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ENT > Ear Disease > Flashcards

Ear Disease Flashcards

1
Q

What is otitis externa?

A

inflammation of the skin of the ear canal

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2
Q

What bacteria can cause otitis externa?

A

Pseudomonas (most common)

Staph aureus

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3
Q

Otitis externa can be caused by a fungal infection. TRUE/FALSE

A

true

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4
Q

What are the symptoms of otitis externa?

A

discharge
itch
pain
tragal tenderness

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5
Q

What are the causes of otitis externa?

A

excess canal moisture (most common)
trauma (e.g. from fingernails in itchy conditions like eczema)
high humidity
absence of wax (e.g. from self-cleaning)
narrow ear canal
hearing aids
dermatitis

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6
Q

What are the clinical features of mild otitis externa?

A

scaly skin with some erythema

normal diameter of external auditory canal

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7
Q

What is the treatment for mild otitis externa?

A

clean external auditory canal
hydrocortisone cream to pinna
EarCalm spray

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8
Q

How do you clean the external auditory canal?

A

syringing or irrigation to remove debris provided tympanic membrane is intact

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9
Q

What is EarCalm and what does it do?

A

2% acetic acid

acts as an antifungal and antibacterial

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10
Q

What are the clinical features of moderate otitis externa?

A

painful ear

narrowed external auditory canal with malodourous creamy discharge

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11
Q

What is the management of moderate otitis externa?

A

swab
clean external auditory canal
prescribe topical antibiotics +/- steroid drops (if inflamed)

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12
Q

What are the clinical features of severe otitis externa?

A

external auditory canal occluded

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13
Q

What is the management of severe otitis externa?

A

ENT referral

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14
Q

When should you suspect malignant/necrotising otitis externa? (life threatening)

A

persistent unilateral otitis externa in diabetics, immunosuppressed or the elderly
otitis externa that is resistant to treatment

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15
Q

What is acute otitis media?

A

middle ear inflammation

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16
Q

In what age group is acute otitis media most common?

A

children

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17
Q

What is acute otitis media associated with?

A

glue ear

upper respiratory tract infections

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18
Q

What is the clinical presentation of acute otitis media?

A 
rapid onset of pain and fever
\+/- 
irritability 
anorexia 
vomiting
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19
Q

When does acute otitis media often occur?

A

after a viral upper respiratory tract infection

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20
Q

What are the common organisms that cause acute otitis media?

A

Pneumococcus
Haemophilus
Moraxella

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21
Q

What causes the pain in acute otitis media?

A

bulging of tympanic membrane - pain relieved if TM bursts

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22
Q

What causes purulent discharge in acute otitis media?

A

tympanic membrane bursting

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23
Q

What is the management of acute otitis media?

A

usually resolves in 24hrs without antibiotics

analgesia

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24
Q

When should antibiotics be considered in acute otitis media?

A 
systemically unwell 
immunocompromised 
no improvement in >4days 
<3 months old 
perforation/discharge 
<2 years old with bilateral OM
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25
Q

What antibiotics are given in acute otitis media?

A

amoxicillin

erythromycin if penicillin allergic

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26
Q

What is otitis media with effusion/glue ear?

A

effusion present after regression of symptoms of acute otitis media

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27
Q

In what age group is otitis media with effusion/glue ear most common in?

A

children

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28
Q

What is the most common cause of hearing loss in young children?

A

otitis media with effusion/glue ear

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29
Q

What causes otitis media with effusion/glue ear in children?

A

eustachian tube dysfunction or obstruction

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30
Q

What causes otitis media with effusion/glue ear in adults?

A

rhinosinusitis
nasopharyngeal carcinoma
nasopharyngeal lymphoma

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31
Q

What are the symptoms of otitis media with effusion/glue ear in children?

A 
poor listening 
poor speech 
language delay 
inattention 
poor behaviour 
ear infections 
upper respiratory tract infections 
balance problems 
poor progress at school
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32
Q

What are the signs of otitis media with effusion/glue ear?

A 
conductive hearing loss with tuning fork tests 
 flat tympanogram 
retracted TM 
reduced TM mobility 
altered TM colour 
visible middle ear fluid or bubbles
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33
Q

What is the management of otitis media with effusion/glue ear?

A

active observation for 3 months (50% will resolve spontaneously)
after 3 months consider insertion of grommet

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34
Q

What does a grommet do?

A

ventilates middle ear

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35
Q

What are the side effects of a grommet?

A 
increased risk of infection 
discharge 
early extrusion 
retention 
persistent perforation 
swimming and bathing issues
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36
Q

What can cause perforation of the tympanic membrane?

A

acute otitis media

trauma (e.g. head injury or cotton bud)

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37
Q

What is the management of perforation of the tympanic membrane?

A

usually heals spontaneously within 6-8 weeks - if kept infection free (avoid water)
myringoplasty if doesn’t heal by itself

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38
Q

What is cholesteatoma?

A

presence of keratin within the middle ear - erodes surrounding bone

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39
Q

What are the clinical features of cholesteatoma?

A 
foul discharge 
\+/-
conductive hearing loss 
headache 
pain 
facial paralysis 
vertigo
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40
Q

What is the peak age for cholesteatoma?

A

5-15 years

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41
Q

What is the management of cholesteatoma?

A

surgical excision and reconstruction - mastoid surgery

42
Q

What are the complications of acute otitis media and cholesteatoma?

A

medially - sensorineural hearing loss, tinnitus, vertigo, facial palsy
superiorly - brain abscess, meningitis
posteriorly - venous sinus thrombosis

43
Q

What is otosclerosis?

A

fixation of the stapes footplate due to new bone being formed around it

44
Q

What are the symptoms of otosclerosis?

A

gradual onset conductive hearing loss
+/-
tinnitus
mild vertigo

45
Q

What is conductive hearing loss?

A

impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes

46
Q

What age is the normal onset for otosclerosis?

A

late teens to 20s

47
Q

Otosclerosis is more common in women. TRUE/FALSE

A

true

48
Q

What makes otosclerosis progress more rapidly?

A

pregnancy

49
Q

How is otosclerosis inherited?

A

autosomal dominant with incomplete penetrance (can skip generations- may not have positive family history)

50
Q

What is the treatment for otosclerosis?

A

hearing aid

correction by stapedectomy

51
Q

What is sensorineural hearing loss?

A

results from defects to the oval window in the cochlea (sensory), cochlear nerve (neural) or (rarely) more central pathways

52
Q

What is presbycusis?

A

gradual, age-related, bilateral, high frequency sensorineural hearing loss

53
Q

What is the treatment for presbycusis?

A

hearing aids

54
Q

What are the symptoms of noise induced hearing loss?

A

bilateral sensorineural hearing loss

+/- tinnitus

55
Q

What is the aetiology of noise induced hearing loss?

A 
acoustic trauma (one time exposure to intense sound e.g. explosion) 
occupational (continuous exposure to loud sounds)
56
Q

What is seen on audiology of someone with noise induced hearing loss?

A

dip at 4kHz

57
Q

What is the management of noise induced hearing loss?

A

prevention

hearing aids

58
Q

What drugs can cause sensorineural hearing loss?

A

gentamicin and other aminoglycosides
chemotherapeutic drugs (e.g. Cisplatin, Vincristine)
overdose of aspirin or NSAIDs
furosemide

59
Q

What is vestibular schwannoma/acoustic neuroma?

A

benign tumour arising in the internal acoustic meatus within the temporal bone

60
Q

What are the symptoms of vestibular schwannoma/acoustic neuroma?

A

progressive ipsilateral tinnitus +/- sensorineural hearing loss (compression of cochlear nerve)
may also feel dizzy and have facial numbness (trigeminal compression above the tumour

61
Q

What cranial nerves are at risk in vestibular schwannoma/acoustic neuroma?

A

V - trigeminal - absent corneal reflex
VI - abducens
VII - facial - facial palsy
VIII - hearing loss, vertigo, tinnitus

62
Q

How is vestibular schwannoma diagnosed?

A

MRI scan

63
Q

What is the treatment for vestibular schwannoma/acoustic neuroma?

A

hearing aids

surgery

64
Q

What is seen on otoscopy of cholesteatoma?

A

“attic crust” - seen in uppermost part of the ear drum

65
Q

What is the Rinne’s test?

A 
tuning fork placed over the mastoid process until the sound is no longer heard - followed by repositioning just over the external acoustic meatus 
air conduction (AC) is normally better than bone conduction (BC) 
if BC> AC = conductive deafness
66
Q

What is Weber’s test?

A

tuning fork is placed in the middle of the forehead equidistant from the patient’s ears
the patient is then asked which side is loudest
unilateral sensorineural deafness sound is localised to the unaffected side
unilateral conductive deafness sound is localised to the affected side

67
Q

What is acoustic neuroma/vestibular schwannoma associated with?

A

Neurofibromatosis type II

68
Q

What is Neurofibromatosis type 2?

A

Benign tumours growing along nerves

69
Q

What are the symptoms of neurofibromatosis type II?

A

Ear problems - progressive sensorineural hearing loss, tinnitus, balance problems
Cataracts
Skin problems- cafe au lait spots (also NF1), skin plaques
Peripheral neuropathy- pins and needles, numbness in feet, burning pain, muscle weakness
Neurological- headaches, vomiting, seizures, vision disturbances
Back pain

70
Q

What may improve tinnitus?

A

Background noise

71
Q

What are some of the risk factors for otitis media with effusion/glue ear?

A 
immunodeficiency 
household smoking 
allergy
day care 
bottle feeding
72
Q

What are the most common fungal causes of acute otitis externa?

A

aspergillus niger

candida albicans

73
Q

What is myringitis?

A

form of acute otitis media in which vesicles develop on the tympanic membrane

74
Q

What can cause myringitis?

A

Ramsay Hunt syndrome

myringitis bullosa

75
Q

What is Ramsay Hunt syndrome?

A

herpes zoster infection of the facial nerve (CN VII)

76
Q

In what age group is Ramsay Hunt syndrome common?

A

the elderly

77
Q

What are the symptoms of Ramsay Hunt syndrome?

A

severe otalgia precedes CN VII palsy (+/- CN VIII, IX, V, VI in order of frequency)
vesicles appear around the ear and tympanic membrane (+/- soft palate, tongue)
+/-
vertigo
tinnitus
sensorineural hearing loss

78
Q

What is the treatment for Ramsay Hunt syndrome?

A

acyclovir

prednisolone

79
Q

What is malignant/necrotising otitis externa?

A

extension of otitis externa into the bone surrounding the ear canal - mastoid and temporal bones
fatal without treatment
osteomyelitis will progressively involve the skull and meninges

80
Q

What are the symptoms of malignant/necrotising otitis externa?

A

otalgia and headache more severe than clinical signs would suggest

81
Q

What are the signs of malignant/necrotising otitis externa?

A

granulation tissue at bone-cartilage junction of the ear canal
exposed bone in the ear canal
facial nerve palsy - drooping face on side of lesion

82
Q

What are the investigations for necrotising/malignant otitis externa?

A

plasma viscosity and CRP - demonstrate an inflammatory response
CT scan
biopsy
culture

83
Q

What bacteria usually cause malignant/necrotising otitis externa?

A

Pseudomonas aeruginosa - most common
Proteus
Klebsiella

84
Q

What causes chronic otitis media?

A

Pseudomonas aeruginosa
Staph aureus
fungal

85
Q

What is the pathogenesis of cholesteatoma?

A

chronic otitis media - perforated tympanic membrane - - abnormally situated squamous epithelium - high cell turnover and abundant keratin production - inflammation

86
Q

What should be considered if there is bilateral vestibular schwannoma/acoustic neuroma in a young person?

A

NF 2

87
Q

What is the gross appearance of vestibular schwannoma/acoustic neuroma?

A

circumscribed (confined) tan/white/yellow mass

88
Q

What is classed as normal on an audiogram?

A

anything above the 20dB line

89
Q

What does a audiogram of sensorineural hearing loss show?

A

both air and bone conduction are impaired - below 20dB line

90
Q

What does an audiogram of conductive hearing loss show?

A

only air conduction is impaired - below 20dB line

91
Q

What does an audiogram of mixed hearing loss show?

A

both air and bone conduction are impaired - below 20dB line

air conduction normally worse than bone

92
Q

What is otalgia in the absence of any ear signs a red flag for?

A

head and neck malignancy

93
Q

What drugs can cause tinnitus?

A

aspirin
aminoglycosides
loop diuretics
quinine

94
Q

What are the clinical features of mastoiditis?

A

severe otalgia - classically behind ear
may have a history of recurrent otitis media
fever
systemically unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated

95
Q

Why is mastoiditis a medical emergency?

A

risk of meningitis

other complications - cranial nerve palsies, hearing loss, osteomyelitis, carotid artery spasm

96
Q

What causes acute mastoiditis?

A

acute otitis media spreading out from the middle ear

97
Q

What causes chronic mastoiditis?

A

cholesteatoma - part of the spectrum of otitis media

98
Q

What is the treatment of malignant/necrotising otitis externa?

A

IV antibiotics that cover pseudomonal infections e.g. ciprofloxacin

99
Q

What is the management of mastoiditis?

A

urgent referral to ENT for admission

100
Q

In a child with persistent glue ear and symptoms reoccur despite grommet insertion what should be the next step?

A

repeat grommet insertion

consider adenoidectomy

101
Q

In patients with chronic or recurrent ear discharge what is the most impart part of the tympanic membrane to visualise on otoscopy?

A

attic - looking for cholesteatoma

ENT (21 decks)

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