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ENT > Otorrhoea And Otitis Media > Flashcards

Otorrhoea And Otitis Media Flashcards

1
Q

What are the different types of discharge from the ears and what are their causes?

A

Otitis externa - scanty discharge - no mucinous glands
Trauma - blood
Liquid wax
Otitis media - mucinous discharge
Chronic otitis media - granular mucosa producing seroanguinous discharge
Cholesteatoma - offensive discharge
CSF otorrhoea - trauma - halo sign on filter paper, high glucose, tau transferrin

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2
Q

What are the symptoms of acute otitis media?

A

Rapid onset pain, irritability, fever, anorexia, vomiting

Often after a viral URTI

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3
Q

What are the common organisms causin acute otitis media?

A

Pneumococcus, haemophilus, moraxella and other streps/staphs

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4
Q

What are the signs of acute otitis media?

A

Bulging tympanic membrane (causes pain)

Pain eases when TM perforates - produces purulent discharge

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5
Q

What is the treatment for acute otitis media? When should you consider antibiotics?

A

Analgaesia
60% resolve in 24hrs without antibiotics
Consider antibiotics if: systemically unwell/immunocompromised/no improvement in over 4 days/perforation/discharge/under 3 months/over 2 with bilateral
Amoxicillin/erythromycin for 5 days

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6
Q

What is otitis media with effusion/glue ear?

A

Effusion present after symptoms of acute OM have regressed

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7
Q

What is chronic otitis media?

A

Tympanic membrane perforation in the setting of recurrent/chronic middle ear infection

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8
Q

What are the associated symptoms of chronic otitis media?

A

Hearing loss
Ottorhoea
Otalgia
Fullness

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9
Q

What is benign/inactive chronic otitis media?

A

Dry tympanic membrane perforation without active infection

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10
Q

What is chronic serous otitis media?

A

Continuous serous drainage from the ear

Typically straw-coloured

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11
Q

What is chronic suppurative otitis media?

A

Chronic purulent discharge through a perforated tympanic membrane

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12
Q

What is the treatment for chronic otitis media?

A

Topical/systemic antibiotics based on swab results
Aural cleaning
Water precautions
Careful follow-up
Surgery may be required (myringoplasty; mastoidectomy)

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13
Q

What are the complications of chronic otitis media?

A

Cholesteatoma

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14
Q

What are the serious, but rare complications of cholesteatoma?

A 
Meningitis
Cerebral abscess
Hearing loss
Mastoiditis
Facial nerve palsy
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15
Q

What is the peak age for cholesteatoma?

A

5-15 years

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16
Q

What is a cholesteatoma?

A

A retraction pocket of the pars tensa and flaccida caused by prolonged low middle ear pressure
Squamous cell epithelium builds up and can no longer escape the sac
Locally destructive around and beyond the pars flaccida from lytic enzymes

17
Q

What are the symptoms of a cholesteatoma?

A 
Foul discharge +/- deafness
Headache
Pain
Facial paralysis 
Vertigo
CNS complications
18
Q

What is the treatment for cholesteatoma?

A

Mastoid surgery needed to make safe dry ear by removing the disease

19
Q

What is mastoiditis?

A

Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation

20
Q

What should you be wary of in mastoiditis?

A

Intracranial extension

21
Q

How can mastoiditis be prevented?

A

By giving antibiotics for middle ear infections

22
Q

What are the signs of mastoiditis?

A

Fever
Tenderness, swelling and redness behind the pinna
Protruding auricle

23
Q

What imaging should be done for mastoiditis?

A

CT head

24
Q

What is the treatment for mastoiditis?

A

Admit for IV antibiotics
Myringotomy
+/- definitive mastoidectomy

25
Q

When is surgery considered in chronic otitis media?

A

Aural cleaning and antibiotics fail

Persistent perforation or discharge/conductive hearing loss/chronic mastoiditis/cholesteatoma formation

26
Q

What is myringoplasty?

A

Repair of the tympanic membrane
Perforation patched using a graft
Acts as a scaffold for the tympanic membrane to grow across
90% success rate

27
Q

What is the surgical intervention for people with mastoiditis/advanced cholesteatoma?

A

Tympanoplasty - surgical repair of the tympanic membrane and ossicles
Mastoidectomy - removal of air cells whilst maintaining posterior canal wall

Eradicates source of infection and reconstruct hearing mechanism

28
Q

What are the risk factors for otitis media?

A 
URTI
Autumn/winter
Bottle feeding
Passive smoking
Dummy/pacifier
Presence of adenoids
Asthma
Malformation e.g. cleft palate
GORD
High BMI in adults

ENT (2 decks)

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