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Neurology and special senses (Y4) > 1-Ears (Infection and tumours) > Flashcards

1-Ears (Infection and tumours) Flashcards

(46 cards)

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1
Q

types of ear infections

A

otitis externa
malignant otitis externa
acute otitis media
chronic supprative otitis media
Otitis media with effusion
Mastoiditis

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2
Q

types of ear tumours

A

acoustic neuroma

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3
Q

Otitis externa
Background

A
  • Is an inflammatory condition of the outer ear that can affect the auricle, external auditory canal and external surface of the tympanic membrane.
  • Can be acute <3 weeks or chronic
  • Sometimes known as swimmers ear
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4
Q

otitis externa causes

A

Bacterial infection- most commonly
- Pseudomonas aeruginosa
- Staph aureus

Others
- Fungal infections
- Eczema
- Contact dermatitis
- Antibiotics for non bacterial infection -> fungal infections more likely

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5
Q

otitis media presentation

A

Presentation
- Ear pain
- Discharge
- Itchiness
- Conductive hearing loss
- Examination
o Erythema and swelling
o Lymphadenopathy

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6
Q

Investigations otitis externa

A
  • Otoscopy
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7
Q

management of mild otitis externa

A
  • Acetic acid – antifungal and antibacterial effects
  • Ensure that the patient is advised to keep the ear dry for the next 7-10 days.
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8
Q

manageemnt of moderative otitis externa

A
  • Topical antibiotic and steroid e.g. neomycin, dexamethasone and acetic acid -> Otomize ear spray
  • Beware of aminoglycosides (gentamicin)-> ototoxic, esp if undiagnosed perforation
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9
Q

management of severe otitis externa

A
  • Oral antibiotics e.g. fluclox or clarithromycin
  • Ear wick

Indication for oral abx
Cellulitis extending beyond the external ear canal
When the ear canal is occluded by swelling and debris, and a wick cannot be inserted
People with diabetes or compromised immunity, and severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa

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10
Q

ear wick

A

Where the meatus is completely occluded and there is significant swelling of the external meatus may be treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration.

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11
Q

fungal otitis externa management

A

clotrimazole ear drops

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12
Q

malignant otitis externa background

A
  • Osteomyelitis of temporal bone
  • Severe and life-threatening form of otitis externa
  • Infection spreads to bones surrounding ear canal and skull
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13
Q

Risk factors for

A
  • DM
  • Immunosuppression
  • HIV
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14
Q

Presentation of malignant otitis externa

A
  • Symptoms more severe than normal otitis external
  • Persistent headache
  • Severe pain and fever
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15
Q

examination findings for malignant otitis externa

A

granulation tissue a the junction between the bone and cartilage in the ear canal (halfway along) – key finding

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16
Q

management of malignant otitis externa

A

Management
- Admission
- IV antibiotics
- Imaging (CT or MRI)

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17
Q

Complications of malignant otitis externa

A
  • Facial nerve damage and palsy
  • Meningitis
  • Intracranial thrombosis
  • Death
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18
Q

What is the difference between otitis media with effusion and acute otitis media?

A

Otitis media with effusion (OME) and acute otitis media (AOM) are two main types of otitis media (OM).
- Otitis Media with Effusion describes the symptoms of middle ear effusion (MEE) without infection
- Acute Otitis Media is an acute infection of the middle ear and caused by bacteria in about 70% of cases

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19
Q

Acute otitis media

Background

Study These Flashcards
A
  • Infection of the middle ear (where cochlea, vestibular apparatus and nerves are found)
  • Bacteria enter via eustachian tube
  • Often viral URTI precedes bacterial infection of the middle ear
20
Q

causes of AOM

Study These Flashcards
A

Causes viruses and bacteria.
- Streptococcus pneumonia
- Haemophilus influenzae

21
Q

Presentation of AOM

Study These Flashcards
A
  • Ear pain
  • Reduced hearing
  • General malaise
  • Coryzal symptoms and sore throat
  • Can cause balance issues if affects vestibular system
22
Q

examination findings for AOM

Study These Flashcards
A
  • Otoscopic exam: **bulging red, yellow or cloudy tympanic membrane **
  • There may also be discharge in the auditory canal if the tympanic membrane has perforated.
23
Q

investigations for AOM

24
Q

management of AOM

Study These Flashcards
A
  • Most resolve without Abx in 3 days
  • Simple analgesia
  • Consider delayed antibiotics prescription
  • When immediate antibiotics:
  • co-morbidities
  • systemically unwell
  • immunocompromised

Which antibitoics
- Amoxicillin for 5- 7 days
- Clarithromycin if penicillin allergic

25
Chronic suppurative otitis media Background
- a complication of otitis media - chronic inflammation of the middle ear and mastoid cavity, leading to tympanic perforation
26
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
27
Otoscopic findings Chronic suppurative otitis media
- Painless examination - Evidence of tympanic membrane perforation - Inflammation with otorrhea
28
Management Chronic suppurative otitis media
- Topical antibiotics with or without steroids, aural toileting (antiseptic ear cleaning)
29
Otitis media with effusion background
- '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 **Pathophysiology** - Due to blockage of the eustachian tube- air pressure cannot equilibrate and mucus cannot drain - Fluid reabsorption and no air equilibration by ET -> negative pressure in middle ear - Decreases mobility of TM and ossicles -> affecting hearing (underwater hearing)
30
causes and risk factors for otitis media with effusion
- More common in children - Acute otitis media - Eustachian tube dysfunction - Low grade viral or bacterial infection
31
Otitis media with effusion Presentation
- Hearing loss - Intermittent ear pain with fullness - Aural discharge - Recurrent ear infections
32
Otitis media with effusion examination findings
- Otoscope- usually no signs of inflammation or discharge on examination - Retracted - Straw coloured TM - Loss of light reflex - Opacification of drum - Fluid level (makes ossicles move less easily- like hearing under water
33
management otitis media with effusion
Management - Watch and wait - Hearing tests - Auto inflation -> nasal balloon -> ventilating middle ear two to three times a day - Hearing aids - Grommets
34
Mastoiditis Background
- Infection of the **mastoid** bone of the skull - 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**
35
mastoiditis causes
Causes - Complication of unresolved otitis media- bacterial infection
36
mastoiditis presentation
Presentation - Fever, irrationality - Swelling of the ear lobe - Redness and tenderness behind the ear - Drainage of the ear - Bulging and drooping of the ear.
37
**investigations for mastoiditis**
- Otoscope - Ear culture - Blood test - CT scan
38
Management of mastoiditis
- IV antibiotics - Mastoidectomy if abx don’t work - Myringotomy- drain middle ear
39
Complications of mastoiditis
- Destruction of mastoid bone - Epidural abscess - Facial paralysis - Meningitis - Hearing loss
40
Acoustic neuroma Background
Benign tumour of **Schwann cells** surrounding auditory nerve (vestibulocochlear nerve) that innervates the inner ear - Also known as vestibular schwannomas - usually unilateral
41
bilateral acoutstic neuromas asscoiated with
neurofibromatosis type II
42
Pathophysiology of acoustic neuroma
- **Schwann cells** are found around PNS and provide myeline sheath around neurones - Occur at the cerebellopontine angle -> sometimes called cerebellopontine angle tumours
43
Presentation of acoustic neuroma
- 40-60 yo - Gradual onset - **Unilateral sensorineural hearing loss** - Unilateral tinnitus - Dizziness or imbalance - Sensation of fullness in the ear - Facial nerve palsy if tumour grows large enough
44
investigations for acoustic neuroma
Investigations - Audiometry- sensorineural hearing loss - Brain imaging (MRI or CT)
45
Management of acoustic neuroma
* Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate * Surgery to remove the tumour (partial or total removal) * Radiotherapy to reduce the growth
46
Notable risks associated with treatment of acoustic neuroma x
Notable risks associated with treatment are: * Vestibulocochlear nerve injury, with permanent hearing loss or dizziness * Facial nerve injury, with facial weakness

Neurology and special senses (Y4) (52 decks)

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