Otology and ear diseases Flashcards
LOs
The normal ear
Rapid ear assessment
Common conditions and how to treat them
what to ask regarding ears
Otalgia- ear pain
Otorrheoa- ear discharge
Hearing loss
Tinnitus- sensation of sounding the absence of external stimulus
Vertigo- sensation of rotatory inertia
what to look at
External ear- pull pinna backward, press on tragus, press on mastoid process looking for pain, bogginess and swelling
Ear canal
Tympanic membrane
Facial nerve- runs through temporal bone, which houses many of the ear components, tends to be a LMN palsy meaning that forehead isn’t spared
Facial nerve palsy- presents with vesicles- reactivation of herpes, amongst other signs
what trauma is this
Tympanic membrane perforation
Hole in eardrum
Causes:
- Trauma
- Barotrauma- high or low pressure
- Infection- e.g., otitis media, build-up of inflammatory substance, putting immense pressure on ear drum, discharge leaks out
Many heal on their own if infection is resolved.
The white area is known as tympanic sclerosis
Shouldn’t affect function of hearing. Often occurs after healing of perforation.
see bubbling behind the TM
what disease has casued this
Otitis media with effusions
Hx:
- Ear pressure/ congestion
- Sometimes otalgia
- Pressure of congestion in ear
- Always conductive hearing loss
Worry that it can affect speech development in children if it is chronic
Tx;
- Gromette- small tube that goes through tympanic membrane and allows discharge to leave
- Give hearing aid
Why do people get these?
- Middle ear inflammation and exudation.
- Eustachian tube sits in front wall of middle ear cavity and it communicates with the back of the nose. Functions to equalise pressure in ears. Problems with effusion see problems with eustachian tube. Eardrum becomes retracted (sucked in).
- Longer that this fluid sits, the thicker it gets- glue ear
Shows conductive hearing loss
For someone of near perfect health you’d expect the dB range to hear at different frequencies to be between
0 –> 20 dB
what kind of hearing loss is shown here?
If the hearing thresholds obtained by bone conduction = air conduction then this indicates that there is nothing stopping the sound from travelling through the outer or middle ear to the cochlea. i.e. no conductive hearing loss
Therefore, think sensorineural hearing loss
If bone conduction hearing thresholds are normal, but there is a loss of hearing for air conduction sounds, this is called conductive hearing loss. Cochlea is normal but there is some form of blockage or abnormality in th e outer or middle ear. Think otitis media with effusion.
Conductive hearing loss in both ears.
It’s possible to have both conductive and sensorineural hearing loss- mixed hearing loss.
e.g., noise exposure and perforated ear drum
acute otitis media
Bulging eardrum, looks dull
Common in u7’s
Hx:
Increasing otalgia, no discharge, ref and bulging TM
Crescendo pain, resolution with a ‘pop’ then discharge and TM perforation
Associated w hearing loss, tinnitus, fever also common
Children: unwell, crying, pulling on affected ear
Tx; often conservative, amoxicillin in severe cases
Red flags: systematic infection, CN palsy, meningism
rare complication of acute otitis media
mastoiditis
Air cells, honeycomb cells
If you pressed on it it would be soft
Mx; aggressive, antibiotics, rill into bone and drain
furuncle
spot
Infected hair follicle
Pop and give antibiotiucs
Chronic suppletive otitis media-
Long standing, associated to hole in eardrum (often that all is left is annulus) and constant infection
can lead to a cholesteatoma
Cholesteatoma
Skin cells that have shed off from the ear lining. Problem if in middle ear. It can build up and form a sac known as a cholesteatoma. Destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and mastoid process.
Attic cholesteatoma- on roof
Don’t spread- can erode through any structures that they’re in contact with for long enough.
Tx: Give eardrops with antibiotics in.
Regular ear cleaning (microsuction)
Surgery; mastoidectomy
acute otitis externa
Inflam of outer ear (auricle to outer surface of TM)
Hx of otalgia with no discharge
Often after change in environment- humidity/ pH or swimming
Conductive hearing loss, dysequiliibrium
Eczema- route for further infection
Rf: age, diabetes, recurrent OE, immunocompromised
Management: topical antibiotics, whick (opens ear canal, put drops on it)
BEWARE- malignant otitis externa- ENT emergency
Associated with pinnacellulitis
