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ENT > Pathology of the ear > Flashcards

Pathology of the ear Flashcards

1
Q

What is otitis media?

A

Inflammation of the middle ear

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2
Q

What is a cholesteatoma?

A

A destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process

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3
Q

What are some of the problems associated with cholesteatoma?

A

Infection

Destruction of the ossicles

Spread through base of skull into brain

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4
Q

What is the usual cause of otitis media?

A

Usually viral

Occasionally bacterial

Strep. Pnuemoniae

H. Influenzae

Moxarella Catarrhalis

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5
Q

Which areas are commonly affected by cholesteatoma?

A

Superior posterior middle ear and/or petrous apex

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6
Q

What is the pathogenesis of acquired cholesteatoma?

A

Chronic otitis media and perforated tympanic membrane

Keratin accumulates in a pouch of tympanic membrane as a result of abnormal repair

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7
Q

What is a vestibular schwannoma?

A

A benign primary intracranial tumour of the myelin-forming cells of the vestibulocochlear nerve (8th cranial nerve)

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8
Q

What are some of the symptoms of a vestibular schwannoma?

A

Hearing loss

Difficulty with balance and/or dizziness

Tinnitus

Pressure in ears

Facial pain

Headaches

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9
Q

What should be considered if a young patient presents with bilateral vestibular schwannoma?

A

Neurofibromatosis type 2

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10
Q

What symptoms are involved in the ‘D’ syndrome?

A

Deafness

Discomfort

Discharge

Dizziness

Din Din (tinnitus)

Destruction by disease

Defective movement of the face

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11
Q

What kinds of deafness are there?

A

Conductive

Sensorineural

Mixed (conductive & sensorineural)

Central

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12
Q

What is conductive hearing loss?

A

Hearing loss when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane, or middle ear (ossicles)

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13
Q

What is sensorineural hearing loss?

A

A type of hearing loss in which the root cause lies in the vestibulocochlear nerve (CN VIII), the inner ear, or central processing centers of the brain

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14
Q

What is central hearing loss?

A

Hearing loss due to a problem in the central nervous system or the brain

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15
Q

Which nerves can cause earache?

A

V

VII

IX

X

C2, C3

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16
Q

What can cause ear discharge?

A

Acute otitis media

Chronic otitis media

Cerebrospinal fluid

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17
Q

What can cause ear destruction by disease?

A

Cholesteatoma

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18
Q

What does this image show?

A

Cholesteatoma

19
Q

What is otitis externa?

A

Inflammation of the external ear canal

20
Q

What can cause otitis externa?

A

Bacterial or fungal infection

Dermatitis

21
Q

What are the signs and symptoms of otitis externa?

A

Pain - worsened when external ear touched or pulled gently

Discharge - if too much, causes conductive hearing loss

Itch

Redness and swelling

22
Q

What are the bacterial causes of otitis externa?

A

Staphylococcus aureus
Proteus spp
Pseudomonas aeruginosa

23
Q

What are the fungal causes of otitis externa?

A

Aspergillus niger
Candida albicans

24
Q

What is the treatment for otitis externa?

A

Topical aural toilet

25
Q

When would a swab be taken in cases of otitis externa?

A

If unresponsive to oral toilet

Then treat depending on culture results.
E.g. topical clotrimazole (trade name canesten) for Aspergillus niger, along with thorough aural toilet

26
Q

What are the symptoms of acute otitis media?

A

Pain

Fever

Cough and nasal discharge may be present if preceded by throat infection

27
Q

What is acute otitis media?

A

An upper respiratory infection involving the middle ear by extension of infection up the eustachian tube

28
Q

Which patients is acute otitis media most common in?

A

Infants and children

29
Q

What are the most common causal bacteria of acute otitis media?

A

Haemophilus influenzae

Streptococcus pneumoniae

Streptococcus pyogenes

30
Q

What is chronic otitis media?

A

An ear infection that lasts for several weeks or more and has failed to resolve after perforation of the ear drum

31
Q

What are the symptoms of chronic otitis media?

A

Discharge with associated conductive hearing loss

Follows an ear infection

32
Q

What is otitis media with effusion commonly called?

A

Glue ear

33
Q

What is otitis media with effusion?

A

Accumulation of fluid in the middle ear due to a dysfunctional eustachian tube creating negative pressure in the middle ear

This draws secretions into the middle ear

34
Q

What are the symptoms of glue ear?

A

Deafness
Poor school performance
Behavioural problems
Speech delay
?Balance problems
?TV volume

35
Q

Which condition is being shown here?

A

Acute otitis media

Notice the red and angry inflammation

36
Q

Does glue ear present with otalgia?

A

No

37
Q

What are the signs of glue ear?

A

Conductive hearing loss with tuning fork

Reduced tympanic membrane movement

Altered TM colour

TM retraction

Visible fluid line/bubbles

38
Q

What is the treatment for glue ear?

A

Waiting - usually self-limiting

Grommets

(If >3 years, second intervention is adenoidectomy)

39
Q

When should glue ear be referred?

A

If symptomatic and condition persists >3 months

40
Q

What kinds of cholesteatoma are there?

A

Congenital
Acquired

41
Q

What are acquired cholesteatomas?

A

Cholesteatomas caused by pathological alteration of the ear drum leading to accumulation of keratin within the middle ear

42
Q

What are congenital cholesteatomas?

A

Caused by pathological alteration of the ear drum leading to accumulation of keratin within the middle ear

43
Q

What are the criteria that define a cholesteatoma as congenital?

A

Mass medial to the tympanic membrane
Normal tympanic membrane
No previous history of ear discharge, perforation or ear surgery

44
Q

What are the symptoms of cholesteatoma?

A

Discharge

Conductive hearing loss

ENT (4 decks)

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