Outer Ear

Question 1

What is otitis externa?

Answer 1

Inflammation of the outer ear caused by bacterial or fungal infection

Question 2

What bacteria are associated with otitis externa?

Answer 2

Pseudomonas aeruginosa

Staphylococcus aureus

Question 3

What fungi are associated with otitis externa?

Answer 3

Candida albicans

Aspergillus niger

Question 4

What organism causes black lesions in otitis externa?

Answer 4

Aspergillus niger

Question 5

How does otitis externa present?

Answer 5

Commonly in swimmers

Inflammed skin in outer ear

Itch

Discharge

Conductive hearing loss

Question 6

What is the mainstay of otitis externa management?

Answer 6

Ear cleaning (topical aural toilet)?

Question 7

What treatments are there for persistent

1. bacterial
2. fungal

otitis externa?

Answer 7

1. Gentamicin drops

2. Topical cotrimoxazole

Question 8

What is a risk factor for otitis externa?

Answer 8

Swimming

Question 9

What is malignant otitis externa?

Answer 9

Extension of otitis externa infection into mastoid/temporal bones

Question 10

What organism most commonly causes malignant otitis externa?

Answer 10

Pseudomonas aeriginosa

Question 11

How does malignant externa present?

Answer 11

Pain worse than clinical picture suggests

Exposed bone in ear canal

Granulation tissue at bone-cartilage junction

Question 12

What does untreated malignant otitis externa progress to?

Answer 12

Infection spreads into skull and meninges causing fatal meningitis

Question 13

What are the two types of temporal bone fracture and how do they differ?

Answer 13

Longitudinal and transverse

Longitudinal fracture lines are parallel to petrous part of the temporal bone

Transverse fractures lines are perpendicular to petrous part of temporal bone

Question 14

How do temporal bone fractures present?

Answer 14

History of blunt trauma

Battle sign (pre-auricular bruising)

Hearing loss

Question 15

How do longitudinal temporal bone fractures present?

Answer 15

Battle sign

Lateral blows

Conductive deafness

Bleeding
CSF leak

Question 16

How do transverse temporal bone fractures present?

Answer 16

Battle sign

Frontal blow

Sensorineural deafness

Vertigo (CN VIII damage)
Facial drooping (CN VII damage)

Question 17

What is a pinna haematoma?

Answer 17

Blood collection within auricle caused by traumatic separation of perichondrium form cartilage

Question 18

How do pinna heamatoma present?

Answer 18

Tender auricular swelling after ear trauma

Question 19

What are the options for pinna haematoma management?

Answer 19

Needle aspiration
Incision and drainage
Pressure draining

Question 20

How do manage ear lacterations?

Answer 20

Transport loose pinna pieces in ice wrapped in gauze

Debride any damaged/infected tissue

Suture pinna together under local anaesthetic

5-day-course of antibiotics if from a bite or looking nasty

Question 21

In what injury mechanism for ear lacerations are debridement ant antibiotics particularly important?

Answer 21

Dog bites

Question 22

What is a complication of untreated pinna haematoma?

Answer 22

Cauliflower ear

Question 23

What type of hearing loss do you get in transverse/longitudinal temporal bone fractures and why?

Answer 23

Transverse: sensorineural (damage to CN VIII)

Longitudinal: conductive (haemotympanum or ossicular chain disruption)