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Finals - Opthalmology and ENT > ENT: Otalgia > Flashcards

ENT: Otalgia Flashcards

1
Q

What proportion of otalgia is due to referred pain?

A

Approx. 50%

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2
Q

What makes up the outer ear?

A

Pinna
Ear canal
Ear drum

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3
Q

What makes up the middle ear?

A

Oscicles

Unlikely to have an abnormal middle ear with normal drum

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4
Q

What makes up the inner ear?

A

Vestibulocochlear apparatus

Insensive

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5
Q

What are the otological (non referred) causes of ear pain?

A

Acute otitis media
Otitis externa
Furuncule
Necrotising otitis externa

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6
Q

What are the refered causes of otological pain?

A 
Dental pathology
TMJ (temperomandibular joint) dysfunction
Osteoarthritis of the cervical spine
Malignancy of pharynx and larynx
Acute infection of pharynx
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7
Q

When would you consider refered pain?

A

In presence of normal ear exam.

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8
Q

What are red flags for oropharyngeal malignancy with otalgia?

A

Dysphagia
Hoarseness
Dysphonia

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9
Q

What is otitis externa?

A

Infection of the outer ear (aka Swimmer’s ear)

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10
Q

What are the symptoms of otitis externa?

A

Painful discharging ear

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11
Q

What are the risk factors of otitis externa?

A

Eczema/dermatitis

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12
Q

What are the common causative organisms of otitis externa?

A

Pseudomonas

Fungal infection

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13
Q

How is otitis externa diagnosed?

A

Ear examination
Debris in ear
Oedema or stenosis of ear canal

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14
Q

What differs in fungal otitis externa?

A

Visible fungus or black debris in ear.

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15
Q

What is the treatment of bacterial otitis externa?

A

Topical antibiotics (1st line)
Gentamycin/Ciprofloxacin
Oral is less recommended, won’t reach the debris.

Microsuction
Insertion of pope wick
Water precautions

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16
Q

What is the treatment of fungal otitis externa?

A

Clotrimazole 1% topical for at least 14 days.

17
Q

How can you prevent otitis externa?

A

Keep ears dry - pool guards
Don’t use ear buds
Acetic acid

18
Q

What is a furuncle?

A

Staphylococcal abcess on a hair follicle.

19
Q

What are the symptoms of a furuncle?

A

Exquisitely tender

Dry ear - not otitis externa

20
Q

What is the treatment of a furuncle?

A

Incision and drainage
Flucloxacillin
Wick insertion

21
Q

What is necrotising (malignant) otitis externa?

A

Potentially fatal osteomyelitis of the EAM and bony tympanic plate.

22
Q

How can necrotising (malignant) otitis externa be fatal?

A

Can spread along the inferior surface of the skull base, complications include meningitis, cerebral abscess and dural sinus thrombosis.

23
Q

Who is more at risk of necrotising (malignant) otitis externa?

A

Elderly diabetic patients

24
Q

What is the typical causative organism of necrotising (malignant) otitis externa?

A

Psudomonas aeruginosa

25
Q

What is the presentation of necrotising (malignant) otitis externa?

A

Severe, unremitting otalgia
Purulent aural discharge
Granulations at the isthmus (bone-cartilage junction) of EAM.
Single or multiple cranial neuropathies may also occur, usually VII.

26
Q

What is acute otitis media?

A

Infection of the middle ear

27
Q

Who does acute otitis media occur in?

A

Mainly children

28
Q

What are the common causative organisms of acute otitis media?

A

RSV
Rhinovirus
Parainfluence

Streptococcus pneumonie
Haemophillus influenxe
Moracella catarrhailis

29
Q

What are the signs and symptoms of acute otitis media?

A

Inflammation of the middle ear
Bulging tympanic membrane

Rapid onset ear ache
Rubbing and tugging of the ear
Systemic signs: fever, irritability, poor sleep
Preceding URTI symptoms: cough, rhinorrhea.

30
Q

What is the treatment of acute otitis media?

A

Largely self limiting
Usually viral resolving in 48-72 hours.

Antibiotics if:
Increasingly unwell
Decreased PO intake
Increasing pain
No improvement in 72 hours
Developing complications

Role for delayed Abx presentation (5 day course)

31
Q

What is the treatment for recurrent acute otitis media?

A

Grommet insertion

32
Q

What are the complications of acute otitis media?

A 
Mastoiditis
Tympanic membrane perforation (chronic)
Rare:
Meningitis
Abscesses
Nerve palsy
Hearing loss

Finals - Opthalmology and ENT (44 decks)

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