5. Ear Flashcards
(36 cards)
Describe a pinna haematoma (cauliflower ear)
Path = blunt trauma, blood between cartilage and perichondrium (subperichondrial plane) - deprives cartilage of blood supply and pressure necrosis of tissue
Mx = prompt drainage needed + packing = untreated leads to fibrosis and new asymmetrical cartilage devel
Outline TM perforation
Ae = acute otitis media, acoustic trauma, foreign objects, severe head trauma
S+S = conductive hearing loss, tinnitus, earache, vertigo (N+V), discharge of mucus
Ix = ear exam
Mx = some are self-resolving, paper patch to promote healing, tympanoplasty
- severe ruptures may need to wear an ear plug to prevent water contact with the ear drum
Describe haemotympanum
Presence of blood in the middle ear cavity
Ae = usually sec to trauma (basilar skull fracture), nasal packing sec to nasal bleeding can cause blood to back up to the middle ear, haemophilia, ITP, anti-coag meds, ear infection
S+S = pain, sense of fullness in the ear, hearing loss
Mx = skull fractures usually heal on their own, Abx + ear drops for infection, remove nasal packing
Outline the aetiology and pathophysiology of acute otitis media
Acute middle ear infection. More common in infants, children than in adults (eustachian tube shorter and more horizontal = easier passage for infection from nasopharynx, can block easily, increased risk of infection)
Bacterial = H. influenzae S. pneumoniae, S. pyogenes (All common upper resp track MO)
Viral (2/3) = Respiratory Syncitial Virus, Rhinovirus
What are the signs and symptoms of acute otitis media?
URTI
Otalgia (infants pull/tug at the ear)
Fever
Red +/- bulging TM and loss of normal landmarks
- Injected
- TM perforation with discharge
Malaise
Conductive hearing loss
Cervical lymphadenopathy
How should acute otitis media be investigated?
Exam:
- CN exam (petrositis can result in Gradenigo’s syndrome (Rare) triad of:
- 6th nerve Palsy
- Retroorbital pain due to irritation of ophthalmic branch of V5
- Otitis media
- Sternocleidomastoid muscle: Bezold’s abscess
- Occipitotemporal region of head: Citelli’s abscess
- LN exam
- Throat and oral cavity examination
FBC, CRP
Discharge = MC+S
What is the best management for acute otitis media?
Majority resolve within 1-3 days - watch and wait
Oral fluids, analgesia
ORAL Abx (commonly amoxicillin) = Systemically unwell children, congenital heart disease, immunosuppression, >4 days, discharge, <2y with bilateral
Comp = temp lobe abscess, sigmoid sinus thrombosis, acute mastoiditis (ear pushed forward, IV Abx, surgical drainage), cerebellar abscess, facial palsy, meningitis,
Outline the aetiology and pathophysiology of otitis media with effusion
Aetiology = chronic inflammatory changes, Eustachian tube dysfunction.
Not an actual infection, build-up of fluid, nitrogen absorbed by middle ear mucosa, -ve pressure in middle ear, inflam of mucosa (glue), due to Eustachian tube dysfunction: can predispose to infection, decreases mobility of TM and ossicles affecting hearing
List the signs and symptoms of otitis media with effusion
Conductive hearing loss
Sensation of pressure
TM will appear dull, red, amber, retracted, retracted pockets, fluid levels, air bubbles
TM light reflex will be lost
Speech delay
How should otitis media with effusion be Ix?
Pure tone audiogram = conductive hearing loss
Tympanometry = reduced membrane compliance, type B (flat)
Flexible nasoendoscopy
How should otitis media with effusion be Mx?
Conservative = balloon
Watchful waiting - most resolve spontaneously in 2-3 months.
Some may persist - require grommets (tympanostomy tube) to ventilate middle ear
Outline otitis externa (swimmers ear)
Ae = trauma, (fingernails from itchy conditions: eczema/psoriasis), high humidity, absence of wax (self-cleaning), narrow ear canal, hearing aids
- pseudomonas
- staph aureus
Path = inflam of the external ear canal
S+S = discharge, pain (seen on retraction of pinna, more than OM), itch, tragal tenderness (usually due to excessive moisture)
Ix = ear exam, swab MC+S
Mx
- Mild = aural toilet, ear kept water free, hydrocortisone cream to the pinna, EarCalm (2% acetic acid, antifungal/bacterial)
- Moderate = cleaning, TOPICAL Abx (cipro ear drops), steroid drops
- Severe = (EAC occluded), thin ear wick inserted, few days meatus will open for microsuction/careful cleaning
*** be aware of recurrent in DM, immunosuppressed = risk of malignant/necrotising otitis externa
Outline chronic otitis media
Ear with a tympanic membrane perforation in the setting of recurrent or chronic infection
S+S = hearing loss, otorrhoea, fullness, otalgia
Benign COM - dry TM perforation without active infection
Chronic serous OM - continuous serous drainage
Chronic suppurative OM - persistent purulent drainage through perforated TM
Ix = pure tone audiometry, MC+S
Mx = topical/systemic Abx, aural cleaning, myringoplasty, mastoidectomy
What is otosclerosis?
New bone formation around the stapes footplate - which leads to its fixation and consequent conductive hearing loss
Ae = autosomal dominant mutation
S+S = can be accelerated by preg, conductive deafness, tinnitus, vertigo, Schwartze’s sign (pink tinge to TM)
Ix = audiometry with masked bone conduction shows dip at 2Hz
Mx = hearing aid, surgery: stapedectomy or stapedotomy, cochlear implant
What causes BPPV?
Idiopathic canalolithiasis-debris in the semi-circular canal
What is the pathophysiology of BPPV?
Otoconia (otoliths) debris disturbed by head movement moving fluid in the vestibular apparatus semi-circular canals causing vertigo
What are the signs and symptoms of BPPV?
Intermittent rotational vertigo lasting <20secs provoked by head turning
NO hearing loss or tinnitis
Can follow ear infection or head injury
How should BPPV be investigated?
Nystagmus (tortional, geotropic - fast phase beats towards floor) on performing the Dix Hallpike manoeuvre
Rapid movement of sitting to supine with head turned 45 degrees to the right, 30 secs look for nystagmus, return to sitting, look for nystagmus for 30 sec again (reversal - beating in opposite direction, habituation - less intense), repeat on L side
How is BPPV best managed?
Epley manoeuvre to clear the debris from the semi-circular canal, watchful waiting, labyrinthectomy
Brandt-Darrof exercises
Outline the pathophysiology of Meniere’s disease
Increased hydraulic pressure within the inner ear endolymphatic system, break in the membrane that separates the perilymph (K-poor fluid) from the endolymph (K-rich fluid), chemical mixture bathes vestibular N receptors, depolarization blockade and transient loss of function, vertigo
What signs and symptoms are seen in Meniere’s disease?
fluctuating sensorineural hearing loss, affects low frequency sounds, rotational vertigo lasting >20mins, unilateral tinnitus, aural fullness, +/- D+V
How is Meniere’s disease investigated?
Pure-tone air and bone conduction with masking
Speech audiometry
Tympanometry/immitance/stapedial reflex levels
Otoacoustic emissions (OAE)
How is Meniere’s disease best managed?
Psycho = reassurance
Diet = reduce salt, caffeine, alcohol, Chinese food
Medical = betahistine (labyrinthine vasodilator), thiazide diuretic, prochlorperazine (vestibular sedative) for acute vertigo
Surgical = grommet, intratympanic dex or gentamicin, antihistamine, endolymphatic sac decompression, surgical labyrinthectomy
Outline Vestibular neuronitis
Inflammation of your vestibular nerve + ganglion - characterised by acute, isolated, spontaneous, and prolonged vertigo of peripheral origin
Ae = viral infection (measles, mononucleosis, rubella, mumps, shingles, chicken pox) - usually preceded by viral URTI
S+S = severe vertigo continuous over 24h, nystagmus, D+V, anxiety, usually unilateral (NO HEARING LOSS)
Ix = head impulse test (sit, fixed eyes on examiner, rapidly turn head 10–20 degrees, normally eyes stay fixed, abnormal the eyes get dragged off and correct back (saccade) to first position) - implies moderate to severe loss of function of the horizontal semi-circular canal on the side to which the test is positive.
Mx = self-limiting, anti-emetics, stop driving and inform the DVLA, buccal/PO prochlorperazine (vertigo, nausea) or cyclizine (antihistamine)
