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Flashcards in Ear conditions Deck (100)
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1

Name the 6 D's

Deafness
Discomfort
Discharge
Dizziness
Din Din (tinnitus)
Defective movement of the face (CN VII palsy)

2

Otitis externa - definition

Inflammation of the outer ear canal

3

Otitis externa - who commonly gets it?

Swimmers

4

Otitis externa - bacterial causes (2)

Staph aureus
Pseudomonas aerginosa

5

Otitis externa - fungal causes (2)

Aspergillus niger
Candida albicans

6

Otitis externa - clinical features

Redness and swelling of the skin of the outer ear canal
Initially itchy
Can become sore and painful
Discharge / increased amounts of earwax

7

Otitis externa - can hearing be affected?

Yes
- if the canal becomes blocked (e.g. by swellings or secretions)

8

Otitis externa - management

Suction clean the ear (instant relief)
Keep the ear clean and dry until it recovers
May need antimicrobials/antibiotics if bacterial

9

Otitis externa - malignant otitis - definition

Extension of the otitis externa into the bone surrounding the ear canal (mastoid and temporal bones)

10

Otitis externa - malignant otitis - cause

Pseudomonas aerginosa

11

Otitis externa - malignant otitis - clinical features

Pain
Headache

12

Otitis externa - malignant otitis - signs

Facial nerve palsy (drooping face on side of the lesion)

13

Otitis externa - malignant otitis - investigations

Inflammatory markers (raised)
Imaging (to see extent of osteitis)

14

Acute otitis media - definition

Acute inflammation of the middle ear with/without an accumulation of fluid

15

Acute otitis media - who gets it

Infants and children

16

Acute otitis media - cause

Usually viral (URTI)
Occasionally bacterial (strep pneumonia, haemophilus influenza, moraxella catarrhalis, strep pyogenes)

17

Acute otitis media - pathogenesis

Often an URTI which involves the middle ear due to the extension of infection up the eustachian tube. This causes fluid/pus accumulation in the middle ear.

18

Acute otitis media - clinical features

Screaming child in middle of night
Earache (otalgia)
Discharge (if tympanic membrane perforates)
Conductive hearing loss
Fever
Lethargy

19

Acute otitis media - investigations

Otoscopy (red and inflamed ear drum)
Swab pus (if discharge present)
DO NOT regular biopsy (only if alternative differential diagnosis needs exclusion)

20

Acute otitis media - management (if less than 4 days)

Most self limiting, resolve within 4 days

21

Acute otitis media - management (if more than 4 days)

First line: oral amoxicillin
Second line: oral erythromycin

22

Acute otitis media - management with antibiotics should be topical/oral?

Oral

23

Otitis media with effusion - definition

Glue ear
This is not an infection
Accumulation of fluid behind an intact ear drum (without signs/symptoms of acute inflammation)

24

Otitis media with effusion - pathogenesis

Eustachian tube gets anatomically blocked and the middle ear is unable to equalise the pressure with the atmospheric environment (nasopharynx end of eustachian tube)
Build up of negative pressure and fluid accumulated in middle ear space

25

Otitis media with effusion - causes of eustachian tube blockage

Enlarged adenoid tonsils
Recurrent URTI
Recurrent AOM

26

Otitis media with effusion - who gets it

Children

27

Otitis media with effusion - clinical features

Hearing loss (conductive)
NO earache, fever, irritability
Middle ear effusion
Impaired tympanic membrane mobility
Speech delay

28

Otitis media with effusion - examinations

Otoscopy
- tympanic membrane retraction
- reduced tympanic membrane mobility
visible middle ear fluid/bubbles
Tuning fork test
- conductive hearing loss

29

Otitis media with effusion - investigations

Audiometry
- conductive hearing loss
Tympanometry
- flat line due to presence of fluid suggests a middle ear effusion

30

Otitis media with effusion - initial management

Watchful waiting for 3 months
- may resolve naturally