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EarNoseThroat > Otology > Flashcards

Otology Flashcards

1
Q

What causes otitis externa?

A 
P aeruginosa 
Staph aureus
Aspergillus (black spores)
Candida
Risk factors:
Cotton buds, water exposure, foreign bodies, adults/teens
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2
Q

What is seen upon examination of otitis externa?

A 
Severe ear pain, discharge, itching, hearing loss
Pinna tender to move
Tragus tender
Ear canal filled with discharge
Ear canal swollen
TM often not seen
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3
Q

What is the management for simple otitis externa?

A 
Keep ears dry
No poking
Analgesia
Topical antibiotics + steroid
Eg gentisone HC, sofradex
(don’t use cipro for OE as Pseudomonas becomes resistant quickly)
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4
Q

What is the management for complex otitis externa?

A 
ENT referral
Microsuction
Pope wick and drops
Admission 
IV antibioitcs (risk of pinna perichondritis)
Aural toilet
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5
Q

What is necrotising otitis externa?

A

Severe unrelenting pain with canal granulation
Skull base osteomyelitis
Affects cranial nerves
Seen in immunocompromised
IV antibiotics for 6 weeks (some palsies may not recover)

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6
Q

What is pinna perichronidritis?

A

Pinna itself red and inflammed, lobule has no cartilage and therefore is spared. Consider autoimmune disorder. IVabx

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7
Q

What are the differential diagnoses for otitis externa?

A

Necrotising OE
Mastoiditis
Pinna perichondritis (lobule spared)
Pinna cellulitis (lobule inflamed)

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8
Q

What are the functions of the parts of the ear?

A 
External:
Sound amplification
Protection of TM
Cosmesis
Middle:
Sound/ energy transformer
Inner:
Hearing (Sensorineural)/ Balance
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9
Q

What is the scale for hearing loss severity?

A

Mild: 20-40 dB
Moderate: 40-70
Severe 70-90
Profound worse than 90

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10
Q

What are the results shown by tympanometry?

A

A: triangle, normal
B: flat, TM perf or effusion (OME)
C: wide triangle at start, negative pressure- poor eustachian function or effusion
As: tiny triangle, stiff- osteosclerosis
Ad: large triangle, dislocated- ossicular discontinuity

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11
Q

What is a pinna haematoma?

A

Collection of blood (distinct from bruise)
Blood between cartilage and perichondrium, leading to increased diffusion distance between cartilage and perichondrium and infection risk (perichondrium supplies cartilage with nutrients and O2)
Cartilage necrosis- cauliflower ear
Requires aspiration / drainage: ENT referral

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12
Q

What is a tympanoplasty / myringoplasty?

A

Repair of tympanic membrane

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13
Q

What are the types of mastoidectomies?

A

Cortical mastoidectomy. Removes just outer cortex. Used for cochlear implant, mastoiditis, combined approach tympanoplasty
Atticotomy (drills attic), atticoantrostomy (attic and antrum), modified radical mastoidectomy (drills out entire mastoid air cell system and creates a mastoid cavity); for cholesteatoma
Combined approach tympanoplasty. Type of cholesteatoma surgery where approach is both via ear canal and via a cortical mastoidectomy. It avoids a cavity, but recurrence rate is high so usually need several procedures

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14
Q

When is a bone anchored hearing aid used?

A

Ear atresia, and chronic ear discharge that stops use of a standard air-conducting hearing aid

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15
Q

What could an adult with glue ear signify?

A

Sign of a nasopharynx tumour

Commoner in south east asia

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16
Q

What are the signs of temporal bone fractures?

A 
Bleeding ear
CSF otorrhoea (test beta2 transferrin)
Perf TM-canal laceration
haemotympanum: blood behind TM
Battle’s sign: mastoid bruise facial palsy
17
Q

What is the management for temporal bone fractures?

A

Need CT
ENT management usually conservative. Steroids for FN palsy. Rarely FN exploration if immediate FN palsy. Management mostly directed by associated injuries

18
Q

What is a cholesteatoma?

A

Squamous otitis media- lined sac in the mid ear
Most common aged 10-20
V=Cleft palate increases risk by 100 fold
When bursts releases osteoclatic enzymes:
Conductive hearing loss, SNHL, facial nerve palsy
Managed by surgical excision
In dry ear or frail patients- observation, aural toilet and ear drops

19
Q

What is benign paroxysmal positional vertigo (BPPV)?

A

Abnormal presence of calcium carbonate crystals, usually in posterior semicircular canals. Spinning lasts seconds, usually on rolling over in bed. Very common
Tested with hallpike- dix
Treated with epley manouvre physiotherapy

20
Q

What is meniere’s disease?

A

Triad of: spinning (hrs), worsening hearing associated with attack, tinnitus worse with attack. (aural fullness also common but not part of triad)
MRI: normal

21
Q

What is the management for meniere’s disease?

A 
MRI to exclude vestibular schwannoma
Dietary: low salt, caffeine
Medical: Betahistine, bendroflumethiazide
Grommets
Intratympanic gentamycin or steroid
Pressure devices
22
Q

What is tinnitus?

A 
Perception of noise in absence of external stimulus
Pulsatile: likely to find a cause. Look for bruits, anaemia, hyperthyridism; consider CT/MR angiogram (especially I unilateral – look for glomus jugulare tumour)
Non pulsatile (Scan only if unilateral). Often associated with SNHL
23
Q

What is the management for tinnitus?

A

Sound enrichment (TV on, music at night)
Hearing aids work well if associated hearing loss
Tinnitus masker plays noise into ear, which for some patients is less annoying than tinnitus
Tinnitus therapy: psychological techniques based on information giving and strategies to avoid stress response
Tell patient several options available, eventhough no easy cure

24
Q

What are the causes of sudden SNHL?

A 
Idiopathic (60%)
Viral (labrynthitis)
Tumours – (vestibular schwannoma)cystic expansion
Temporal bone fractures
Perilymph fistula- blast or barotrauma
Menieres disease
Ototoxic drugs (aminoglycoside, furosemide)
CVA (hypoxic damage 8th nerve)
Autoimmune
Treated with steroids- narrow window
Over 30db hearing loss in one frequency
25
Q

What are the features of a cholesteatoma?

A 
Foul-smelling, non-resolving discharge 
Conductive hearing loss 
Vertigo 
Facial nerve palsy 
Cerebeloopontine angle syndrome
Attic retraction filled with squamous debris 
Attic aural polyps 
Discharging attic perforation
26
Q

What are the complications of a cholesteatoma?

A

Facial palsy, vertigo, intracranial sepsis

27
Q

What is the pathology of a cholesteatoma?

A

A negative pressure in the middle ear has its maximal effect on the pars flaccida of the tympanic membrane
causes it to balloon backwards forming a retraction pocket and trapping the outer layer of epithelium, this ball of squamous debris slowly enlarges and invariably becomes infected with pseudomonas
It tends to grow upwards into the attic region and backwards into the mastoid

28
Q

Which structures are at risk of being eroded in cholesteatoma?

A

Ossicles- causing a conductive deafness of 50dB or more
Lateral semicircular canal- causing vertigo
Facial nerve- causing facial palsy
Labyrinth/cochlear- causing a sensorineural hearing loss (total or partial)
Roof of the middle ear- causing intracranial sepsis
Sigmoid sinus- causing it to thrombose

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