Week 5/6 - ENT - Ear Conditions Flashcards
1
Q
Otitis Externa
What is it?
Clinical Features
Management
Complications
A
- ) What is it? - inflammation of external ear canal
- often caused by P. aeruginosa and S. aureus - ) Clinical Features
- ear pain, itch, discharge, hearing loss
- swollen, red, or eczematous ear canal/external ear - ) Management
- topical antibiotics: otomize ear spray (neomycin, dexamethasone, acetic acid) for 7-14 days
- codeine can be given for additional pain relief - ) Complications - malignant otitis externa (osteomyelitis)
- immunocompromised: spreads into mastoid and temporal bones
- fatal condition, should refer immediately
2
Q
Acute Otitis Media (AOM)
What is it?
Clinical Features
Management
Complications
A
- ) What is it? - acute inflammation of the middle ear
- usually in young children (0-4) - ) Clinical Features
- ear ache, fever, crying, poor feeding, cough
- tympanic membrane is red/yellow/cloudy or bulging - ) Management
- usually resolves spontaneously after a few days
- oral amoxicillin (5-7days) if patient is seems very unwell or has high risk of complications e.g. <2 yrs (clarithromycin if penicillin allergic)
- surgery is rare(laryngotomy?) - ) Complications - require immediate referral
- meningitis, mastoiditis, intracranial abscess, sinus thrombosis, facial nerve paralysis
3
Q
Otitis Media w/ Effusion (glue ear)
What is it?
Clinical Features
Management
A
- ) What is it? - collection of fluid within the middle ear space WITHOUT signs of acute inflammation
- usually in young children (2-5 yrs) - ) Clinical Features
- ear pain w/ hearing loss, effusion under otoscopy - ) Management
- most resolve spontaneously after 2-3 months
- grommets can be used to maintain equilibration of pressures
4
Q
Chronic Suppurative Otitis Media (CSOM)
What is it?
Clinical Features
Management
A
- ) What is it? - chronic inflammation of the middle ear and mastoid cavity, presenting w/ recurrent otorrhoea through a tympanic perforation
- complication of acute otitis media - ) Clinical Features
- otorrhoea (>2w) w/out pain or fever +/- hearing loss
- h/o AOM, glue ear, ear trauma, or grommets
- painless ear exam w/ TM perforation
3.) Management - referral to ENT
5
Q
Cholesteatoma
What is it?
Clinical Features
Management
A
- ) What is it? - accumulation of keratinizing squamous epithelium within the middle ear
- secondary to chronic ET dysfunction (retraction of pars flaccida of the TM forms a pocket, trapping cells) - ) Clinical Features
- painless, smelly otorrhoea +/- hearing loss - ) Management - semi-urgent referral to ENT
- can treat with antibiotics if also presents with otitis externa/media
- mastoid surgery leaves mastoid cavity
6
Q
Referred Pain to the Ear
Nose and Sinuses Teeth and TMJ Parotid Gland Tongue and Oropharynx Larnxy and Laryngopharnx Oesophagus Cervical Spine
A
- ) Nose and Sinuses (Vb) - e.g. sinus infection
- ) Teeth and TMJ (Vc) - e.g. tooth abscesses, cavities, impacted molars, TMJ dysfunction
- ) Parotid Gland (Vc) - e.g. parotiditis
- ) Tongue and Oropharynx (Vc, XI) - e.g. tonsillitis, pharyngitis, tumours of the oropharynx
- ) Larynx and Laryngopharynx (X) - e.g. goitre, thyroid tumours, vocal cord cancers
- ) Oesophagus (X) - e.g. GORDs
- ) Cervical Spine (C2/3) - e.g. osteoarthritis, disc herniation, spinal stenosis
7
Q
5 causes of sensorineural hearing loss
Presbyacusis Noise Induced Acoustic Neuroma Meniere's Disease Congenital Deafness
A
- ) Presbyacusis - gradual hearing loss in elderly
- bilateral, symmetric, high-frequency loss - ) Noise-Induced - gradual hearing loss w/ tinnitus
- bilateral, symmetric, loss at 4000Hz
- most common cause - ) Acoustic Neuroma - gradual hearing loss w/ tinnitus
- unilateral, any abnormal configuration in audiometry
- MRI required to exclude in unilateral hearing loss
- possible facial nerve weakness and unsteadiness - ) Meniere’s Disease - sudden hearing loss w/ tinnitus and episodic vertigo w/ N/V
- unilateral low frequency loss - ) Congenital Deafness - due to many factors, tests:
- automated otoacoucstic emission test (AOAE)
- automated auditory brainstem response (AABR)
- management: hearing aids or surgical intervention
8
Q
Audiometry
Indication Pure Tone Threshold Masking Sensorineural (2 examples) Conductive (1 example)
A
1.) Indication - patient presenting with diminished hearing with no signs of infection or eax/foreign body
- ) Pure Tone Threshold - softest sound a patient can hear at each frequency 50 percent of the time
- air conduction: tested using earphones
- bone conduction: uses bone conduction oscillator
3.) Masking - block the ear that isnt being tested with other noise
- ) Conductive
- wax: hearing loss across all frequencies
- TM perforation: low-mid freq hearing loss - ) Sensorineural
- noise-induced: bilateral loss at specific freq (4000Hz)
9
Q
Rinne’s and Weber’s Test
A
Rinne’s - tests conductive hearing (place on mastoid process)
- positive test is normal (air > bone conduction)
- negative test is abnormal ( bone > air conduction)
Weber’s - tests sensorineural and conductive hearing (place on middle of forehead)
- negative test is normal (equally loud in both ears)
- conductive: louder in impaired ear
- sensorineural: louder in unimpaired ear
10
Q
Red flags for urgent/immediate ENT referral
A
- ) Sudden Onset Sensorineural Hearing Loss
- can’t be explained by external or middle ear causes
- sudden onset means over 3 days or less
- immediate (24h) if <30 days, urgent (2w) if >30 day - ) Unilateral Hearing Loss w/ Focal Neurology
- e.g. facial nerve palsy
3.) Hearing Loss w/ associated H/N injury
- ) Suspected H/N Malignancy
- otitis media w/ effusion in adults w/out recent URTI
- bloody otorrhoea - ) Mastoiditis - inflammation of mastoid air cells
- can be caused by persistent AOM or cholesteatoma
- mastoid tenderness/swelling, fever, very unwell, hearing loss
