Week 1.1 - Outer and Middle Ear

Question 1

What is auricular haematoma?

Answer 1

blood collecting in layer between perichondrium and cartilage, restricting blood supply to cartilage. deprivation of this supply may lead to cauliflower ear - necrosis of cartilage.

Question 2

How do you treat auricular haematoma?

Answer 2

• incision and drainage before cauliflower ear occurs.
• pressure dressing to prevent re-accumulation
• antibiotics to prevent infection of cartilage

Question 3

How do you manage a foreign body in the outer ear?

Answer 3

usually children, varying urgency.
- button battery remove within hours to prevent corrosion
- organic remove within days to prevent infection
- inorganic can be weeks

Question 4

What is otitis externa?

Answer 4

• most common ENT
• inflammation of external auditory meatus, usually infection
• shows pain, discharge, itching and/or hearing loss (due to inflammation or discharge)

Question 5

How do you manage otitis externa?

Answer 5

• cilodex drops
• antibiotics for infection.
• steroids for inflammation
• may need suction out discharge to allow ear drops to get into ear
• advise to stay out of water and avoid cotton buds

Question 6

What is ‘malignant’ otitis externa?

Answer 6

• inflammation spreads throughout skull base
• osteomyelitis of temporal bone

Question 7

How do you treat ‘malignant’ otitis externa?

Answer 7

• ciprofloxacin topical and IV - continue for weeks or months.
• urgent CT
• few need surgical debridement

Question 8

How does malignant otitis externa present?

Answer 8

• severe pain
• usually in elderly and diabetics.
• very rare.
• see granulations in external auditory meatus.
• may spread to lower cranial nerve palsies

Question 9

What is otitis media with effusion and presentation?

Answer 9

• pus secreted from middle ear.
• hearing loss, maybe as speech delay, behavioural problems.

Question 10

How does ‘glue ear’ arise?

Answer 10

eustachian tube supposed to allow fresh air from nose into middle ear. middle ear absorbs gas. if this gas isn’t being replaced by fresh air via inadequately functioning eustachian tube, pressure lowers in middle ear and it secretes fluid.

Question 11

How do you treat otitis media with effusion?

Answer 11

• usually self-limiting
• otovent balloon (blow nose)
• Grommets (tube in ear drum for aeration)

Question 12

What is acute suppurative otitis media? management?

Answer 12

• pus in middle ear. increasing pain in ear, followed by discharge when ear drum bursts, resolving the pain
• just observe - self limiting. hold off antibiotics a few days - usually don’t need

Question 13

What is the name for ear pain and ear drainage?

Answer 13

otalgia and otorrhea

Question 14

What is tympanosclerosis?

Answer 14

• calcification of tympanic membrane and/or middle ear, as a consequence of previous infection or grommet insertion.
• seen as white patches with otoscope in many patients.

Question 15

What is the cause of chronic suppurative otitis media?

Answer 15

can be perforated tympanic membrane or cholesteatoma

Question 16

What is perforated tympanic membrane? and management?

Answer 16

• may be due to infection, trauma or grommet insertion.
• can present as recurring infections and/or hearing loss.
• keep water out, or myringoplasty.

Question 17

What is cholesteatoma?

Answer 17

maybe by eustachian tube dysfunction, pressure causes collapse of ear drum, forming pocket where skin can be trapped, and this can back up into the mastoid bone. leads persistent, offensive discharge from ear - red flag.

Question 18

How do you manage cholesteatoma?

Answer 18

• microscope to see dead skin
• suction out discharge
• may need mastoidectomy to drill into mastoid and remove cholesteatoma

Question 19

What are complications of chronic suppurative otitis media?

Answer 19

its chronic so..
- long term discharge from ear
- can spread to inner ear and cause complete hearing loss, meningitis or brain abscess
- can affect facial nerve which runs through middle ear - facial palsy

Question 20

What is otosclerosis?

Answer 20

• presents with conductive hearing loss and normal tympanic membrane
• stapes may be fixated with extra bone, so it cant move.
• need hearing aid, or stapedectomy - removal of stapes

Question 21

What is facial nerve palsy?

Answer 21

• facial nerve runs through middle ear and can be a victim of many pathologies
• see lower motor neurone facial palsy - forehead affected.

Question 22

How do you manage facial nerve palsy?

Answer 22

• manage underlying cause
• steroids for bell’s palsy proven to help
  -eye management - eye drops as many of them cant close their eyes properly

Question 23

What may cause facial nerve palsy?

Answer 23

• intratemporal bone issue - e.g. cholesteatoma
• extratemporal issue - parotid gland tumour

Question 24

What is Bell’s palsy?

Answer 24

diagnosis of exclusion! umbrella term for idiopathic facial nerve palsy. thorough examination and scanning done first to determine cause, but cant be found.