Ear Conditions Flashcards

Question

TM Perforation: Aetiology

Answer 1

Trauma Abuse >> Red Flag Foreign body Forceful ear irrigation Barotrauma Acute Otitis Media (AOM) Chronic Otitis Media (COM)

Answer 2

Otalgia >> ear pain Otorrhoea >> ear discharge Sudden hearing loss Tinnitus Dizziness

Answer 3

Bloody and/or purulent otorrhoea Perforated tympanic membrane that is visible on otoscopy Decreased hearing in the affected ear

Answer 4

Clinical examination Otoscopy

Answer 5

Most TM perforations heal spontaneously within 2 months. Avoid inserting anything into the affected ear. Keep the ear dry; use caution while showering or bathing. Apply a warm, moist compress for pain relief. Use acetaminophen or ibuprofen for pain. Consider antibiotics if the perforation is related to infection. Refer for potential surgical intervention if the perforation does not heal.

Answer 6

Accumulation of squamous epithelium (skin cells) and keratin debris in the middle ear.

Answer 7

Long standing eustachian tube dysfunction >> retraction of eardrum >> can trapped epithelium infected and this can proliferates >> can become inflamed and infected

Answer 8

Hearing loss Chronic purulent aural discharge Crust in upper part of eardrum TM could be perforated

Answer 9

Ear exam >> Otoscopy CT to find extent of lesion and to do surgical assessment

Answer 10

Urgent referral to ENT (2 week) Surgical excision

Answer 11

Inflammation of external ear and ear canal Localised >> inflammation of hair follicle >> can turn into a boil Diffused >> inflammation of canal that spreads >> can be acute or chronic

Answer 12

Bacterial: Pseudomonas aeruginosa, Staphylococcus aureus. Fungal: Aspergillus, Candida. Skin diseases: Seborrheic dermatitis, allergic/contact dermatitis, psoriasis. Physical trauma Swimming: moisture trapped in the ear canal can contribute to infection. Pseudomonas aeruginosa likes water >> swimmers at higher risk

Answer 13

Acute onset of pruritus >> itching Otalgia >> ear pain Hearing loss Aural fullness Otorrhoea >> ear discharge Pain or discomfort when moving the jaw or chewing

Answer 14

Erythema (redness) and swelling of the ear canal and/or external ear Ear canal oedema (swelling) Purulent (pus-like) or serous (clear) discharge Increased otalgia when the tragus or pinna is moved Inflamed tympanic membrane (if visible; may be obscured by swelling)

Answer 15

Clinical diagnosis Ear swab for bacterial and fungal cultures in cases of treatment failure, recurrent or chronic infections, or when the infection extends beyond the external auditory canal.

Answer 16

General self-care >> avoid swimming, painkiller, keep ears dry, avoid cotton buds Localise OE >> If abscess can create an incision and drain fluid. Oral antibiotic if signs on systemic illness or boil formation Diffuse OE >> Topical antibiotic with/without topic corticosteroid- Gentamicin, ciprofloxacin, neomycin // betamethasone or prednisolone Ear wick if extensive swelling Oral antibiotic if systemic illness or recurrent.

Answer 17

Malignant Necrotising Otitis Externa A severe form of otitis externa that progresses to osteomyelitis. Osteo >> bone mye >> muscle litis >> inflammation

Answer 18

Increases due to predisposing conditions

Answer 19

Trauma Alcohol Drug Chronic steroid use TB Immunosuppression HIV

Answer 20

Constant deep otalgia (pain) Vertigo Profound hearing loss

Answer 21

Fever Palsy of cranial nerves- VII (facial nerve) XII (glossopharyngeal nerve)

Answer 22

CT scan >> will show destruction of bone and muscle

Answer 23

Emergency Admission IV antibiotics

Answer 24

Accumulation of cerumen >> earwax. Also include sebum, dead cells, sweat, hair and dust.

Answer 25

Cerumen (earwax) naturally cleans, protects, and lubricates the external auditory canal. Impaction occurs when an accumulation of cerumen leads to symptoms.

Answer 26

Conductive hearing loss Aural fullness Otorrhoea >> ear discharge Tinnitus Dizziness

Answer 27

Visualisation and clinical otoscopy examination

Answer 28

Manual removal: by a healthcare professional. Aural irrigation: using a syringe, if no contraindications are present. Cerumenolytic agents: topic agents to soften cerumen, aiding in manual removal or irrigation. Micro-suction: For safe removal, particularly in more complex cases. Complication if perforated TM, history of ear surgery, active dizziness, recurrent ear infections.

Answer 29

Vertigo is a feeling like you or everything around you is spinning. It's more than just feeling dizzy.

Answer 30

Not a diagnosis >> a symptom Can be central (brain) or peripheral (ear)

Answer 31

Usually medically less serious, but potentially life-disrupting- Benign Paroxysmal Positional Vertigo Otitis Media Labyrinthitis Vestibular neuronitis Foreign body or wax in ear Acoustic Neuroma >> tumour of 8th cranial nerve >> vestibucochlear nerve Motion Sickness

Answer 32

Usually more medically serious, can sometimes go undetected or less disruptive to lifestyle- Stroke Temporal Lobe Epilepsy Tumor Post-concussive syndrome Vertebral Artery Insufficiency Basilar Artery Migraine Multiple Sclerosis

Answer 33

Sudden onset Severe intensity Lasts for a few minutes and is intermittent Unidirectional, horizontal nystagmus >> rapid, uncontrolled eye movement Worse with specific head position No focal neurological findings >> no peripheral weakness, haven’t speech fine, reflexes fine, sensations fine Some hearing loss or tinnitus

Answer 34

Gradual onset Mild intensity Lasts for hours to days, and is constant in duration Multidirectional and Vertical nystagmus >> rapid, uncontrolled eye movement No particular head position worsens it May have focal neurological findings >> peripheral weakness, loss of speech, reflexes, or sensation Normal hearing

Answer 35

Disorder of inner ear characterised by repeated episodes of positional vertigo Benign >> doesn’t cause further illness Paroxysmal >> temporary and sudden onset Positional >> related to change in body position Vertigo >> causes false sensation of spinning

Answer 36

Caused by loose calcium carbonate debris in semi-circular canals of inner ear With head movement, debris move in canals >> inner ear fluid (endolymph) movement disrupted >> induces symptom of vertigo

Answer 37

Head injury Prolonged recumbent position >> rolling over in bed Ear surgery Previous of inner ear pathology Age

Answer 38

Episodic vertigo Nausea Rare vomiting Imbalance or falling Worse in mornings No hearing loss or tinnitus No neurological abnormalities

Answer 39

Clinical >> take history Dix - Hallpike Manoeuvre >> looking for nystagmus of eyes >> rhythmic oscillation of eyes >> >> patient sits on bed with legs out >> move face 45 degrees >> quickly lower them onto bed so head off bed >> check eyes for rapid movement

Answer 40

Epley Manoeuvres to reposition debris in semi-circular canals >> turn head 45 degrees towards affected side >> lie down keeping head turned for 30 seconds >> turn head 90 degrees towards unaffected side for 30 seconds >> turn another 90 degrees by moving body to unaffected side for 30 seconds >> sit up keeping head turned If severely dehydrated from vomiting, may need IV fluids Advice patient to avoid provoking movements Help patient learn to “self-Eppley” After 4 weeks, refer if symptoms not resolved- No improvement with repeat manoeuvres Atypical nystagmus Consider imaging and further referral

Answer 41

Chronic long-term conditions affecting the inner ear, balance, and hearing

Answer 42

Cause unknown in most patients Possible abnormal endolymph production and absorption >> accumulation of fluid

Answer 43

Autoimmune disease Metabolic disturbances involving balance of sodium/potassium levels of inner ear Viral infection Head trauma Migraine headaches

Answer 44

Episodic attacks lasting from 20 minutes to an hour Vertigo Hearing loss Tinnitus >> noise in ear Aural fullness

Answer 45

Nystagmus during attacks

Answer 46

Refer ENT or Audiovestibular medicine to confirm diagnosis Diagnostic criteria includes- More than 2 vertigo episodes lasting 20mins-12hrs Fluctuating hearing, tinnitus, or aural fullness of affected ear Hearing loss confirmed by audiometry testing

Answer 47

No cure >> understanding of Meniere’s pathophysiology is limited Rapid relief >> prochlorperazine eases dizziness and vomiting >> take medicine when attack starts Betahistine >> antihistamine to prevent attacks Lifestyle >> very low salt diet, avoid caffeine/alcohol/tobacco, regular exercise Avoid heights, do not swim alone, DVLA must be alerted SAFETY NETTING

Answer 48

Infection or inflammation of the vestibular nerve

Answer 49

Most common in 30-60 year olds Men and women equally affected

Answer 50

Inflammation of vestibulocochlear nerve Often occurs in conjunction with or after viral infection of body, head, or neck Occasionally provoked by immunisation

Answer 51

Abrupt onset of peripheral vertigo >> days-weeks Cannot walk or balance without falling Nausea and vomiting >> dehydration or electrolyte imbalances Typically present at emergency care

Answer 52

No treatment >> wait for infection to clear Prochlorperazine >> dopamine receptor blocker >> rapid relief DO NOT USE STEROIDS >> don’t help and side effects are too severe to justify Refer to ENT

Ear Conditions Flashcards

(76 cards)