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ENT > Infective Ear Conditions > Flashcards

Infective Ear Conditions Flashcards

1
Q

what are the causes of otitis media?

A
  • Usually viral
  • Also Strep pneumoniae, H-influenza, moxerella catarhars
  • Chronic – pseudomonas, aeruginosa
  • Follows URTI
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2
Q

what are the risk factors to developing Otitis Media?

A

UTRI, bottle fed, passive smoking, gastric reflux, presence of adenoids, asthma, malformations, low socioeconomic

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3
Q

what is the pathophysiology of otitis media?

A

inflammation of the inner ear

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4
Q

what are the investigations for otitis media?

A
  • Audiometry – OAE, distraction testing, COR, PTA

* Tympanometry

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5
Q

what are the complications of otitis media?

A
  • Acute mastoiditis
  • Facial paralysis
  • Labyrinthitis
  • Thrombosis of the lateral venous sinus
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6
Q

what are the cause of acute otitis media?

A

Post viral

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7
Q

what are the cause of chronic otitis media?

A

Multiple episodes

of AOM, crowded living, day-care, congenital cranial deformities

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8
Q

what are the cause of otitis media with effusion?

A

URTI, oversized adenoids, narrow nasopharyngeal dimension, bacterial biofilms on adenoids.

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9
Q

what is the immune cell involved in acute otitis media?

A

macrophages

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10
Q

what is the pathophysiology of chronic otitis media?

A

Prolonged inflammatory response results in ulceration, oedema, perforation, polyps

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11
Q

what is the pathophysiology of Otitis Media with Effusion?

A

Fluid accumulation in the middle ear + mastoid cells

Due to negative pressure creates a vacuum

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12
Q

what are the clinical features of acute otitis media?

A 
Rapid onset pain, fever +/- irritability, anorexia or vomiting
Easing of pain if rupture (discharge)
URTI symptoms
TM Early – clear
TM late – bulges, blister
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13
Q

what are the clinical features of chronic otitis media?

A

Hearing loss, otorrhea, fullness, otalgia

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14
Q

what are the clinical features of otitis media with effusion?

A

Hearing impairment, poor listening/speech, balance problems
Young kids – impact of education + development – bilateral
Adults – unilateral, ear pain, tinnitus, fullness

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15
Q

what is the management of acute otitis media?

A

Most self-resolving
Optimise analegisa
Antibiotics – give none or delay, if no improvement in 4 days, 1st Amoxicillin, 2nd Erythromycin

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16
Q

what is the management of chronic otitis media?

A

Antibiotics
Aural Cleaning
Topical Steroids
Surgery – myringoplasty, mastoidectomy

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17
Q

what is the management of otitis media with effusion?

A 
Observe (self resolving)
Auto inflation
Surgery
1st Line - grommets (last 6mths-4yrs)
2nd Line - adenoidectomy
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18
Q

what are the risk factors to developing otitis media with effusion?

A

More common in DS, cleft palate, inter, atopy, passive smoking, primary ciliary dyskinesia

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19
Q

what are the clinical features of benign COM?

A

dry TM perforation -ve active infection

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20
Q

what are the clinical features of chronic serous COM?

A

continuous serous drainage through perforated TM

21
Q

what is a safe tympanic membrane perforation?

A

perforation in centre

22
Q

what is a unsafe tympanic membrane perforation?

A

perforation in periphery

23
Q

what does the tympanic membrane look like in otitis media with effusion?

A

retracted or bulging, dull, grey, yellow, may be bubbles or a fluid level, loss of light reflex

24
Q

what is a cholesteatoma?

A

Non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction

25
Q

where do cholesteatomas occur?

A

middle ear

26
Q

what is the histology of cholesteatoma?

A

squamous, high cell turnover + keratinisation

normal lining is cuboidal or columnar glandular epithelium

27
Q

what are the two types of cholesteatoma?

A

acquired

congenital

28
Q

what are the features of acquired cholesteatoma?

A

o Keratin accumulates in the pouch of the tympanic membrane
o “attic” invagination form retraction pockets
o Result of perforation

29
Q

what are the features of congenital cholesteatoma?

A

o Epidermal keratin filled cysts

o Found medial to tympanic membrane (intact)

30
Q

what are the clinical features of cholesteatoma?

A

• Foul smelling discharge +/ deafness, headache, pain, facial paralysis (invades nerve) and vertigo (invades middle ear), cerebellopontine angle syndrome

31
Q

how are cholesteatomas diagnosed?

A
  • CT, MRI, Diffusion weighted MRI

* Otoscope – attic crust – seen in uppermost part of the ear drum

32
Q

what is the management of cholesteatoma?

A

mastoidectomy = URGENT REFERAL

33
Q

what is otitis externa?

A

Inflammation of the outer ear canal

34
Q

what are the types of otitis externa?

A

o Localised – associated with infection of hair follicle
o Acute – rapid onset
o Chronic – (acute lasting > 6 weeks)

35
Q

what are the bacterial causes of otitis externa?

A

staph aureus, pseudomonas aeruginosa – multi-microbial disorder

36
Q

what are the fungal causes of otitis externa?

A

aspergillus niger (immunocompromised = diabetes), candida albicans

37
Q

what are the causes of otitis externa?

A

bacterial
fungal
allergies and autoimmune

38
Q

what are the risk factors to otitis externa?

A

swimming, trauma (finger nails), hearing aids, skin problems (eczema, psoriasis), absence of cerebrum, high humidity, retained water in canal, increased temperature, external auditory exostosis

39
Q

what is the pathophysiology of otitis externa?

A

Once infection established, an inflammatory response occurs – oedema, pus, spread

40
Q

what are the clinical features of otitis externa?

A
  • Redness and swelling
  • itchy
  • sore and painful
  • Discharge or increased ear wax
  • Canal blockage – hearing affected
  • Pre-auricular lymphadenopathy
41
Q

what is the management of mild otitis externa?

A

cleaning EAC, hydrocortisone cream and Ear Calm Spray

42
Q

what is the management of moderate otitis externa?

A

Swab, clean, topical antibiotic+/- steroid drops (otosporin, sofradex, genitsone)

43
Q

what is the management of severe otitis externa?

A

thin ear wick e.g. aluminium acetate

44
Q

what is the complication of malignant otitis externa?

A

Extension of otitis externa into bone surrounding ear canal (mastoid + temporal)
Eventually evolve in the skull and meninges

45
Q

what are the risk factors to developing malignant otitis externa?

A

diabetes + radiotherapy

46
Q

what are the clinical features of malignant otitis externa?

A

pain and headache (more severe than findings suggest)

granulation tissue at bone cartilage junction, exposed bone in canal, facial nerve palsy

47
Q

what are the investigations for malignant otitis externa?

A

plasma viscosity + CRP, radiological imaging + biopsy + culture

48
Q

what is the management of malignant otitis externa?

A

antibiotics

ENT (13 decks)

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