Ear- Infection & inflammation

Question 1

Why is otitis media more common in children?

Answer 1

Small & horizontal eustachian tube
Poor drainage function
Inc infection risk

Question 2

What organisms can cause otitis media?

Answer 2

Bacteria: Strep Pneumonia, Group A B-haemolytic strep, HiB
Virus: RSV, Rhinovirus

Question 3

What is secretory otitis media?

Answer 3

Middle ear effusion WITHOUT Sx of acute otitis media

Question 4

How does acute otitis media present?

Answer 4

Follows viral URTI
Rhinorrhoea & Coryza
Otitis → Otalgia (bulging TM) → discharge
Hearing loss
Systemic: Fever, irritability, anorexia, N&V

Question 5

How does secretory otitis media present?

Answer 5

Middle ear effusion (lasts months)
Hearing loss
Inattentive

Question 6

How does the fluid in acute otitis media differ from that in secretory otitis media?

Answer 6

ACUTE: Purulent
SECRETORY: Serous, mucoid or purulent

Question 7

How is otitis media investigated?

Answer 7

1) Otoscope
2) Conductive loss & flat trace tympanometry: ONLY if hearing loss suspected
3) CT/MRI: If complications

Question 8

What is seen in acute & secretory otitis media when using an otoscope?

Answer 8

ACUTE: Tympanic membrane bright + red + bulging, loss of normal light reflex
SECRETORY: Tympanic membrane retracted & opaque

Question 9

How is otitis media treated?

Answer 9

Supportive: Fluids & analgesia
Abx: 5-7days Amoxicillin/ Clarithromycin
Surgical: Myringotomy + grommets

Question 10

What are the indications for admission with otitis media?

Answer 10

Child <3m WITH temp >38
Child 3-6m WITH temp >39
Suspected complications

Question 11

When do antibiotics need to be prescribed in otitis media?

Answer 11

Systemic upset
↑Risk of complications
Sx lasted >4 days w/o improvement
<2 yrs w/ bilateral AOM
Perforation / Otorrhoea

Question 12

When should referral to ENT be done in otitis media?

Answer 12

Recurrent cases: >3/6m or >4/yr

If complications present

Question 13

What are the signs of mastoiditis?

Answer 13

Hx of: Recurrent OM or Cholesteatoma
Severe pain
Forward protrusion of ear
Tender boggy mass behind ear

Question 14

What can mastoiditis lead to?

Answer 14

Meningitis

Requires URGENT Tx

Question 15

How is otitis externa subdivided?

Answer 15

Acute: <3w "swimmer's ear"
Chronic: >3m usually fungal
OR
Diffuse: Skin &amp; subcut tissue
Localised: Infected hair follicle progresses to form boil in ear canal

Question 16

What are the causes of Otitis externa?

Answer 16

90% Bacteria: Staph Aureus, Pseudomonas
10% Fungal: Aspergillus, Candida
Irritants: TOP meds, hearing aids, Water
Inflammation: Eczema, Psoriasis, Acne, Dermatitis

Question 17

What are the risk factors for otitis externa?

Answer 17

Moisture (swimming)
Trauma (ear clearance w/cotton bud)
Hearing aids
Age
Wax build up
Obstruction
DM
ImmunoC
Gentamicin (ototoxic)

Question 18

How does otitis externa present?

Answer 18

Pruritic itchy ear
Otalgia especially on movement of tragus
Erythema & oedema
Mobile tympanic membrane 
LATE:
Pre-auricular lymphadenopathy
Discharge & hearing loss
Fever

Question 19

How is otitis externa managed?

Answer 19

Aural hygiene advice
Supportive: Analgesia
Mild: TOP Acetic acid spray 2%
Mod: TOP Abx +/- steroids

Question 20

What are the complications of otitis externa?

Answer 20

Hearing loss
Narrowed ear canal
Abscess
Necrotising (malignant) OE

Question 21

Who is at increased risk of getting Necrotising (malignant) OE?

Answer 21

Diabetics
ImmunoC
90% caused by Pseudomonas

Question 22

How does necrotising OE present?

Answer 22

Severe pain
Exudative
Oedema
Micro-abscesses
Headache +/- Facial nerve palsy

Question 23

What are the complications of Necrotising (malignant) OE?

Answer 23

Spread to bone causing osteomyelitis & death

URGENT admission & REFERRAL to ENT

Question 24

How is Necrotising (malignant) OE treated?

Answer 24

PO + TOP Quinolones for 6-8w

Question 25

What is Ramsay Hunt Syndrome?

Answer 25

Peripheral facial nerve weakness accompanied by a vesicular rash caused by Herpes Zoster infection of the facial nerve and geniculate ganglion

Question 26

How does Ramsay Hunt Syndrome present?

Answer 26

``` Auricular pain (1st feature) Peripheral facial nerve weakness Ipsilateral rash Vertigo Tinnitus ```

Question 27

In Ramsay Hunt Syndrome where is the vesicular rash typically found?

Answer 27

- In the ear canal or behind the ear - Over the lateral neck - On the tongue or buccal mucosa - On the palate, uvula and/or pharynx

Question 28

How is Ramsay Hunt Syndrome treated?

Answer 28

PO Aciclovir 800mg x5/day for 7days | Steroids: Prednisolone 60mg OD for 10days

Question 29

What is labyrinthitis?

Answer 29

AKA Vestibular Neuritis | Inflammation of vestibular apparatus

Question 30

What is the mechanism behind how labyrinthitis causes balance & hearing impairment?

Answer 30

Inflammation of vestibular apparatus → AFFERENT input of the vestibular system is disturbed → a spectrum of BALANCE & HEARING problems, depends on site of inflammation

Question 31

How does labyrinthitis present?

Answer 31

``` SUDDEN Spont & severe vertigo Exacerbated by movement N&V Horizontal nystagmus Tinnitus Hearing loss ```

Question 32

What examinations should be done on someone with labyrinthitis?

Answer 32

HINTS Exam H I: Head impulse test- look at nose turn head 10degrees assess if still looking at nose or have to readjust gaze N T: Nystagmus type- horizontal S: Skew- cover each eye

Question 33

How is labyrinthitis treated?

Answer 33

Reassurance & supportive Acute attack: Lie still w/eyes closed Prochlorperazine for dizziness Surgery: If effusion or mastoiditis

Question 34

What are the Sx of Benign paroxysmal positional vertigo?

Answer 34

Gradual onset Triggered by head position Episodic- last 10-20secs +ve nystagmus

Question 35

How is paroxysmal positional vertigo managed?

Answer 35

Epley manoeuvre