Pathology of ear Flashcards
A. total absence of the auricle most often with narrowing or absence of the external auditory meatus.
B. condition in which the external portion of the ear (the auricle) is malformed. There is also narrowing or absence of the external auditory canal
C. anomaly in the tragus area. .
D. congenital malformation characterized by a nodule, dent or dimple located anywhere adjacent to the external ear. Susceptible to infection
Identify this conditions
A. Anotia (Atresia)
B. Microtia
C. Accessory auricle
D. Preauricular sinus
Laceration of the auricle
Hematoma auris
Perichondritis of the pinna is the nflammation of what?
Perichondrium, a layer of connective tissue, which surrounds cartilage.
What causes perichondritis of the pinna
Follow trauma (to cartilage, hematoma auri, surgical mastoid surgery, frostbie, burn) or otitis externa and piercing
The commonly causes of perichondritis of the pinna
Common caused by pseudomonas, fever, pain, redness and sweeling (causing narrowing anf further low hearing level)
Complications of perichondritis or trauma
Cauliflower ear (End stage of unrelated hematoma).—> Hematoma —> ischemia —> necrosis —-> ear deformity
What is otitis externa
An acute (Less than 3 months) or chronic (more than 3 months) infection of the whole or a part of the skin of the external ear canal. Any pathology affecting skin can also affect external ear
Pathophysiology of otitis externa
Pathophysiology: − Aggressive washing of wax or retention water ,Microtrauma (cotton swabs, fingernails). : An acute (Less than 3 months) or chronic (more than 3 months) infection of the whole or a part of the skin of the external ear canal. Any pathology affecting skin can also affect external ear
List the bacteria that causes Otiti externa
Pseudomonas (commonly in immunocompromised like diabetic, post radio or chemotherapy and it has a very bad smell if it present with cholesteatoma)
Staphylococcus aureus (furuncle) most common, like in swimming ear
List fungal microorganisms that causes the otitis externa
News paper apearance, aspergillus niger (spores forming, hyphae), candida albicans (whitesh and cheesy, cotton like) dx by seeing it.
Name virus that causes otitis externa
Herpes zoster
A diseases of the sebaceous glands charaterised by excessive secretion of sebum or an alteration in its quality, resulting in an oily coating, crusts, or scales on the skin. Usually painless
Seborrhea
A non contagious inflammtion of the skin, characterised chiefly by redness, itching
Eczama, dermatitis
A. Localize Otitis Externa:
B. Diffuse infective Otitis Externa:
C. Otomycosis:
d. Herpetic Otitis Externa:
E. Eczematous and seborrheic Otitis Externa: painless
differentiates this clinical types of otitis externa
Localize Otitis Externa: (furuncle): ○ small rounded swelling in the external canal.
Diffuse infective Otitis Externa: swimming ear ○ General narrowing of the canal
Otomycosis: fungal infection.
Herpetic Otitis Externa: Herpes Zoster oticus is a specific form of Herpes Zoster that presents with pre-eruptive (“pre-herpetic”) lesion reactivated from either the trigeminal or cervical ganglions. characterized by: Painful vesicles Complications: Facial n. paralysis
Eczematous and seborrheic Otitis Externa: painless
What is a referred earache?
pain in the ear due to a disease in an area supplied by a nerve that also supply the ear.
List cranial nerves and conditions that rsults to refered earache
Cervical II and III: Cervical spondylosis, neck injury (disc,muscle spasm)
V (Trigeminal): dental infections, sinonasal diseases
IX (glossopharyngeal): tonsilitis, pharyngitis, post-tonsillectomy, carcinoma.
X(vagus): tumors of hypopharynx, larynx and oesophagus
A rare disorder within the labyrinth of the inner ear that can lead to a progressive loss of hearing.
Meniere’s disease
List symptoms of Meniere’s disease
Vertigo, hearing loss, tinnitus, and the sensation of pressure in the ear. causes unknown
A benign tumor of the accoustic nerve sheath. Symptoms results from pressure exerted on surrounding tissue
Acoustic neuroma
Impairment of hearing from old age
Presbycusis
Acute or chronic infectious disease of middle ear
Otitis media
Otitis media occurs where?
Post pharyngitis via eustachian tube
Otitis media in children is usually caused by what?
Streptococcus penumoniae or haemophilus influenzae aso coinfection by viruses
In HIV+ patients, the otitis media is caused by what
Rrely caused by fungi or pneumocystis
Explain the tympanic membrane when the person is suffering from otitis media
Hyperaemic, opaque and bulging tympanic membrane with limited mobility, may have purulent otorrhea
In otitis media severe cases are associated with what?
Destruction of ossicles
what is tympanosclerosis
Dystrophic calcification of tympanic membrane or middle ear associated with recurrent cases of otitis media, occur in 3-33% of cases, may be reversible in children, usually irreversible in adults and associated with conductive hearing loss
What does a viral URTI or allergy results to
OTITIS MEDIA
results in congestion of the respiratory mucosa of the nose, nasopharynx and eustachian tube.
The congestion of the mucosa in the eustachian tube obstructs what?
Isthmus
Obstruction of the isthmus causes what?
Negative pressure followed by accumulation of secretions produced by the mucosa of the middle ear.
The secretions caused by isthmus obstruction accumulates where?
Middle ear space
Viruses and bacteria that colonize the upper respiratory tract can reach what ?
middle ear via aspiration, reflux or insufflation
Microbial growth in the middle ear may results in what?
Suppuration
Explain the pathophysiology of the otitis media
Viral URTI or allergy → results in Congestion of the respiratory mucosa of the nose, nasopharynx, and Eustachian tube →
Congestion of the mucosa in the Eustachian tube obstructs the isthmus.
Obstruction of the isthmus causes negative pressure followed by accumulation of secretions produced by the mucosa of the middle ear → these secretions have no egress and accumulate in the middle ear space → Viruses and bacteria that colonize the upper respiratory tract can reach the middle ear via aspiration, reflux, or insufflation → microbial growth in the middle ear secretions may result in suppuration.
Explain the clinical picture of otitis media
Tubal occlusion: produces early signs of acute otitis media. Discomfort, autophony (feeling own sounds), retracted drum (opposite of bulging) caused by pressure difference
There is mild deafness
Tinnitus in children, not adults
Suppurative inflammation of the middle ear: fever, severe earache, deafness, congestion and bulging drum (pus behind it).
List the complications associated ith Otitis media
Mastoiditis
Labyrinthitis
Meningitis
Abscess
List 2 variations in clinical presentation of otitis media
Chronic suppurative otitis media (CSOM)
Chronic serous otitis media
What is chronic serous otitis media
May be defined as a middle ear effusion without perforation that is reported to persist for more than 1-3 months
Define chronic suppurative otitis media
Defined as a perforated tympanic membrane with persistant drainage from middle ear for more than 2-6 weeks.
Chronic suppuration can occur?
With or without cholesteatoma, and the clinical history of both conditions can be very similar
Gross description of otitis media
Not a common specimen, but may have small fragments of soft/rubbery granulation tissue
Differential diagnosis of otitis media
Middle ear adenoma: regular, not haphazard, no cilia
Miscroscopic appearance of otitis media describe
Acute and chronic inflammatory cells, haphazard glandular metaplasia with cilia, fibrosis, hemorrhage, foci of calcification (tympanosclerosis), cholesterol granulomas and reactive bone formation
Cholesterol granulomas:foreign body granulomas in response to cholesterol crystals from rupture of red blood cells and breakdown of lipid bilayer in cell membrane, prominent cholesterol clefts; associated with interference to drainage or ventilation of middle ear space; not related to cholesteatomas
Benign nonneoplastic destructive lesion in the middle ear or mastoid
Cholesteatoma
What the cholesteatoma involves
May involve medial external canal with potential destruction of surrounding structures, including bone, ossicular chain, erosion into external ear, inner ear and cranial cavity
The cholesteatoma is unilateral or bilateral?
Unilateral
Histology appearance of cholesteatoma
Histology :Accumulation of nondysplastic keratinizing squamous epithelium and keratinous debris, with stromal fibrosis and associated inflammatory reaction, leads to destruction of adjacent structures (e.g., bone)
Untreated cholesteatoma complicates what?
Infected
Lead to conductive hearing loss
Intracranial mass: complication
Explain the acquired cholesteatoma
Acquired cholesteatoma Due to recurrent otitis media, traumatic or iatrogenic tympanic membrane perforation Usually occurs in superior posterior middle ear, posterior epitympanic (pars flaccida) or posterior mesotympanic (posterior superior quadrant of the pars tensa)
Explain the congenital cholesteatoma
Congenital cholesteatoma: Persistent epidermoid:squamous epithelium present in the fetus in middle ear mucosa adjacent to the tympanic membrane), that fails to resorb after 15 week gestationthey presumably continue to grow and develop into congenital cholesteatomas .Arise in the superior anterior middle ear, possibly in area of tensor tympani
- History of otitis media is present in most—————-
- Pathophysiology of otitis media
- Treatment of otitis media
History of chronic otitis media is present in most
include expansile pearly cyst within the middle ear or mastoid cavity
Pathophysiology is likely multifactorial and remains controversial
Treatment is surgical but may recur locally
