Path Flashcards
external ear histology
Auditory meatus and external canal are lined by epidermis (skin – stratified squamous)
Dermis contains hair follicles, sebaceous and ceruminous glands (made by apocrine glands)
(superficial to deep)
middle ear histology
Columnar lined mucosa
nose histology
Nasal vestibule – squamous epithelium (skin)
Nose, sinus etc. – respiratory epithelium (pseudostratified ciliated columnar). Sero-mucinous gla
throat histology
squamous epithelium depending
resp epithelium under larynx in trachea
salivary glands types of cells
acinar and ductal
ducts lined by columnar/cuboidal epithelium
Serous cells – darkly staining. Contain digestive enzymes including amylase
Mucinous component – clear grey staining. Contain glycoproteins
Myoepithelial cells – often flat or cuboidal with clear cytoplasm. Have some contractile properties
Otitis Media
Inflammation of middle ear
children
usually viral/ bacterial – Strep. pnuemoniae, H. influenzae and Moxarella catarrhalis
chronic – Pseudomonas aeruginosa, Staph aureus, fungal
Otitis Media symptoms
pain
fever
irritability
anorexia
vomiting
often after a viral upper respiratory tract infection
acute otitis media symptoms
impaired hearing and fever
discharge when the tympanic membrane perforates with relief of pain.
bacterial
chronic otitis media
persistent pain lasting a couple of weeks after the initial episode
glue ear, cholesteatoma, perforation
Cholesteatoma
Acquired - chronic otitis media and perforated tympanic membrane
accumulation of skin, squamous epithelium/keratin within the middle eat cleft and mastoid air cells- dead skin in middle ear
goes backwards into mastoid and erodes bone
congenital- Proliferation of embryonic rest
Superior posterior middle ear/ petrous apex or anterior superior
Macro – pearly white mass in middle ear
Micro – squamous epithelium with abundant keratin production. Associated inflammation
Cholesteatoma symptoms
persistent foul smelling discharge, headache and otalgia
area of white in the attic behind the tympanic membrane
Cholesteatoma management
surgery
ear tumours
SSC- most common
or BCC
chronic inflammation or radiation
vestibular schwannoma
benign subarachnoid tumour causes pressure on vestibular portion of vestibulocochlear nerve (VIII)
in Internal Auditory Meatus
in temporal bone
cerebellopontine angle tumours
mostly sporadic and unilateral
may be due to exposure to loud noise
Vestibular Schwannoma symptoms
asymmetric or unilateral hearing loss and progressive ipsilateral tinnitus
dizzyness
headaches
Vestibular schwannoma investigations and management
MRI
40mm + surgery
under then 6 monthly MRI and surveillance
rhinitis
Infectious rhinitis – common cold (viral)
Allergic rhinitis – hay fever. IgE mediated type 1 hypersensitivity reaction.
Sinusitis
most commonly preceded by rhinitis, but can spread from dentition
Nasal polyps causes
- Occur with inflammation and oedema of the sinus nasal mucosa
- This oedematous mucosa prolapses into the nasal caviity and can cause significant obstruction
common in adults ,If young – consider cystic fibrosis
causes -allergy, infection, asthma, aspirin sensitivity, nickel exposure
Micro – allergic aetiology associated with eosinophils.
Nasal polyps histology
Lined by respiratory or squamous epithelium, oedematous stroma containing mixed inflammatory cells +/- eosinophils
nasal polyps symptoms
- Blocked nose
- Runny nose
- Reduced sense of taste or smell
nasal polyps investigations and management
Nasoendoscopy
- Treat with oral then topical steroids
- If the polyps are large or unresponsive surgical removal is necessary
otitis media treatment
if doesn’t resolve in 4 days then amoxicillin or erythromycin
ear drops- Neomycin, Gentamicin, Polymyxin B
Framycetin
fungal- Aspergillus niger
Candida albicans
SCC symptoms
- Firm, red nodules and sores on skin of the ear
- Discomfort in the affected ear
- Hearing problems
- Tinnutus
- Vertigo
mri?
other possible ear tumours
Ceruminous adenoma/adenocarcinoma, meningioma, middle ear adenoma, aggressive papillary tumour
rhinitis treatment
Nasal irrigation with saline
antihistamines
if no change then intranasal steroids
sinusitis treatment
antibiotics for severe/deteriorating cases of >10 days duration, 1ST LINE phenoxymethylpenicillin, 2ND LINE doxycycline – NOT IN CHILDREN!!!
sinusitis symtoms
- nasal blockage or nasal discharge with facial pain/pressure (or headache) and/or reduction of the sense of smell
- Severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
Granulomatosis with polyangiitis/ wegners
Rare autoimmune disorder characterized by inflammation of small- and medium-sized blood vessels (vasculitis)
40 +
cancer
wegners symptoms
sinusitis, nasal crushing, epistaxis, mouth ulcers, sensorineural deafness, otitis media and deafness, ‘saddle nose’ (due to cartilage damage from ischaemia), subglottic inflammation
kidney necrosis
wegners signs
ANCA positive
microscopic polyangiitis
wegners managemnt
IV steroids and cyclophosphamide/chemo
Eczematous Otitis Externa treatment
steroid without antibiotic is preferred.
Antibiotics, particularly neomycin and gentamicin, may cause local sensitivity
exposure to water
Otitis Externa- what is it and causes
Inflammation of the skin of the ear canal
Almost always infective
bacterial/fungal
Common causes - water, cotton buds, skin conditions
glue ear causes adults
blocked eustachian tube/obstruction
check back of nose-
Rhinosinusitis
Nasopharyngeal Carcinoma
Nasopharyngeal Lymphoma
perforation of ear drum
Commonly due to Acute Otitis Media
usually heals by itself or wont due to infection - water/cotton bud
Complications of Acute Otitis Media and Cholesteatoma
Medially-
Sensorineural Hearing Loss /Tinnitus / Vertigo / Facial Palsy
Superiorly-
Brain Abscess / Meningitis
Posteriorly-
Venous Sinus Thrombosis
