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ENT > Otorrhoea > Flashcards

Otorrhoea Flashcards

1
Q

What protects the outer ear from infection?

A
  1. Wax (cerumen)
  2. The shape of the canal
  3. Skin - epithelial migration to the external auditory meatus
  4. Hair
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2
Q

What are the risk factors for developing otitis externa?

A
  1. Allowing water to enter the ear
  2. Instrumentation of the ear canal e.g. cotton buds
  3. Skin conditions e.g. eczema and psoriasis
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3
Q

What are the 3 most common causes of otitis externa?

A
  1. Staphylococcus aureus (bacteria)
  2. Aspergillus niger (fungi)
  3. Pseudomonas aeriguinosa (bacteria)
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4
Q

What are the signs on examination of otitis externa?

A
  • Swelling (oedema)
  • Itching
  • Watery discharge
  • Otalgia
  • Erythema of the surrounding skin
  • Lymph node swelling (pre and post auricular commonly)
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5
Q

Which patients are at risk of developing osteomyelitis if they get otitis externa (malignant otitis externa)?

A

Diabetic patients

Immunosuppressed patients

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6
Q

How would you treat a simple bacterial otitis externa infection?

A
  1. Oral analgesia
  2. Topical antibiotic drop with steroid
  3. Keeping the ear dry
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7
Q

What is perichondritis?

A

Inflammation of cartilage AKA cauliflower ear

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8
Q

How would you treat someone with complicated otitis externa with perichondritis?

A
  1. Gentle micro-suction of the ear
  2. Continuation of topical drops with insertion of an aural wick (aural tampon)
  3. Admission of the patient to hospital and provision of IV Abx
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9
Q

What are the early complications of acute otitis externa?

A
  1. Facial cellulitis

2. Otomycosis (fungal infection)

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10
Q

What are the late complications of acute otitis externa?

A
  1. Canal stenosis with hearing loss

2. Osteomyelitis

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11
Q

When should you presume osteomyelitis in a patient who is immunocompromised or has diabetes with otitis externa?

A

If the infection persists for 2 weeks

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12
Q

How do we treat otitis externa with temporal bone osteomyelitis?

A

IV Abx for at least 6 weeks

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13
Q

If someone presents with discharging ear (otorrhoea) what are the important parts of the history to cover?

A
  1. Duration
  2. Otalgia
  3. Texture, colour and smell of the discharge
  4. Hearing loss?
  5. Balance
  6. Tinnitus
  7. Treatments received and their impact
  8. Hobbies - swimming most important to ask about
  9. Have they had surgery in the ear?
  10. Any other significant PMH?
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14
Q

What can cause a perforated round window?

A

Rapid changes in pressures (barotrauma)

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15
Q

What can cause a perforation in the tympanic membrane?

A
  1. Recurrent infection
  2. Iatrogenic causes (surgery etc)
  3. Trauma
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16
Q

What are the 4 most common organisms involved in chronic otitis media?

A
  1. Pseudomonas aeruginosa
  2. Staphylococcus aureus
  3. Streptococcus
  4. Anaerobic bacteria
17
Q

How do we medically manage a perforation in the tympanic membrane?

A
  1. Micro-suction and inspection of the ear under the microscope
  2. Topical Abx and steroid drop: 7-10 days if active infection
  3. Strict water precautions
18
Q

How do we surgically manage a perforation in the tympanic membrane?

A

Myringoplasty - repair of the eardrum

19
Q

What is a cholesteatoma?

A

This is a deep retraction of the tympanic membrane due to an accumulation of keratin which develops into a cyst as the keratin cannot migrate out of the ear canal

20
Q

What is a glomus jugulare?

A

A vascular tumour which presents as a red mass behind an intact tympanic membrane

21
Q

What might a patient complain of if they have a glomus jugulare?

A

Pulsatile tinnitus

22
Q

How would you manage a patient with cholesteatoma?

A
  1. Pure tone audiogram
  2. Topical Abx and steroid drop
  3. Close inspection of the ear
23
Q

How do we surgically manage a cholesteatoma?

A

Mastoidectomy - opening of the mastoid air cells, remove the cholesteatoma from the middle ear and reconstruction of the ossicles and tympanic membrane

24
Q

Define acute otitis media (AOM)?

A

An acute inflammatory process in the middle ear.

25
Q

When does AOM become Recurrent acute otitis media (RAOM)?

A

If there has been more than 4 episodes of AOM in a 6 month period

26
Q

Define Chronic Otitis media (COM)

A

An inflammatory condition affecting the middle ear for a period of 3 months or more.

27
Q

What sort of hearing loss occurs in someone with a middle ear effusion?

A

Conductive hearing loss

28
Q

What is the largest part of the tympanic membrane called?

A

Pars Tensa

29
Q

What is the smallest part of the tympanic membrane called?

A

Pars flaccida

30
Q

What are the 4 potential intra-temporal complications that can occur due to COM?

A
  1. Vertigo - inflammation that spreads from the middle ear to the labyrinth
  2. Hearing loss - conductive due to damage to the ossicles and tympanic membrane. Sensorineural if there is inflammation of the cochlea
  3. Acute otitis externa
  4. Facial weakness - erosion of the bony canal can expose the facial nerve
31
Q

What are the 4 potential extra-temporal complications that can occur due to COM?

A
  1. Meningitis - erosion of the tegmen and exposure of the dura
  2. Subdural abscess
  3. Temporal lobe abscess
  4. Sigmoid sinus thrombosis

ENT (5 decks)

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