoea Otalgia
Time pattern / precipitating factors
Exposure to drugs / environmental noise
What 2 predisposing factors/conditions involved in otitis externa
Eczema (can lead to infection)
Trauma
What are the symptoms of otitis externa (3)
Otalgia
Otorrhoea (would be purulent)
Hearing loss (due to narrowed EAM)
What would be seen O/E in otitis externa (2)
And what specifically would be seen in Chronic Otitis Externa?
Tenderness on movement in tragus + postauricular
Poss skin cracked/crust (risk fungal infection)
Chronic - thickened/fissured skin + permanently moist
What are the possible treatments for otitis externa? (4)
What important to exclude when cleared?
Aural toilet (washing out ear)
Abx drops (or systemic if severe)
Steroid drops
Antifungals (eg glycerine) can be used to withdraw moisture
Important to check for otitis media as is a common cause
Who is malignant otitis externa seen in?
What is the common causative organism?
Elderly + diabetes
Pseudomonas
What are the complications of malignant (pseudomonal) otitis externa?
How is it treated?
Spreads to bone causing osteomyelitis of skull base
Can damage facial nerve + other nerves that exit thru jugular foramen (9/10/11)
IV Abx + poss surgical debridement
What are the complications of a trauma-related haematoma of the external ear? (2)
If not drained, can cause dense scarring/thickening of the ear
Infection can lead to cartilage necrosis + gross deformity
Define presbyacusis + its cause / features
+ its management
Degenerative hearing loss of old age
Caused by atrophy of labyrinth and cochlear nerve fibres
Gradual hearing loss in both ears w/wo tinittus
Mainly affects higher frequencies
Not cured but hearing aid amplifies sound + masks tinittus
What is cholesteatoma
Where exactly is it
What is it classed as
Cyst/sac of keratinising squamous epithelium - half necrotic, half proliferative
Epitympanic part of middle ear
Classed as Chronic Suppurative Otitis Media (CSOM)
What are the symptoms (2) + signs (3) of Cholesteatoma
How is it treated
Foul smelling discharge
Conductive hearing loss
Attic retraction w/ squamous debris
Attic perforation + discharge
Attic aural polyps
Surgical excision (op required depends on extent)
What are the complications of Cholesteatoma (which a pt may initially present with) (3) (Otologically Is Very Fucked)
Facial nerve palsy
Vertigo
Intracranial sepsis
Ossicular damage
(Condition is able to erode bone so all middle ear / mastoid structures at risk
Whats the difference between glue ear and acute (suppurative) otitis media?
Glue ear = otitis media with effusion of sterile (non-purulent) fluid
Acute = accumulation of pus creating pressure on tympanic membrane (usually URTI via eustachian tube)
What are the symptoms of acute otitis media + complications
Otalgia Otorrhoea Hearing loss (conductive) Pyrexia Systemic upset
How is acute otitis media treated?
Abx + analgesics
Abx/steroid drops if discharging
Nasal decongestants can speed up recovery
What is the aetiology behind glue ear?
What proportion of children get it ?
Poor ventilation of middle ear cavity leading to sterile/non-purulent effusion build-up
Causes include:
recurrent acute otitis media
infection/allergy of middle ear mucosa
eustachian tube dysfunction
70-80% children
What are the symptoms of glue ear
Long term effects/ complications of glue ear
Mild conductive hearing loss
Long-term can affect child’s behaviour/schooling
Chronic effusion predisposes to recurrent attacks of acute otitis media
When is treatment required in glue ear?
What is the management?
If symptomatic + not resolved within 3m
Grommets / hearing aids (equally effective)
Only for few years as child usually grows out
What is Chronic Suppurative Otitis Media
+ its complications
+ treatment
prolonged/repeated otitis media (otalgia, otorrhoea, hearing loss)
Can damage tympanic membrane and cause a non-healing perforation (normally hearing loss mild at 10-20dB but in membrane involvement can be 50-70dB)
Treatment is aural toileting + abx/steroid drops
Surgical repear of ear drum poss necessary
Describe the pathophysiology behing otosclerosis
Labyrinth bone replaces from hard to spongy
Overgrowth can affect stepes footplate leading to fixation + conductive loss
OR less commonly
Toxins produced by new bone can damage cochlear and cause sensorineural loss
What are the poss symptoms of otosclerosis (4)
Bilateral hearing loss**
Paracusis willsii (better hearing with background noise)
Tinittus
Positional vertigo
How is a diagnosis of otoslcerosis made?
Consider when conductive hearing loss with normal ear drum
Conclusively done by surgical examination of stapes footplate (commonest prob is fixation)
How is symptomatic otosclerosis treated?
Mild - observation / hearing aid
Large conductive loss - surgically replace stapes with Teflon piston
What is noise induced hearing loss?
+ how can symptoms become permanent
Loud auditory stimulus causing mild hearing loss / tinittus that quickly resolves
Repeated traumas of this type can lead to permanent symps
OR
Very loud nosie e.g. explosion
