Outer and Middle Ear: Otitis Externa, Media, Glue Ear, Otomycosis, Cholesteatoma, Mastoiditis, Ear wax, Tympanic membran perforation Flashcards

1
Q

AOM
-epidemiology, etiology
-presentation

A

Vv common in young children
-MOST COMMON - bacterial (S pneu, H inf, M catarrhalis)
-from URTI => viral

Ear pain - tugging
-fever
-hearing loss
-recent URTI symptoms
-discharge from perforation

Bulging tympanic membrane => loss of light reflex
Opaque/red TM
Perforated => discharge

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2
Q

AOM
-management
-complications

A

Self limiting, supportive - fluids, analgesia

Abx - amox/erythromycin 7days
-no improvement in 4days
-systemic illness
-IC/high risk
-bilateral + U2
-perforation, discharge found

Complications
-mastoiditis
-meningitis, brain abscess
-VII paralysis

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3
Q

AOE
-epidemiology, etiology
-presentation

A

MOST COMMON - P aeruginosa, S aureus
Common in swimmers, older adults

Ear pain, itch, discharge
Otoscopy - red, swollen, eczema
Conductive hearing loss

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4
Q

AOE
-management
-complications

A

Supportive
-keep clean and dry - use ear plugs when showering

Self limiting

1st line - TOP neomycin + TOP CS if no perforation
2nd line - fluclox
PO ciprofloxacin if likely to be MOE
Empirical antifungal

ENT REFERRAL IF NO RESPONSE TO TOP ABx

Complications
-cellulitis, pinna perichondritis/chondritis, abscess, parotitis
-COE - persistent inflammation from fungal infection
-MOE - lifethreatening progression to osteomyelitis in temporal

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5
Q

Signs of MOE
-pathophysiology
-presentation
-diagnosis
-management

A

OE found in IC and diabetics => infection of soft tissues and bony ear canal => temporal bone osteomyelitis

Pseudomonas

Diabetes/IC
Severe, constant, deep ear pain
Temporal headache
Purulent discharge
Dysphagia, hoarse, VII problems

CT

Non resolving OE with increasing pain => urgent ENT
IV ABx with pseudomonas cover

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6
Q

Glue ear/OM with effusion
-epidemiology, etiology
-presentation
-investigations

A

Fluid collects within middle ear without acute infection signs
-MOST COMMON AFTER AOM in young children

Conductive hearing loss, tinnitus
Mild, intermittent ear pain with fullness
Speech, language delay in children

Pneumatic otoscopy
Tympanometry - assess eardrum reaction to sound
Audiometry - assess for hearing loss

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7
Q

Glue ear/OM with effusion
-management

A

Watchful waiting for 3 months
-assess for worsening hearing, delay in reaching developmental milestones
-if symptoms persist => ENT referral
-if Downs => immediate referral

Non surgical
-autoinflation - drain fluid via auditory tube with Valsalva
-hearing aids - bilateral persistant OME

Surgical
-grommet insertion into ear drum => fluid drainage. Will fall out in their own time

If in adults => ENT 2ww referral for posterior nasal space tumour

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8
Q

Otomycosis
-causative organism
-associations
-presentation
-management

A

Outer ear fungal infection
-aspergillus
-candida

Hot, humid
DM

Itchy, smelly, ear pain
Cotton wool in ears

Clean out debris and dry ear
2% acetic acid - superficial fungus
1% clotrimazole - severe fungal

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9
Q

Cholesteatoma
-what is it
-presentation
-investigations
-management

A

Non-cancerous growth of squamous epithelium in skull => local destruction

Foul smelling, non-resolving discharge
Hearing loss
Depending on location
-vertigo
-CN7 palsy
-CPA syndrome

Otoscopy - attic crust
-may be hiding behind ear wax

ENT referral for surgical removal

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10
Q

Ear wax
-what is it
-presentation
-investigations
-management

A

Normal substance that protects ear canal

Causes symptoms when impacted
-pain
-conductive hearing loss
-tinnitus
-vertigo

Ear drops or irrigation
-olive oil
-sodium bicarb

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11
Q

Mastoiditis
-what is it
-presentation
-investigations
-management
-complications

A

Infection from middle ear => mastoid air spaces in temporal bone

Severe ear pain behind ear
Systemically unwell
Swelling, erythema, tenderness over mastoid => protrude forward

CLINICAL DIAGNOSIS - CT if complications suspected

IV ABx

CN7 palsy
hearing loss
meningitis

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12
Q

Tympanic perforation
-most common causes
-management

A

INFECTION
Barotrauma
Direct trauma

Will heal in 6-8wks - keep dry during this time
If associated with AOM => ABx

If not healed in 6wks => myringoplasty by ENT

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13
Q

Myringitis
-what is it
-presentation
-investigation
-management

A

Inflammation of the tympanic membrane => blistering
MOST OFTEN VIRAL

Severe sudden ear pain
Fever
Hearing loss
Fluid from ears

Otoscopy

Self limiting
Analgesia, keep it dry
If purulent, likely strep - amox/erythro/clari

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