Pathology of the Ear Flashcards
Where are conditions affecting the ear found?
Both adults and children, and in primary and secondary care
What are the symptoms of ear disease?
Varied;
- Pain (otalgia)
- Discharge
- Hearing loss
- Tinnitus
- Vertigo
- Facial palsy
What are the types of hearing loss?
- Conductive
- Sensorineural
What are the categories of abnormalities of the pinna?
- Congential
- Inflammatory
- Traumatic
- Infective
Give an example of a traumatic abnormality of the pinna?
Pinna Haematoma
What causes a pinna haemotoma?
Blunt injury to the pinna
Where are pinna haemotomas common?
In contact sport
What is a pinna haematoma?
Accumulation of blood between cartilage and perichondrium
What results from the accumulation of blood between cartilage and perichondrium in a pinna haemotoma?
Deprives the cartilage of its blood supply, and pressure necrosis of the tissue can occur
What does a pinna haemotoma require?
- Prompt drainage
- Measures to prevent re-accumulation
- Re-apposition of two layers if necessary
What happens if a pinna haemotoma is untreated, or poorly treated?
Leads to fibrosis and new asymmetrical cartilage development - cauliflower ear
Give an example of an infective abnormality of the pinna
Ramsey-Hunt palsy
What is Ramsey-Hunt palsy?
Facial nerve palsy caused by shingles of the facial nerve
How common is otitis externa?
Very common
What is otitis externa?
Infection and inflammation of the ear canal
Do you get discharge with otitis externa?
May do
How is otitis externa treated?
- Antibiotics
- Steroid drops
What are the common abnormalities of the tympanic membrane?
- Perforation
- Bulging and redness secondary to otitis media
What is otitis media with effusion known as?
Glue ear
Is glue ear an infection?
No
What happens in glue ear?
There is a build up of fluid and negative pressure in the middle ear
What is the result of the fluid in glue ear?
Means the tympanic membrane doesn’t vibrate as well, and so decreases the mobility of TM and ossicles, thus affecting hearing
What is dysfunctional in glue ear?
The Eustachian tube
What is wrong with the Eustachian tube in glue ear?
It stays closed all the time
What can glue ear predispose to?
Infection
Why does glue ear predispose to infection?
Due to stagnant fluid in the cavirty
How is glue ear managed?
- Most resolve spontaneously within 2-3 months
- Some may persist, and require grommets
What is otitis media?
An acute middle ear infection
Who is otitis media common in?
More common in infants and children in adults
What are the symptoms of otitis media?
- Otalgia
- Other non-specific symptoms, e.g. temperature
- Red, with or without bulging of the TM and loss of the normal landmarks
What are the complications of otitis media?
- Tympanic membrane perforation
- Facial nerve involvement
- Mastoiditis
- Intracranial complications
What allows otitis media to cause mastoiditis?
The mastoid air cells communicates with the middle ear cavity, which provides a potential route for middle ear infections to spread to the mastoid bone
What does mastoiditis require for treatment?
- IV antibiotics
- Surgery to drain
What are the intracranial complications of otitis media?
- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess
What is the middle ear in important anatomical relationship with?
The facial nerve
What is the anatomical relationship between the facial nerve and the middle ear?
The facial nerve, in particular the chorda tympani branch, runs through the middle ear cavity
How is the facial nerve seperated from the middle ear?
A very thin bony partition
What is the clinical relevance of the anatomical relationship between the middle ear and the facial nerve?
A middle ear infection may cause a lesion of the facial nerve
What are the pathologies of the vestibular apparatus?
- Vertigo
- Meniere’s disease
What is vertigo?
A symptom, rather than a condition itself
Sensation that you, or the environment, is moving or spinning
Give a common cause of vertigo
Benign paroxysmal positional vertigo
What can Meniere’s disease affect?
The vestibular and cochlear components of the inner ear
What are the symptoms of Meniere’s disease?
- Vertigo
- Hearing loss
- Tinnitus
- Feeling of pressure or fullness in the ear
How common is cholesteatoma?
Rare
What is the clinical feature of cholesteatoma?
Painless otorrhea
What is cholesteatoma usually secondary to?
Chronic/recurring ear infections and blockage of ET
What does a blockage of the ET cause?
A sucking, negative pressure, drawing the eardrum inwards, producing a retraction pocket at the top of the middle ear cavity
What results from the formation of a retraction pocket in the top of the middle ear cavity?
Skin cells get trapped, collect, and continue to grow in this small pocket within the middle ear
How does cholesteatoma progress?
Not malignant, but slowly grows and expands, eroding into structures;
- Ossicles
- Mastoid bone
- Cochlea
What is a cholesteatoma initially more likely to grow into?
Structures in the middle ear
What happens to a cholesteatoma over time?
It may grow into and erode structures in the inner ear or into the bone of the skull, then brain
How does the pharyngotympanic tube differ in infants?
It is shorter and more horizontal
What is the result of the pharyngotympanic being shorter and more horizontal in infants?
- Easier passage for infection from the nasopharynx to the middle ear
- Tube can block more easily
What problems does a blockage of the pharyngotympanic tube do?
Compromises ventilation and drainage of middle ear, and increases risk of middle ear infection
