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3D week 5 - the ear > ear disease (see DM) > Flashcards

ear disease (see DM) Flashcards

1
Q

what section of the ear is the tympanic membrane part of

A

the middle ear - although embryological is is both middle and external ear

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2
Q

what is migration (ear)

A

the outer layer of the skin lining the ear canal very gradually migrates outwards -> this is how wax and dead skin is naturally removed from the canal

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3
Q

function of the Eustachian tube

A

equalise the pressure between the middle and outer ear

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4
Q

what epithelium lines the middle ear

A

respiratory epithelium

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5
Q

what nerve traverses the middle ear

A

chorda tympani (branch of CN VII) => facial nerve palsies can arise due to ear surgery

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6
Q

what nerves innervate the inner ear

A
  1. The auriculotemporal nerve (branch of CN V mandibular) - general sensory innervation to the meatal side of tympanic membrane
  2. vagus nerve (CN X) - general sensory innervation to the meatal side of tympanic membrane
  3. The tympanic branches of the glossopharyngeal nerve - general sensory impulses of the mucosal side of the tympanic membrane transmitted
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7
Q

what are the 5 main symptoms of ear disease

A
  1. hearing loss
  2. otalgia (pain)
  3. otorrhoea (dishcarge)
  4. vertigo
  5. tinnitus
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8
Q

what other class of disease can affect the external ear

A

derm diseases -> the external ear is skin lined and so may present w itchiness, redness, scales, lumps, ulcerations and even skin cancers

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9
Q

5 acquired diseases of the external ear

A
  1. haematoma
  2. exostosis (benign outgrowth of cartilaginous tissue on a bone)
  3. osteoma
  4. infection
  5. foreign body
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10
Q

4 common external ear dformaties

A
  1. prominent cup - abnormally protuding ear, may have an incomplete opening of the ear (cup ear deformity)
  2. stahl’s ear - helix not formed properly, often in combination w other deformities
  3. lidding/lop ear - folding over the helical rim/upper third of the ear
  4. helical rim deformity - irregularities or compressions that may occur anywhere along the helix
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11
Q

what is microtia and what are the grades

A

a congenital condition in which the cartilage of the outer ear is underdeveloped or absent (but normal middle + inner ear)

grade 1 - small but almost normal
grade 2 - some recognisable anaotmy present
grade 3 - small rudiment of soft tissue and no ear canal
grade 4 - no external ear and no ear canal

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12
Q

congenital abnormalities of the external ear (3)

A
  1. microtia
  2. pinna abnormalities
  3. external canal stenosis
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13
Q

what is an auricular haematoma an what is the consequence of this

A

the stripping of the perichondrium off the cartilage by blood => nutrients and oxygen can’t reach cartilage (it is avascular itself) -> ischaemia and necrosis leading to permanent deformity

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14
Q

what is perichondritis

A

an infection of the skin and tissue surrounding the cartilage of the outer ear -> just the cartilaginous part, sparing of the lobe and tragus

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15
Q

what is acute otitis externa

A

inflammation of the external auditory meatus lasting <6wks

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16
Q

2 common causes for otitis externa

A
  1. self cleaning -> cotton buds leading to trauma or foreign body blockage
  2. swimming (swimmer’s ear -> diffuse bacterial otitis externa)
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17
Q

2 common bacteria causing otitis externa

A
  1. pseudamonas aeruginosa
  2. staphylococcus aureus
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18
Q

what is furunculosis (ear)

A

acute localised otitis externa

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19
Q

what is otomycosis

A

fungal otitis externa

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20
Q

what is a severe complication of otitis externa

A

necrotising otitis externa

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21
Q

what is chronic otitis externa

A

inflammation of the external ear lasting >3 months

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22
Q

what mico-organisms usually cause chronic otitis externa (2)

A
  1. aspergillus
  2. candida albicans
23
Q

mgx of chronic otitis externa (5)

A
  1. cleaning of ear canal
  2. topical abx
  3. steroid drops
  4. ear hygiene advice (plug ear w Vaseline when going swimming etc.)
  5. oral abx - if pt is immunocomprimised or infection spread beyond ear canal
24
Q

what is necrotising otitis externa

A

a potentially life threatening progressive infection of the external ear canal which may spread to cause osteomyelitis of the temporal bone and adjacent structures

25
Q

risk factors for otitis externa (7)

A
  1. swimming
  2. skin conditions e.g. eczema, dermatitis
  3. hot, humid
  4. trauma
  5. climates
  6. tightly fitting hearing aid
  7. use of ear plug
26
Q

signs/symptoms of otitis externa (7)

A
  1. itch
  2. pain of the tragus and pinna, possibly the jaw
  3. ear discharge
  4. hearing loss (canal occlusion - rare)
  5. red ear canal
  6. tender regional lymphadenitis
  7. scaly ear canal (chronic)
27
Q

what organism commonly causes NOE

A

psuedamonas aerogenosa

28
Q

5 diseases of the middle ear

A
  1. acute otitis media
  2. chronic otitis media (incl. cholesteatoma)
  3. ossicular chain dysfunction
  4. otosclerosis
  5. trauma/iatrogenic
29
Q

what is acute otitis media

A

inflammation of the middle ear <6wks

30
Q

what are the common causes of acute otitis media

A

80% viral - usually URTI related
bacteria - H.influenzae, S.aureus, Moraxella catarrhalis

31
Q

risk factors for acute otitis media (7)

A
  1. young age
  2. smoking/passive smoking
  3. nursery attendance
  4. formula feeding (breastfeeding has a protective effect)
  5. craniofacial abnormalities (e.g. cleft palate)
  6. use of a dummy
  7. prematurity
    etc.
32
Q

suppurative vs non suppurative otitis externa

A

suppurative - chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation for at least 2 weeks;
non suppurative - A otitis media which involves transudation of fluid in the middle ear without pus formation

33
Q

2 types of chronic suppurative otitis media

A
  1. tubotympanic -> mucosal, safe
  2. atticoantral -> squamous, unsafe
34
Q

3 types of chronic non- suppurative otitis media

A
  1. effusion
  2. atelectasis
  3. adhesion
35
Q

what is atelectasis otitis media

A

a condition of retraction and atrophy of the tympanic membrane in chronic otitis media with effusion

36
Q

what is adhesion otitis media

A

a condition in which the tympanic membrane is depressed and adheres to the fibrous scar tissue caused by chronic inflammation in the inner wall of the middle ear cavity, resulting in the loss of aeration in the tympanic cavity

37
Q

what is glue ear

A

otitis media with effusion

38
Q

what is mucosal chronic otitis media

A

develops due to chronic inflammation secondary to a perforation in the tympanic membrane

39
Q

suppurative otitis media presentaion (3)

A
  1. copious mucopurulent ear discharge
  2. hearing loss
  3. no pain
40
Q

where is the perforation in tubotympanic otitis media

A

central perforation of the ear drum - i.e. there is some normal TM on the edge

41
Q

example of a squamous chronic otitis media

A

cholesteotoma

42
Q

cholesteotoma presentaiton (3)

A
  1. intermittent foul smelling discharge (may be blood stained)
  2. hearing loss
  3. complications icl. facial palsy, vertigo, abscess
43
Q

what are 6 disease of the inner ear

A
  1. labyrinthitis/vestibular neuritis
  2. menieres disease
  3. bppv
  4. vestibular schwannoma
  5. presbycusis
  6. noise induced hearing loss
44
Q

what kind of hearing loss do inner ear problems present with

A

sensorineural hearing loss

45
Q

what frequency of sound if lost first is presbycusis

A

high frequencies

46
Q

presbycusis mgx

A

hearing aid

47
Q

4 ototoxic drug classes

A
  1. NSAIDs
  2. aminoglycosaids
  3. loop diuretics
  4. cytotoxic cancer drugs (e.g. platinum)
    + many more
48
Q

examples of autoimmune conditions that can cause sensorineural hearing loss (4)

A
  1. werger’s granulamatosis
  2. churg - strauss
  3. SLE
  4. relapsing polychondritis
49
Q

what appearance do the semicircular canals have on MRI internal auditory meatus

A

signet ring appearance

50
Q

what are the 2 main ear conditions that cause pain

A
  1. otitis externa
  2. otitis media
51
Q

what is neuropathic otalgia

A

a diagnosis of exclusion - poorly understood condition where there is a dull ache in the ear that doesn’t respond to simple analgesics and there is no sign of any other ear symptoms (discharge, HL etc.)

52
Q

neuropathic otalgia mgx

A
  1. simple analgesics
  2. amytriptiline
  3. gabapentin
53
Q

what are 6 characteristics of ear discharge to ask about

A
  1. mucous
  2. mucopurulent
  3. purulent
  4. bloody
  5. clear
  6. foul smelling

3D week 5 - the ear (5 decks)

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