Discharging ears and otitis media

Question 1

What are causes of discharge in the external ear? what is the appearance of the discharge?

Answer 1

OE - scanty (sparse) watery discharge
Trauma - blood
Liquid wax

Question 2

What is the external ear comprised of?

Answer 2

1. Auricle (pinna)

2. External acoustic meatus - ends at the tympanic membrane (ear drum)

Question 3

What are causes of middle ear discharge? what is the appearance?

Answer 3

i. Middle ear disease - mucous discharge
ii. Chronic otitis media - serosanginous (blood + serous fluid)
iii. cholesteatoma - offensive

Question 4

What causes CSF otorrhoea? What would u see on filter paper?

Answer 4

CSF leakage into middle ear 
1. Trauma
2. Halo sign on filter paper 
or
glucose is ↑, or beta 2 (tau) transferrin is present.

Question 5

What is the middle ear comprised of?

Answer 5

Tympanic cavity containing the bones (ossicles) - malleus, incus and stapes
Epitympanic recess - superior to tympanic cavity next to mastoid air cells

Question 6

How does acute OM present?

Answer 6

Rapid onset of pain
Fever (+/- irritability)
Anorexia
Vomiting 
Often after viral URTI
Conductive hearing loss

Question 7

What are the common causative organisms of acute OM?

Answer 7

Strep pneumoniae
H influenzae
Moraxella catarrhalis

Question 8

What is a sign of a perforated eardrum in acute OM?

Answer 8

Purulent discharge

Question 9

What is rx of acute om?

Answer 9

Analgesia

Amoxicillin for 7 or less days

Question 10

what are complications of acute OM?

Answer 10

mastoiditis
petrositis
labyrinthitis
facial palsy 
meningitis
intracranial abscesses

Question 11

What is chronic otitis media?

Answer 11

chronic inflammation of the middle ear and mastoid cavity that is characterised by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks.

Question 12

What causes chronic otitis media?

Answer 12

following an upper respiratory tract infection that has led to acute otitis media

Question 13

How does chronic OM present?

Answer 13

discharge
reduced hearing
little pain

Question 14

what are the types of chronic om?

Answer 14

mucosal
squamous
each may be inactive or w active inflammation

Question 15

What is a complication of chronic OM?

Answer 15

cholesteatoma as secretions cannot drain and it differentiates into squamous epithelium

Question 16

What is a cholesteatoma? How does it occur?

Answer 16

Abnormal sac of keratinising squamous epithelium + accumulation of keratin in the middle are or mastoid air cells spaces that can become infected and erode neighbouring air spaces
- chronic middle ear pressure causes a weak area in the upper TM to be sucked inwards and form a retraction pocket, this has a large pouch w a narrow neck which traps desquamating surface epithelium, becomes filled w keratin debris
Outermost layer is metabolically active and produces proteolytic enzymes, they’re locally destructive and erodes adjacent bones

Question 17

What age does cholesteatoma commonly affect?

Answer 17

5-15yrs

Question 18

How does cholesteatoma present? What features indicate impending CNS complications?

Answer 18

1. Foul discharge +/- deafness (conductive)
2. Indication of impending CNS complications:
   Headache
   Pain
   Facial paralysis
   Vertigo

Question 19

What is the treatment of cholesteatoma?

Answer 19

mastoid surgery

Question 20

What is the treatment of cholesteatoma when the TM can’t be clearly seen due to purulent discharge

Answer 20

Treat for presumed infection + bring the person back for re-examination after rx has completed

Question 21

What are complications of cholesteatoma?

Answer 21

• Meningitis
• Cerebral abscess
• Hearing loss
• Mastoiditis
• Facial nerve dysfunction

Question 22

What is mastoiditis?

Answer 22

bacterial infection of the mastoid air cells surrounding the inner and middle ear

Question 23

What can mastoiditis progress to?

Answer 23

Destruction of air cells in the mastoid bone +/- abscess

intracranial extension

Question 24

What is an RF of mastoiditis?

Answer 24

Withholding abx in OM

Question 25

What are signs of mastoiditis?

Answer 25

• Raised temperature
• Tender mastoid
• Protruding auricle

Question 26

What is the treatment of mastoiditis?

Answer 26

1. Hospital
2. IV abx
3. Myringotomy +/- definitive mastoidectomy

Question 27

what is a myringotomy?

Answer 27

incision in eardrum to relieve pressure

Question 28

How does acute otitis media appear on otoscopy?

Answer 28

bulging red tympanic membrane with red vessels