Outer and Middle Ear: Otitis Externa, Media, Glue Ear, Otomycosis, Cholesteatoma, Mastoiditis, Ear wax, Tympanic membran perforation Flashcards
AOM
-epidemiology, etiology
-presentation
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
AOM
-management
-complications
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
AOE
-epidemiology, etiology
-presentation
MOST COMMON - P aeruginosa, S aureus
Common in swimmers, older adults
Ear pain, itch, discharge
Otoscopy - red, swollen, eczema
Conductive hearing loss
AOE
-management
-complications
Supportive
-keep clean and dry - use ear plugs when showering
Self limiting
1st line - TOP ciprofloxacin + TOP dexmeth
2nd line - neomycin or PO fluclox if spreading
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
Signs of MOE
-pathophysiology
-presentation
-diagnosis
-management
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
Glue ear/OM with effusion
-epidemiology, etiology
-presentation
-investigations
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
Glue ear/OM with effusion
-management
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
Otomycosis
-causative organism
-associations
-presentation
-management
Outer ear fungal infection
-aspergillus
-candida
Hot, humid
DM
Itchy, smelly, ear pain
Cotton wool in ears
Clean out debris and dry ear
Clotrimazole
Cholesteatoma
-what is it
-presentation
-investigations
-management
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
Ear wax
-what is it
-presentation
-investigations
-management
Normal substance that protects ear canal
Causes symptoms when impacted
-pain
-conductive hearing loss
-tinnitus
-vertigo
Ear drops or irrigation
-olive oil
-sodium bicarb
Mastoiditis
-what is it
-presentation
-investigations
-management
-complications
Infection from middle ra => 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
Tympanic perforation
-most common causes
-management
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
