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Year 3 GP > Ear pathology > Flashcards

Ear pathology Flashcards

1
Q

Conditions of the external ear

A

Haematoma
Otitis externa
Costochondritis
Ear wax

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2
Q

Conditions of the middle ear

A 
Otitis media with effusion 
Chronic suppurative otitis media
Tympanic perforation
Otitis media 
Sinusitis 
Cholesteatoma
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3
Q

Inner ear conditions

A

Mastoiditis
Meniere’s disease
Labyrinthitis
Age relate hearing loss

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4
Q

Red flag signs

A

Inflammation behind ear - mastoiditis

Facial droop - facial nerve palsy

Unilateral tinnitus - Acoustic neuroma

Smelly discharge that causes recurrent ear infections - cholesteatoma

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5
Q

Otitis externa

A

Presentation: inflammation of the external ear canal

  • red, swollen, or eczematous with shedding of the scaly skin.
  • Discharge may be present in the ear canal
  • Pruritis
  • Severe ear pain
  • Tender over jaw

Causes:

  • bacterial infection
  • fungal infection
  • Seborrhoeic dermatitis
  • Contact dermatitis
  • Trauma

Prognosis :
- Symptoms usually improve within 48–72 hours of initiation of treatment

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6
Q

Acute vs chronic otitis externa

A

Acute - lasts 3 weeks or less

Chronic - lasts longer than 3 months

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7
Q

Malignant (necrotising) otitis externa

A

Aggressive infection that predominantly affects people who are immunocompromised.

Otitis externa spreads into the bone surrounding the ear canal (the mastoid and temporal bones).

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8
Q

Common causative organism of otitis externa

A

Bacterial:
Psuedomonas aeruginosa
Staphylococcus aureus

Fungal:
Aspergillus
Candida
Deep - trichophyton

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9
Q

Mx of otitis externa

A

Conservative:

  • Analgesia and heat pad
  • Clean external auditory canal

Medical:

  • Otomize Ear Spray - topical abx + corticosteroid- minimum of 7 days
  • Oral antibiotics for severe infection - 7-day course of flucloxacillin or clarithromycin

Chronic:
Fungal infection - topical antifungal - Acetic acid spray or clotrimazole
7-day course of a topical corticosteroid without antibiotic

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10
Q

When are oral antibiotics indicated in otitis externa

A

Cellulitis extending beyond the external ear canal.

When the ear canal is occluded by swelling and debris, and a wick cannot be inserted.

People with diabetes or compromised immunity, and severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa

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11
Q

Methods for cleaning external auditory canal

A

Syringing or irrigation
Dry swabbing
Microsuction

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12
Q

Complications of untreated ear haematoma

A

Cauliflower ear - costochondritis

Cartilage is avascular and receives blood supply from skin therefore if disrupted causes necrosis of cartilage

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13
Q

Mx of ear haematoma

A

Pack skin against cartilage

Drain blood

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14
Q

Acute otitis media definition and causes

A

Inflammation in the middle ear accompanied by the rapid onset of symptoms and signs of an ear infection - commonly in children

Causes: 
Bacterial: 
- Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
-  Streptococcus pyogenes

Viral:

  • respiratory syncytial virus
  • rhinovirus
  • adenovirus
  • influenza virus
  • parainfluenza virus
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15
Q

Acute otitis media with effusion

A

Fluid in the middle ear, not associated with symptoms and signs of an acute ear infection

Fluid caused by a build up of exudate and causes TM retraction

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16
Q

Why are children more likely to get acute otitis media

A

Acquire viral infections more often

Have shorter and more horizontal eustachian tubes

17
Q

Presentation of acute otitis media

A

Otalgia

Younger children - tugging at ear, fever, crying

Coexisting systemic
illness, such as bronchiolitis

Hearing loss - conductive

18
Q

Otoscopic findings of acute otitis media

A

Distinctly red, yellow, or cloudy tympanic membrane.

Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks

  • bubbles behind the tympanic membrane - indicates effusion

Perforation of the tympanic membrane and/or discharge in the external auditory canal - suppurative OM

19
Q

Mx of acute otitis media

A
  1. Advise usual course of acute otitis media is ~ 3 days, but can be up to 1 week.
  2. Regular doses of paracetamol or ibuprofen for pain
  3. 5–7 day course of amoxicillin back up
  4. 5–7 day course of co-amoxiclav 2nd line
20
Q

Otitis media with effusion causes and mx

A

Causes:

  • Impaired eustachian tube function causing poor aeration of the middle ear.
  • Low-grade viral or bacterial infection.
  • Adenoidal infection or hypertrophy

Mx

  • observe for 6 - 12 wks as active resolution is common
  • hearing aid
  • grommets
21
Q

Congenital deafness

A

Sx:

  • Muffling of speech
  • Difficulty understanding words
  • Delayed speech development
  • Not being startled by loud sounds
22
Q

Dx and Mx of congenital deafness

A

Dx:

  • Neonatal hearing-screening programme
  • Referral paeds ENT
  • CT or MRI - temporal bone and internal acoustic meatus
  • FHx & Genetic testing

Mx:

  • Hearing aids
  • Cochlear implants
  • Surgery
23
Q

Cholesteatoma presentation

A

Sx:

  • Smelly otorrhea
  • Recurrent or chronic purulent discharge that does not respond to antibiotics
  • Hearing loss
  • Tinnitus

Signs:

  • Inflamed lesion in ‘attic’ of pars flaccida
  • Retracted tympanic membrane
  • Crust or discharge
  • Perforation - insight into middle ear
24
Q

Cholesteotoma Dx and Mx

A

Diagnosi:
- Clinical suspicion from history and otoscopy findings

Management:
Semi urgent referral to ENT (emergency if pt has facial nerve palsy or vertigo)

Audiology assessment
CT scan
Topical antibiotics for discharge

Surgery - canal wall up mastoidectomy + 9 - 12 month follow up

25
Q

Cholesteatoma

A

Abnormal accumulation of squamous epithelium and keratinocytes within the middle ear or mastoid air cell spaces

26
Q

Chronic suppurative otitis media

A

Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation

  • Ear discharge persisting for more than 2 weeks, without ear pain or fever.
  • Hearing loss in the affected ear.
  • A history of acute otitis media (AOM), ear trauma, or glue ear and grommet insertion.
  • A history of allergy, atopy, and/or upper respiratory tract infection.
  • Tinnitus and/or a sensation of pressure in the ear may also be present.
27
Q

Chronic suppurative otitis media mx

A

Do not swab the ear or initiate treatment

Refer for ENT assessment

Secondary care: abx and steroids (usually topical), and intensive cleaning of the affected ear

28
Q

Mastoiditis

A

Acute inflammation of the mastoid periosteum and air cells occurring when AOM infection spreads out from the middle ear

29
Q

Presentation of mastoiditis

A
  • History of acute or recurrent episodes of otitis media.
  • Intense otalgia and pain behind the ear.
  • Fever.
  • Swelling, redness or a boggy, tender mass behind the ear.
  • Tympanic membrane bulges and is erythematous.
30
Q

Mx of mastoiditis

A

Refer to secondary care

31
Q

Acoustic Neuroma

A

Inner ear pathology:

Symptoms:

  • unilateral sensorineural hearing loss
  • tinnitus
  • vertigo
  • facial numbness
  • loss of corneal reflex
32
Q

Ramsey Hunt syndrome

A

Viral infection - Herpes Zoster

  • painful rash
  • vertigo
  • sensorineural hearing loss
  • facial palsy
33
Q

Vestibular neuronitis presentation

A
  • episodes of vertigo - hours
  • occurs after a recent viral illness
  • nausea and vomiting
  • hearing is not affected
34
Q

Otosclerosis presentation and Mx

A 
Presentation: 
Bilateral hearing loss - conductive 
Tinnitus 
Pink tinge on otoscopy
FHx 
Onset is usually at 20-40 years

Mx:
Hearing aid
Stapedectomy

35
Q

Otitis media with perforation Mx

A

First line - amoxacillin

2nd line - erythromycin

36
Q

When to give abx for otitis media

A

Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission

Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal - otorrhoea

Year 3 GP (20 decks)

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