Ear Disease Flashcards
(101 cards)
1
Q
What is otitis externa?
A
inflammation of the skin of the ear canal
2
Q
What bacteria can cause otitis externa?
A
Pseudomonas (most common)
Staph aureus
3
Q
Otitis externa can be caused by a fungal infection. TRUE/FALSE
A
true
4
Q
What are the symptoms of otitis externa?
A
discharge
itch
pain
tragal tenderness
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
6
Q
What are the clinical features of mild otitis externa?
A
scaly skin with some erythema
normal diameter of external auditory canal
7
Q
What is the treatment for mild otitis externa?
A
clean external auditory canal
hydrocortisone cream to pinna
EarCalm spray
8
Q
How do you clean the external auditory canal?
A
syringing or irrigation to remove debris provided tympanic membrane is intact
9
Q
What is EarCalm and what does it do?
A
2% acetic acid
acts as an antifungal and antibacterial
10
Q
What are the clinical features of moderate otitis externa?
A
painful ear
narrowed external auditory canal with malodourous creamy discharge
11
Q
What is the management of moderate otitis externa?
A
swab
clean external auditory canal
prescribe topical antibiotics +/- steroid drops (if inflamed)
12
Q
What are the clinical features of severe otitis externa?
A
external auditory canal occluded
13
Q
What is the management of severe otitis externa?
A
ENT referral
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
15
Q
What is acute otitis media?
A
middle ear inflammation
16
Q
In what age group is acute otitis media most common?
A
children
17
Q
What is acute otitis media associated with?
A
glue ear
upper respiratory tract infections
18
Q
What is the clinical presentation of acute otitis media?
A
rapid onset of pain and fever \+/- irritability anorexia vomiting
19
Q
When does acute otitis media often occur?
A
after a viral upper respiratory tract infection
20
Q
What are the common organisms that cause acute otitis media?
A
Pneumococcus
Haemophilus
Moraxella
21
Q
What causes the pain in acute otitis media?
A
bulging of tympanic membrane - pain relieved if TM bursts
22
Q
What causes purulent discharge in acute otitis media?
A
tympanic membrane bursting
23
Q
What is the management of acute otitis media?
A
usually resolves in 24hrs without antibiotics
analgesia
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
25
What antibiotics are given in acute otitis media?
amoxicillin
| erythromycin if penicillin allergic
26
What is otitis media with effusion/glue ear?
effusion present after regression of symptoms of acute otitis media
27
In what age group is otitis media with effusion/glue ear most common in?
children
28
What is the most common cause of hearing loss in young children?
otitis media with effusion/glue ear
29
What causes otitis media with effusion/glue ear in children?
eustachian tube dysfunction or obstruction
30
What causes otitis media with effusion/glue ear in adults?
rhinosinusitis
nasopharyngeal carcinoma
nasopharyngeal lymphoma
31
What are the symptoms of otitis media with effusion/glue ear in children?
```
poor listening
poor speech
language delay
inattention
poor behaviour
ear infections
upper respiratory tract infections
balance problems
poor progress at school
```
32
What are the signs of otitis media with effusion/glue ear?
```
conductive hearing loss with tuning fork tests
flat tympanogram
retracted TM
reduced TM mobility
altered TM colour
visible middle ear fluid or bubbles
```
33
What is the management of otitis media with effusion/glue ear?
active observation for 3 months (50% will resolve spontaneously)
after 3 months consider insertion of grommet
34
What does a grommet do?
ventilates middle ear
35
What are the side effects of a grommet?
```
increased risk of infection
discharge
early extrusion
retention
persistent perforation
swimming and bathing issues
```
36
What can cause perforation of the tympanic membrane?
acute otitis media
| trauma (e.g. head injury or cotton bud)
37
What is the management of perforation of the tympanic membrane?
usually heals spontaneously within 6-8 weeks - if kept infection free (avoid water)
myringoplasty if doesn't heal by itself
38
What is cholesteatoma?
presence of keratin within the middle ear - erodes surrounding bone
39
What are the clinical features of cholesteatoma?
```
foul discharge
+/-
conductive hearing loss
headache
pain
facial paralysis
vertigo
```
40
What is the peak age for cholesteatoma?
5-15 years
41
What is the management of cholesteatoma?
surgical excision and reconstruction - mastoid surgery
42
What are the complications of acute otitis media and cholesteatoma?
medially - sensorineural hearing loss, tinnitus, vertigo, facial palsy
superiorly - brain abscess, meningitis
posteriorly - venous sinus thrombosis
43
What is otosclerosis?
fixation of the stapes footplate due to new bone being formed around it
44
What are the symptoms of otosclerosis?
gradual onset conductive hearing loss
+/-
tinnitus
mild vertigo
45
What is conductive hearing loss?
impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes
46
What age is the normal onset for otosclerosis?
late teens to 20s
47
Otosclerosis is more common in women. TRUE/FALSE
true
48
What makes otosclerosis progress more rapidly?
pregnancy
49
How is otosclerosis inherited?
autosomal dominant with incomplete penetrance (can skip generations- may not have positive family history)
50
What is the treatment for otosclerosis?
hearing aid
| correction by stapedectomy
51
What is sensorineural hearing loss?
results from defects to the oval window in the cochlea (sensory), cochlear nerve (neural) or (rarely) more central pathways
52
What is presbycusis?
gradual, age-related, bilateral, high frequency sensorineural hearing loss
53
What is the treatment for presbycusis?
hearing aids
54
What are the symptoms of noise induced hearing loss?
bilateral sensorineural hearing loss
| +/- tinnitus
55
What is the aetiology of noise induced hearing loss?
```
acoustic trauma (one time exposure to intense sound e.g. explosion)
occupational (continuous exposure to loud sounds)
```
56
What is seen on audiology of someone with noise induced hearing loss?
dip at 4kHz
57
What is the management of noise induced hearing loss?
prevention
| hearing aids
58
What drugs can cause sensorineural hearing loss?
gentamicin and other aminoglycosides
chemotherapeutic drugs (e.g. Cisplatin, Vincristine)
overdose of aspirin or NSAIDs
furosemide
59
What is vestibular schwannoma/acoustic neuroma?
benign tumour arising in the internal acoustic meatus within the temporal bone
60
What are the symptoms of vestibular schwannoma/acoustic neuroma?
progressive ipsilateral tinnitus +/- sensorineural hearing loss (compression of cochlear nerve)
may also feel dizzy and have facial numbness (trigeminal compression above the tumour
61
What cranial nerves are at risk in vestibular schwannoma/acoustic neuroma?
V - trigeminal - absent corneal reflex
VI - abducens
VII - facial - facial palsy
VIII - hearing loss, vertigo, tinnitus
62
How is vestibular schwannoma diagnosed?
MRI scan
63
What is the treatment for vestibular schwannoma/acoustic neuroma?
hearing aids
| surgery
64
What is seen on otoscopy of cholesteatoma?
"attic crust" - seen in uppermost part of the ear drum
65
What is the Rinne's test?
```
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
What is Weber's test?
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
What is acoustic neuroma/vestibular schwannoma associated with?
Neurofibromatosis type II
68
What is Neurofibromatosis type 2?
Benign tumours growing along nerves
69
What are the symptoms of neurofibromatosis type II?
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
What may improve tinnitus?
Background noise
71
What are some of the risk factors for otitis media with effusion/glue ear?
```
immunodeficiency
household smoking
allergy
day care
bottle feeding
```
72
What are the most common fungal causes of acute otitis externa?
aspergillus niger
| candida albicans
73
What is myringitis?
form of acute otitis media in which vesicles develop on the tympanic membrane
74
What can cause myringitis?
Ramsay Hunt syndrome
| myringitis bullosa
75
What is Ramsay Hunt syndrome?
herpes zoster infection of the facial nerve (CN VII)
76
In what age group is Ramsay Hunt syndrome common?
the elderly
77
What are the symptoms of Ramsay Hunt syndrome?
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
What is the treatment for Ramsay Hunt syndrome?
acyclovir
| prednisolone
79
What is malignant/necrotising otitis externa?
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
What are the symptoms of malignant/necrotising otitis externa?
otalgia and headache more severe than clinical signs would suggest
81
What are the signs of malignant/necrotising otitis externa?
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
What are the investigations for necrotising/malignant otitis externa?
plasma viscosity and CRP - demonstrate an inflammatory response
CT scan
biopsy
culture
83
What bacteria usually cause malignant/necrotising otitis externa?
Pseudomonas aeruginosa - most common
Proteus
Klebsiella
84
What causes chronic otitis media?
Pseudomonas aeruginosa
Staph aureus
fungal
85
What is the pathogenesis of cholesteatoma?
chronic otitis media - perforated tympanic membrane - - abnormally situated squamous epithelium - high cell turnover and abundant keratin production - inflammation
86
What should be considered if there is bilateral vestibular schwannoma/acoustic neuroma in a young person?
NF 2
87
What is the gross appearance of vestibular schwannoma/acoustic neuroma?
circumscribed (confined) tan/white/yellow mass
88
What is classed as normal on an audiogram?
anything above the 20dB line
89
What does a audiogram of sensorineural hearing loss show?
both air and bone conduction are impaired - below 20dB line
90
What does an audiogram of conductive hearing loss show?
only air conduction is impaired - below 20dB line
91
What does an audiogram of mixed hearing loss show?
both air and bone conduction are impaired - below 20dB line
| air conduction normally worse than bone
92
What is otalgia in the absence of any ear signs a red flag for?
head and neck malignancy
93
What drugs can cause tinnitus?
aspirin
aminoglycosides
loop diuretics
quinine
94
What are the clinical features of mastoiditis?
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
Why is mastoiditis a medical emergency?
risk of meningitis
| other complications - cranial nerve palsies, hearing loss, osteomyelitis, carotid artery spasm
96
What causes acute mastoiditis?
acute otitis media spreading out from the middle ear
97
What causes chronic mastoiditis?
cholesteatoma - part of the spectrum of otitis media
98
What is the treatment of malignant/necrotising otitis externa?
IV antibiotics that cover pseudomonal infections e.g. ciprofloxacin
99
What is the management of mastoiditis?
urgent referral to ENT for admission
100
In a child with persistent glue ear and symptoms reoccur despite grommet insertion what should be the next step?
repeat grommet insertion
| consider adenoidectomy
101
In patients with chronic or recurrent ear discharge what is the most impart part of the tympanic membrane to visualise on otoscopy?
attic - looking for cholesteatoma
