Week 3: ENT 1 (common conditions of the ear) Flashcards
Otitis externa Background
an inflammatory condition of the outer ear that can affect the auricle, external auditory canal and external surface of the tympanic membrane.
causes of otitis externa
bacterial
presentation of otitis externa
- erythema of the auricle and external auditory canal with associated pain.
- Other findings may include oedema of the auditory canal causing narrowing, regional lymphadenopathy and discharge in the ear canal
investigations for otitis externa
otoscopy
management of ototis externa
- Self-care advice e.g. no cotton buds, keep ears clean and dry, over-the counter acetic acid ear drops
- Aural toileting
- Advice on analgesia
- Consider prescribing topical antibiotic (oral if immunocompromised)with or without topical corticosteroid 7-14 days
otosclerosis background
- One of the most common causes of acquired hearing loss in young adults
- Ossicles fused at articulations due to abnormal bone growth particularly between base plate of stapes and oval window
- Sound vibrations cannot be transmitted effectively to cochlea
causes of otosclerosis
- Both genetic and environmental
- Exact cause unknown
presentation of otosclerosis
- Present with gradual unilateral or bilateral conductive hearing loss
investigation for otosclerosis
- Audiometry
- CT scan
management of otosclerosis
- Hearing aid
- Surgery stapedectomy prosthetic device in middle ear to bypass abnormal bone and permit sounds waves to travel to inner ear and restore hearing
background menieres disease
- Disorder affecting the inner ear which affects balance and hearing
- Syndrome characterised by episodes of vertigo, fluctuating hearing loss and tinnitus
- Associated with feeling of fullness
causes of menieres disease
- Usually unknown
- General view that abnormal endolymph production and / absorption is associated
- Risk factors: autoimmunity, genetic susceptibility, metabolic disturbances, vascular factors, viral infection, head trauma
presentation of menieres disease
- Vertigo, tinnitus, hearing loss, aural fullness
- H and N finding normal
- Romberg test negative
investigation for MD
- To confirm diagnosis refer to ENT
- Audiology assessment
management of MD
- Reassure patient that vertigo should get better within 24hours
- Advise not to drive when dizzy
- Symptomatic treatment
- Admit people with severe symptoms for IV labyrinthine sedative and fluids to maintain hydration and fluid
- Antiemetics
Age related hearing loss- presbycusis background
Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs in most of us as we grow older
cause sof presbycusis
- can be both S and C
- changes in anatomical structures of the ear e.g.
- Inner ear
- Middle ear
- Vestibular cochlear nerve
- Loud noise
- Loss of hair cells
- Aging
- Ototoxic drugs
presentation of prebycusis
- Bilateral hearing loss
- Gradual change
- High-pitched noises hardest to hear
- Speech sounds slurred
- Some sounds overly loud
- tinnitus
investigations for presbycusis
- Otoscope
- audiogram
management of presbycusis
- Hearing aids
- Assistive devices e.g. telephone amplifier
- Training in speech reading
- Techniques for preventing excess wax
Noise related hearing loss background
- Permanent hearing loss caused by being around loud noises over a long time or a very loud noise e.g. explosion
- Sensorineural
- Shearing forces of sound energy impact on the stereocilia of hair cells of the basilar membrane of the cochlea
presentation of noise related hearing loss
- Bilateral hearing loss
- Aural fullness
- Muffled speech
- Tinnitus
investigations for noise related hearing loss
- Rinne’s positive (AC>BC)
- Weber lateralises to good ear
management of Noise related hearing loss
hearing aids
Mastoiditis background
- Middle ear cavity communicates via mastoid antrum with mastoid air cells
- Provides a potential route for middle ear infections to spread into the mastoid bone (mastoid air cells)
- Osteomyelitis
causes of mastoiditis
- Complication of unresolved otitis media- bacterial infection
presentation of mastoiditis
- fever,
- irrationality,
- swelling of the ear lobe,
- redness and tenderness behind the ear,
- drainage of the ear,
- bulging and drooping of the ear.
investigations of mastoiditis
- Otoscope
- Ear culture
- Blood test
- CT scan
mastoiditis management
- IV antibiotics
- Mastoidectomy
- Myringotomy- drain middle ear
Dry tympanic perforation background
hole in the eardrum, usually heals in a few weeks and might not need any treatment
causes of dry TP
- Ear infection
- Injury to eardrum such as foreign body
- Changes in pressure
- Loud noise e.g. explosion
presentation of dry TP
- Hearing loss
- Earache
- Itching
- Fluid leaking
- High temp
- tinnitus
investigastions for dry TP
otoscopy
managmenrt of dry TP
- Infection caused by perforated eardrum → antibiotics
- Usually self limiting if small
- If big hole → surgery for perforated eardrum
cholesteoma background
- Rare- should not be missed
- Not a tumour or related to cholesterol
- Potentially serious- not malignant but slowly grows and expands
- Can erode ossicles, mastoid/petrous bone, cochlea via enzymatic action
pathophysiology of cholesteoma
- If chronically increased negative ear pressure in the middle ear – the pars flaccida will start to retract →forms a sac/pocket
- Trapping stratified squamous epithelium and keratin → collecting in the retraction pocket
- Proliferates forming cholesteatoma
- Usually secondary to chronic eustachian tube (ET) dysfunction
presentation of cholesteoma
- Painless, often smell otorrhea (ear discharge) +/- hearing loss
Acute otitis media background
- is an inflammatory condition of the middle ear
- Causes viruses and bacteria.
presentation of AOM
- Typical findings on otoscopy include a bulging red, yellow or cloudy tympanic membrane with an associated air-fluid level behind the membrane.
- There may also be discharge in the auditory canal if the tympanic membrane has perforated.
nvestigation of AOM
otoscopy
management of AOM
- Antibiotics
- Regular analgesia
chronic suppurative otitis media
- a complication of otitis media - chronic inflammation of the middle ear and mastoid cavity, leading to tympanic perforation
chronic suppurative otitis media presentation
- Most common in childhood
- Recurrent ear discharge (otorrhoea) through without pain or fever >6 weeks
- History of ear problems
- Conductive hearing loss
- Occasional otalgia or true vertigo
chronic suppurative otitis media otoscopic findings
- Painless examination
- Evidence of tympanic membrane perforation
- Inflammation with otorrhea
management of Chronic suppurative otitis media
- Topical antibiotics with or without steroids, aural toileting (antiseptic ear cleaning)
otitis media with effusion
- ‘glue ear’, is a condition characterized by a collection of fluid within the middle ear space without signs of acute infection- like hearing under water
- Due to blockage of the eustachian tube- air pressure cannot equilibrate and mucus cannot drain
causes of otitis media with effusion
- More common in children
- Acute otitis media
- Eustachian tube dysfunction
- Low grade viral or bacterial infection
presentation of acute otitis media with effusion
- Hearing loss
- Intermittent ear pain with fullness
- Aural discharge
- Recurrent ear infections
- Otoscope- usually no signs of inflammation or discharge on examination
- Straw coloured TM
- Loss of light reflex
- Opacification of drum
- Fluid level (makes ossicles move less easily- like hearing under water
- Retracted
management of acute otitis media with effusion
- Watch and wait
- Hearing tests
- Autoinflation→ nasal balloon → ventilating middle ear two to three times a day
- Hearing aids
cauliflower ear
- is an irreversible condition that develops as a result of repeated blunt ear trauma.
- Blunt trauma causes bleeding under the perichondrium of the pinna, stripping away the ear’s cartilage.
- This cartilage normally relies on the perichondrium for its nutrient supply and as a result, once separated it becomes fibrotic, causing distortion of the ear’s architecture
anotia
complete absence fo the pinna (congenital deformity)
microtia
underdevelopment of the pinna (congenital deformity)
low set ears
the ears are positioned lower on the head than usual. Low-set ears are a feature of several genetic syndromes including Down’s syndrome and Turner’s syndrome.
infective causes of pinna abnormalities
-
E.g. Ramsey hunt syndrome
- Unilateral face droop and red ear with vesicles
-
Perichondritis
- Layer which coats the cartilage and provides blood supply
- Causes by infection introduced by ear piercings/ insect bites
- Needs ABx
traumatic causes of pinna abnormalities
pinna haematoma
pinna haematoma
-
accumulation of blood between the cartilage and its overlying perichondrium from blunt injury
- Common in contact sport
- Subperichondrial haematoma deprive cartilage of blood supply, increase in blood build up = increased pressure= necrosis of tissue
treatment of pinna haematoma
- Drainage and prevent re-accumulation/re-apposition of two layers
- Untreated→ fibrosis, new asymmetrical cartilage development→ cauliflower deformity)
pathophysiology of benign paraoxysmal positional vertigo
Caused by crystals that forms within the tubes of the vestibular apparatus→ crystal dislodge → create movement in the fluid→ movement of stereocilia → signals via AP when we are still
presentation of BPPV
- Vertigo only (most common cause)
- Only upsets vestibular apparatus)
- Short lived episodes (seconds): triggered by movement of head e.g. tuning over in bed, bending down
management of BPPV
- Dix- Hallpike and Epley manoeuvres dislodging crystals
infections (URTI) which can affect the apparatus within the ear
acute labyrinthitis and acute vestibular neuronitis
acute labyrinthitis vs acute vestibular neuronitis
Acute labyrinthitis
- Involvement of all inner ear structures, associated with hearing loss/tinnitus, vomiting and vertigo
Acute vestibular neuronitis
- Just affects the vestibular
- No hearing disturbances or tinnitus
- Sudden onset of vomiting and severe vertigo (lasting days)
Causes of conductive hearing loss include
- excessive ear wax
- otitis externa
- otitis media
- perforated tympanic membrane
- otosclerosis.
