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SPC- ENT > SPC- ENT- Otalgia and Otorrhoea > Flashcards

SPC- ENT- Otalgia and Otorrhoea Flashcards

The know the common causes of otalgia and ottorhea

1
Q

What is otalgia and how can it be classified?

A

Otalgia is a painful ear. The cause can be classified as being otological (from the ear itself) or non-otological (from elsewhere)

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2
Q

What is chondritis/perichonritis? How is it differentiated from cellulitis of the pinna?

A

Inflammation of the cartilage of the pinna and inflammation of the peri-chondrium.

Differentiation from cellulitis of the pinna is based on wether there is lobular involvement- there is for cellulitis (it doesn’t contain cartilage)

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3
Q

What is often a predisposing factor to chondritis?

A

Trauma that allows for entry of pathogens. This then allows for pathogen entry and infection

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4
Q

What is often a predisposing factor to perichonritis?

A

Perichondritis occurs after inadequately treated cellulitis of the ear

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5
Q

What is the treatment for chondritis/perichondritis?

A

Drain any pus

IV Antibiotics

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6
Q

What is a pinna haematoma and how is it caused?

A

Pinna/auricular haematoma is bleeding into the perichondrial space that occurs following trauma to the auricle. Most commonly affects the helical rim of the auricle.

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7
Q

How is a pinna haematoma treated?

A

Treatment is drainage and primary closure. If not treated adequately/repeated episodes it can lead to cauliflower ear due to chronic scaring and fibrous organisation.

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8
Q

What is otitis externa?

A

Inflammation of the external auditory canal and meatus

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9
Q

What are some of the symptoms of otitis externa?

A

Discharge
Itch
Painful ear
Tragal Tenderness is a strong indicator

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10
Q

What causes otitis externa?

A

Excess canal moisture- prolonged water exposure (called swimmers ear)
Cotton buds- Absence of wax
Trauma
Narrow ear canal- e.g. with surfer’s ear (Auditory Exostosis)

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11
Q

What are the main causative organisms of otitis externa?

A

Pseudomonas is the main causative organism

Staph Aureus is also common

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12
Q

What is a possble differential diagnosis for otitis externa?

A

Contact dermatitis

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13
Q

For all severities of OE what should be done first?

A

The external auditory canal should be cleaned as increases the effectiveness of topical treatment. This can be done with:
Gentle Syringing (Only if TM is intact)
Mopping using some cotton on a probe
Micro-suction

Note- The ear should be kept dry during treatment

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14
Q

How is mild OE treated? What are the features ?

A

Mild- normal diameter, some erythema, scaly skin

Use hydrocortisone cream to the pinna and EarCalm Spray (2% acetic acid- anti-bacterial/ anti-fungal properties)

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15
Q

How is moderate OE treated? What are the features)

A

Moderate- Reduced diameter, painful ear, discharge
Swab for microscopy and culture
Topical antibiotic drops and steroid drops should be used

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16
Q

How is severe OE treated? What are the features?

A

Severe- OE is deemed to be severe if the EAC is occluded. Patients may require an ENT referral to inset a thin ear wick (aluminium acetate). When open cleaning and treatment should begin (steroid and abx drops)

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17
Q

When is OE a worrying pathology?

A

Persistent unilateral OE in diabetics or the immunosuppressed or elderly could be a sign of malignant/necrotising OE.
Another sign is resistance to treatment.
Do a biopsy and refer.

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18
Q

What is malignant OE?

A

Aggressive, life threatening infection of the external ear that can lead to temporal bone infection and base of skull osteomyelitis.

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19
Q

When should you worry about malignant OE?

A

Persistent unilateral OE in patients who are diabetic/immunosuppressed/diabetic (90% are diabetic)

+ Symptoms that might indicate malignant OE- deep severe pain, CN paralysis/facial nerve paralysis, fever.

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20
Q

How is malignant OE treated?

A

Surgical debridement
Systemic Antibiotics- Ciproflaxacin
Specific immunoglobulins

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21
Q

What are the symptoms of malignant OE?

A 
Severe ear pain
Foul smelling discharge
Fever
Headaches
CN paralysis involving 7 (facial paralysis),9,10,11
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22
Q

How is malignant OE diagnosed?

A

If suspected order urgent CT scan of temporal bone
Biopsy
Swab for cultures

23
Q

How could ear wax cause otalgia?

A

Pain can be caused by impaction of wax from using ear buds

Wax is only produced in the outer 1/3 of the ear canal, any wax deeper than this must have been pushed in

24
Q

How can ear wax be treated?

A

Sodium bicarbonate drops
Ear syringing (not if TM perforation, or Gromet in last 1.5 year)
Direct vision removal
Never recommend ear buds

25
Q

How is trauma to the EAC normally caused and how is it managed?

A

Usually by cotton buds/ foreign bodies

Management- to observe as normally self-resolves

26
Q

How can barotrauma cause ear pain?

A

If the eustacian tube is not functioning correctly the pressures either side of the tympanic membrane will not equalise (e.g. during diving or flying). This can cause bulging and damage to the tympanic membrane.

27
Q

How can barotrauma be prevented?

A

Not flying with an URTI
Consciously equalising middle ear pressure by yawning, swallowing, breathing against obstructed outflow
Decongestants in the nose

28
Q

What is acute otitis media?

A

Infection in the middle ear. Causes pus and inflammation of the middle ear. There is bulging of the tympanic membrane and reduced conduction of sounds.

29
Q

What are the symptoms of acute otitis media?

A

Ear pain
Discharge from the ear
Fever
Hearing loss

There is nearly always a preceding URTI

30
Q

What are the causative organisms of acute OM?

A

Strep pneumoniae
Moraxella catarrhali
Haemophilus influenzae

31
Q

What group is OM more common in and why?

A

Children (<3 years) - shorter and more horizontal Eustachian tube. Infected fluid can therefore pass more easily from nose to middle ear during an URTI.

32
Q

Children struggle to describe symptoms, what sign might indicate otitis media in children?

A 
Tugging or pulling at the ear
Reduced hearing
Fever
Irritability
Nausea and vomiting
Discharge- perforation of the TM can occur due to bulging, this results in ear discharge that is mucous like
33
Q

If OM is present what might be seen on otoscopy?

A

Bulging, red tympanic membrane

Look for a fluid level

34
Q

What is the treatment for acute OM?

A

Pain relief- Parcetemol will reduce pain and fever
Acute OM resolves without ABx in 60% over 24 hours therefore:
- No ABx with advice to seek help if worsening symptoms, person becomes very unwell or no improvement after 3 days
- Back up ABx- advice to use if symptoms do not improve after 3 days or worsen. Seek help if rapidly worsening or very unwell.
- Immediate ABx if systemically unwell, immunocompromised or no improvement after 4 days
- Consider immediate or 2 day delayed ABx if less than 3 months old, perforation/discharge, <2 years with bilateral OM
- ABx- Give amoxicillin or erythromycin in penicillin allergy

35
Q

When should admission to hospital be considered for acute OM?

A

Severe systemic infection
Suspected complications of acute OM- meningitis, mastoiditis, intracranial abscess, sinus thrombosis, facial nerve paralysis
Children <3months with temp 38 C or above
(Consider admitting is 3-6 months with temp 39 C or above)

36
Q

What are the complications of acute OM?

A

Perforation of Tympanic Membrane (pain and hearing improves when this happens)
Mastoiditis- rare now with good ABx use
Meningitis
Intracranial abscess

37
Q

What is glue ear?

A

This is otitis media with effusion that remains after the symptoms of acute OM have passed.

38
Q

What is chronic otitis media?

A

Defined as an ear with tympanic membrane perforation in the setting of recurrent or chronic infections
>6 weeks

39
Q

What are the symptoms of chronic OM?

A

Otalgia
Discharge (Otorrhea)
Hearing loss
Feeling of fullness

40
Q

What are the types of chronic OM?

A

Benign (or inactive)- Dry tympanic membrane perforation without active infection
Chronic serous OM- Continuous serous (straw coloured) drainage from TM
Chronic suppurative OM- Persistent purulent (pus) drainage

41
Q

What is a complication of chronic OM?

A

Reduced pressures in the middle ear can lead to the formation of retraction pockets within the TM. There is reduced epithelial migration and a cholesteatoma can form in the pocket.

42
Q

What is a cholesteatoma?

A

Destructive and expanding growth consisting of keratinised squamous epithelium. Erosive process can result in destruction of the ossicles and can grow into bones of skill. Often become infected. Symptoms include discharge or conductive hearing loss. Always consider if hearing loss and discharge.
Either congenital or acquired (more common). Acquired occurs when keratin accumulates in a pouch/retraction of the tympanic membrane. Often surgically removed.

43
Q

What is mastoiditis?

A

Mastoiditis is a complication that con occur following untreated OM. It is infection of the mucous lining of the mastoid air cells.

44
Q

What are the symptoms of mastoiditis?

A

Pain, tenderness, erythema and swelling in the region of the mastoid process. Ear pain due to otitis media. Fever or headaches may also be present. Protruding auricle.

45
Q

What is the management for mastoiditis?

A

Admit to hospital
IV ABX
Surgical debridement

46
Q

What are the risk factors for OM?

A 
URTI
Bottle feeding
Passive smoking
Dummy use
Presence of adenoids
Malformations such as cleft palate
GORD/High BMI in adults
47
Q

What is glue ear?

A

Also called OME- Ottitis Media with Effusion

Fluid in the middle ear- detected by otoscopy (visible fluid level/bubbles)

48
Q

What causes glue ear?

A

Generally dysfunction of the Eustachian tube

49
Q

How does glue ear often present?

A

Hearing impairment that is noticed by parents.

OME is the main cause of hearing loss in children

50
Q

What are some risk factors for OME?

A 
Male sex
Parents are smokers
Down's Syndrome
Cleft palate
Upper Respiratory Tract Infections
Primary Ciliary Dyskinesia
51
Q

What is the treatment for OME?

Surgical and non- surgical.

A

OME is usually transient and mild
Active Observation for 3 months- hearing tests using Pure Tone Audiometry and Tympanometry
If persist refer to ENT
Note- If Down’s Syndrome, Cleft Palate refer to ENT immediately
ENT Options:
Non-Surgical-
-Auto-inflation- Balloon in the Eustachian tube
-Hearing Aids- If surgery not appropriate or contraindicated
Surgical
-Tympanostomy (Grommets)- Usually stop functioning after average of 10 months and may require re-insertion or process may have naturally resolved

52
Q

What are some referred causes of ear pain?

A

Any nerve that supplies the ear and other can cause referred pain to the ear.

Therefore requires a full ENT inspection to investigate

53
Q

What is TMJ dysfunction? What are the symptoms?

A

Pain and dysfunction of the temperomandibular joint. Symptoms include ear pain, facial pain and joint popping or clicking. It is related to teeth grinding and stress.

54
Q

What are the signs of TMJ dysfunction?

A

Tenderness over the TMJ

Exacerbated by lateral movement of open jaw

SPC- ENT (12 decks)

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