37.2 Outer and Middle Ear Conditions

Question 1

ddx for conductive hearing loss?

Answer 1

wax
exostoses
foreign body
atresia
stenosis

Question 2

otitis externa caused by 2 main things?

Answer 2

bacteria: pseudomonas/staph aureus

fungal

Question 3

presentation of otitis externa?

Answer 3

smelly
painful to move the pinna
-discharge

Question 4

management of otitis externa?

Answer 4

• swab MCS
• stay on side for 5-10 minutes
• sofradex
• keep it dry
• topical drops

Question 5

otitis externa fungal? presentation?

Answer 5

• candida, aspergillosis
• can see black dots.spores
• not painful
• itchy

Question 6

drops for fungal otitis externa?

Answer 6

if drum intact:
locacortin-viofrom drops
-kenacomb drops
-nilstat drops
-Need Rx for 3 weeks

Question 7

management of ear wax?

Answer 7

nothing if no problem

• ceruminolytics
• syringing: no if perforation or if only hearing ear
• aural toilet

Question 8

foreign body in ear: bug?

Answer 8

drown it in olive oil

direct/syringe

Question 9

foreign body in ear: bead?

Answer 9

• suction
• glue in stick
• wax curette

Question 10

glue ear definition?

Answer 10

CHRONIC Otitis media with effusion:

>3months or more

Question 11

risk factors for chronic Otitis media with effusion?

Answer 11

season: fall-winter
FHx
-URTI
-cleft palate
-child care centres

Question 12

likely cause of chronic Otitis media with effusion?

Answer 12

biofilm

Question 13

how to find out if fluid in middle ear?

Answer 13

pneumatic otoscopy

Question 14

which retraction pockets are dangerous?

Answer 14

posterior: damage to ossicles through erosion from vibration - like sand paper
- Manage with grommets

Question 15

what to remember with kids with resolved chronic Otitis media with effusion?

Answer 15

check in a few months for any retraction pockets

Question 16

how old to use the otovent?

Answer 16

age 6 usually

Question 17

how does otovent work?

Answer 17

positive pressure in post nasal space, pushes air up the eustachian tube

Question 18

steroids for chronic Otitis media with effusion?

Answer 18

NOPE

Question 19

grommets, any discharge through them?

Answer 19

no, should allow drainage into eustachian tube

Question 20

chronic Otitis media with effusion and adenoidectomy?

Answer 20

research divided

-age 4-8 might benefit with grommets

Question 21

glue ear and flying?

Answer 21

• need to be careful - might have rapid expanding air from pressure changes
• can use ear planes
• suck lollipops/milk

Question 22

peaks of incidence for acute otitis media?

Answer 22

6-12 months

4-5 years

Question 23

management of acute otitis media?

Answer 23

• 60% of patients pain-free within 24 hours, give pain relief
• review in 2-3 days: if pain no settled: give antibiotics

Question 24

how long to use Abx for acute otitis media?

Answer 24

8-10 days

Question 25

exceptions for acute otitis media treating with ABx?

Answer 25

- children under 2 - cochlear implant - unlikely to come back for follow up

Question 26

complications of acute otitis media?

Answer 26

- facial palsy: urgent grommet | - mastoiditis

Question 27

what is considered recurrent acute otitis media?

Answer 27

3 or more in past 6 months

Question 28

what is myringoplasty?

Answer 28

grafting ear drum

Question 29

mastoiditis Rx?

Answer 29

- if early, Abx | - send to hospital

Question 30

when to refer for acute otitis media?

Answer 30

- chronic, more than 3 months - suspect cholesteatoma - hearing loss

Question 31

what is cholesteatoma?

Answer 31

squamous cells bundle

Question 32

what does congenital cholesteatoma look like?

Answer 32

white pearl behind intact ear drum

Question 33

cholesteatoma formation?

Answer 33

- retraction pocket - chronic discharge for year - MUST refer

Question 34

classic presentation of cholesteatoma?

Answer 34

middle ear infection, chronic, due to pocket

Question 35

dangers of cholesteatoma?

Answer 35

- erode through bone and nerves | - brain abscess

Question 36

treatment of choice worldwide for severe cholesteatoma?

Answer 36

modified radical mastoidectomy

Question 37

big cholesteatoma surgery in australia

Answer 37

combined approach tympanoplasty

Question 38

otitis externa bacterial presentation and treatment?

Answer 38

``` swollen canal smelly painful Rx ciloxin Sofradex for 1/52 ```

Question 39

otitis externa fungal presentation and treatment?

Answer 39

``` spores white blotting paper Rx locacortin oviform drops kenacomb nil stat 1/12 ```