Pathology of the ear

Question 1

What is otitis media?

Answer 1

Inflammation of the middle ear

Question 2

What is a cholesteatoma?

Answer 2

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

Question 3

What are some of the problems associated with cholesteatoma?

Answer 3

Infection

Destruction of the ossicles

Spread through base of skull into brain

Question 4

What is the usual cause of otitis media?

Answer 4

Usually viral

Occasionally bacterial

Strep. Pnuemoniae

H. Influenzae

Moxarella Catarrhalis

Question 5

Which areas are commonly affected by cholesteatoma?

Answer 5

Superior posterior middle ear and/or petrous apex

Question 6

What is the pathogenesis of acquired cholesteatoma?

Answer 6

Chronic otitis media and perforated tympanic membrane

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

Question 7

What is a vestibular schwannoma?

Answer 7

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

Question 8

What are some of the symptoms of a vestibular schwannoma?

Answer 8

Hearing loss

Difficulty with balance and/or dizziness

Tinnitus

Pressure in ears

Facial pain

Headaches

Question 9

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

Answer 9

Neurofibromatosis type 2

Question 10

What symptoms are involved in the ‘D’ syndrome?

Answer 10

Deafness

Discomfort

Discharge

Dizziness

Din Din (tinnitus)

Destruction by disease

Defective movement of the face

Question 11

What kinds of deafness are there?

Answer 11

Conductive

Sensorineural

Mixed (conductive & sensorineural)

Central

Question 12

What is conductive hearing loss?

Answer 12

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

Question 13

What is sensorineural hearing loss?

Answer 13

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

Question 14

What is central hearing loss?

Answer 14

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

Question 15

Which nerves can cause earache?

Answer 15

V

VII

IX

X

C2, C3

Question 16

What can cause ear discharge?

Answer 16

Acute otitis media

Chronic otitis media

Cerebrospinal fluid

Question 17

What can cause ear destruction by disease?

Answer 17

Cholesteatoma

Question 18

What does this image show?

Answer 18

Cholesteatoma

Question 19

What is otitis externa?

Answer 19

Inflammation of the external ear canal

Question 20

What can cause otitis externa?

Answer 20

Bacterial or fungal infection

Dermatitis

Question 21

What are the signs and symptoms of otitis externa?

Answer 21

Pain - worsened when external ear touched or pulled gently

Discharge - if too much, causes conductive hearing loss

Itch

Redness and swelling

Question 22

What are the bacterial causes of otitis externa?

Answer 22

Staphylococcus aureus
Proteus spp
Pseudomonas aeruginosa

Question 23

What are the fungal causes of otitis externa?

Answer 23

Aspergillus niger
Candida albicans

Question 24

What is the treatment for otitis externa?

Answer 24

Topical aural toilet

Question 25

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

Answer 25

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

Question 26

What are the symptoms of acute otitis media?

Answer 26

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

Question 27

What is acute otitis media?

Answer 27

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

Question 28

Which patients is acute otitis media most common in?

Answer 28

Infants and children

Question 29

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

Answer 29

Haemophilus influenzae Streptococcus pneumoniae Streptococcus pyogenes

Question 30

What is chronic otitis media?

Answer 30

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

Question 31

What are the symptoms of chronic otitis media?

Answer 31

Discharge with associated conductive hearing loss Follows an ear infection

Question 32

What is otitis media with effusion commonly called?

Answer 32

Glue ear

Question 33

What is otitis media with effusion?

Answer 33

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

Question 34

What are the symptoms of glue ear?

Answer 34

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

Question 35

Which condition is being shown here?

Answer 35

Acute otitis media Notice the red and angry inflammation

Question 36

Does glue ear present with otalgia?

Answer 36

No

Question 37

What are the signs of glue ear?

Answer 37

Conductive hearing loss with tuning fork Reduced tympanic membrane movement Altered TM colour TM retraction Visible fluid line/bubbles

Question 38

What is the treatment for glue ear?

Answer 38

Waiting - usually self-limiting Grommets (If \>3 years, second intervention is adenoidectomy)

Question 39

When should glue ear be referred?

Answer 39

If symptomatic and condition persists \>3 months

Question 40

What kinds of cholesteatoma are there?

Answer 40

Congenital Acquired

Question 41

What are acquired cholesteatomas?

Answer 41

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

Question 42

What are congenital cholesteatomas?

Answer 42

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

Question 43

What are the criteria that define a cholesteatoma as congenital?

Answer 43

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

Question 44

What are the symptoms of cholesteatoma?

Answer 44

Discharge Conductive hearing loss