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Flashcards in Ear Disease Deck (20):
1

What is the D principle of ear disease?

• Deafness
• Discomfort
• Discharge
• Dizziness
• Din Din
• Destruction by disease (cholesteatoma)
• Defective movement of face

2

What is conductive deafness? what can cause this?

• Problem in ear canal/middle ear
• Fluid – effusion/blood/CSF
• Tympanic membrane perforation – traumatic or chronic
• Ossicular problem – in temporal bone fracture incus can dislocate from malleus/long process of incus is a ‘watershed’ area and is susceptible to ischaemia
• Otosclerosis of stapes – congenital or acquired

3

What is sensorineural deafness? what causes this?

Sensorineural:
• Problem in inner ear
• Sensory is chochlear problem and neural is CNVIII

4

What is central deafness?

Central:
• This is problems in the auditory centre of the brain e.g. from damaged stroke

5

Otitis media with effusion:
-what is this?

This is where middle ear pressure has dropped to become a vacuum and pulls all secretions into the middle ear up the Eustachian tube.
Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

6

What are the causes of otitis media with effusion?

• This can be due to Eustachian tube dysfunction where It is narrowed/blocked/not opening properly
• It can follow inflammation where there is extra mucus made

7

Who does otitis media with effusion affect? what increases the risk?

• Age – any child
• M>F
• 30% children <4yrs at any time
• Increase in day care/presence of older siblings/smoking households/recurrent URTI

8

What patient factors can cause otitis media with effusion?

Recurrent URTI
Recurrent AOM
Prematurity
Craniofacial abnormalities/Genetic abnormalities
Immunodeficiency

9

What environmental factors can cause otitis media with effusion?

Household smoking
Day care
Allergy
Nutrition?
Bottle feeding (antibody lack)
Seasonal (more in winter)

10

What are the symptoms of otitis media with effusion?

¥ Deafness
¥ Poor school performance
¥ Behavioural problems
¥ Speech delay
¥ ?Balance problems
¥ ?TV volume
NOT OTALGIA

11

What are the signs of otitis media with effusion?

¥ TM retraction
¥ Reduced TM mobility
¥ Altered TM colour
¥ Visible ME fluid/bubbles
¥ CHL tuning fork tests

12

What is included in the diagnosis of otitis media with effusion?

¥ History
¥ Otoscopy
¥ Tuning fork tests
¥ Audiometry
¥ Tympanometry

13

What is the treatment of otitis media with effusion?

Watchful waiting as 90% resolve @3/12

Review at 3months:

OME persistent for > 3/12 with symptoms
¥ Deafness
¥ Speech
¥ Balance
=referral:

• Persistent (> 3/12), bilateral OME
¥ CHL >25dB
¥ Speech/language problems
¥ Developmental behavioral problems

14

What is the surgical management of otitis media with effusion?

• A grommet can be inserted into the tympanic membrane and ventilate the middle ear and the grommet is extruded from the tympanic membrane as it heals.
• Developmental outcomes are not improved by grommet insertions.
< 3yrs = Grommets
> 3yrs, first intervention = Grommets
> 3yrs, second intervention = Grommets and adenoidectomy
If nasal symptoms, adenoids may be considered earlier

15

What are the complications of grommets?

Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/Bathing issues

16

what is chronic otitis media?

Hole in the eardrum that does not heal within 6 weeks and this can present in one of 3 ways:

17

What are the three ways chronic otitis media can present?

1. Non-infected COM
There is a hole but no infection/fluid in the middle ear and as long as the ear remains dry this can remain stable for years
The hole can be repaired to improve hearing or prevent infection.
2. Suppurative COM (filled with pus)
An infection in the middle ear and a hole in the membrane can cause pus to drain out through the opening
3. COM with cholesteatoma

18

What is cholesteatoma?
-what is the management?

This is defined as keratinizing squamous cell epithelium within the middle ear cleft and can present with foul smelling otorrhea.

Mastoid surgery is required to remove this sac of squamous debris as it can erode local structures such as the facial nerve or even extend intracranially.

19

How does a cholesteatoma develop?

• ‘Dead’ skin does not shed out the ear but collects as a ‘skin mass’. This is because the tympanic membrane is retracted in and skin collects in centre.
• It can develop where there is a hole in the tympanic membrane, or if there is no hole but the Eustachian tube is blocked.

20

What is otosclerosis?

Autosomal dominant, replacement of normal bone by vascular spongy bone. Onset is usually at 20-40 years - features include:

conductive deafness
tinnitus
tympanic membrane - 10% of patients may have a 'flamingo tinge', caused by hyperaemia
positive family history