Flashcards in Pathology of the Middle Ear Deck (23):
What is meant by an auricular haemotoma?
Give one consequence.
A localised collection of blood forms between the Perichondrium and the auricular cartilage, causing distortion of the contours of the auricle. The cartilage is avascular and relies on diffusion of gases and nutrients from the perichondrium. The haematoma has pushed the perichondrium away from the cartilage. The cartilage can no longer be perfused- avascular necrosis
What is meant by Cauliflower/Boxer's ear?
Following an auricular haematoma, if the blood isn't aspirated, fibrosis develops in the overlying skin, forming a deformed auricle
What is meant by otitis externa?
How does it present?
Infection/inflammation of the external acoustic meatus and pinna
Bugs involved: PSA, Staph aureus
Often develops in swimmers who do not dry their meatus after swimming
Itching and pain in the external ear (pulling the auricle or applying pressure on the tragic increases the pain), they may be discharge from the ear
Management: topical Abx (flucloxacillin)
Give three micro-organisms responsible for otitis externa
What is meant by Ramsay-Hunt syndrome?
Re-activation of pre-existing varicella zoster virus is the geniculate ganglion. Ear pain and tympanic membrane vesicles.
Affects the facial nerve : facial paralysis, loss of taste
The vascular rash can extend around the ear
Management: aciclovir and corticosteroids
What are the causes of conductive hearing loss?
Wax build up
Perforation of the tympanic membrane
Otitis media with effusion
What are the common causes of perforation of the tympanic membrane?
How do we manage these patients?
Otitis media (infection is the most common cause)
Others: barotrauma (diving), direct trauma (the insertion of foreign bodies, such as cotton buds)
If secondary to barotrauma - self-limiting - reassure likely to resolve after 6-8 weeks
Surgery intervention to repairthemembrane if it has not healed in 6 months
Patients should be advised to keep the affected ear dry, and avoid putting anything in to their ear, such as ear drops, water etc.
What is meant by acute otitis media?
How does it present?
INFECTION of the middle ear
Earache and bulging red tympanic membrane (pus or some fluid in the middle ear), ear pulling, may have discharge, tympanic membrane may perforate which will resolve the pain, fever
Inflammation of the mucous membrane lining the tympanic membrane may cause partial or complete blockage of the Eustachian tube
Otitis media often occurs secondary to upper respiratory infections via the Eustachian tubes. Why does this commonly happen in children?
Their Eustachian tube is shorter and more horizontal, making it easier for organisms to travel up it and harder for fluid to drain away from the middle ear
What is a serious consequence of untreated otitis media in children?
It may spread to the mastoid air cells. The infection may break through the superior wall of the mastoid and into the cranial cavity. It may affect the meninges or temporal bone of the brain causing meningitis or a temporal lobe abscess
What happens in mastoiditis?
Give one possible complication.
Infection of the mastoid Antrum and mastoid air cells
Results from otitis media
Causes inflammation of the mastoid process, swelling behind the ear
Infection may spread superiorly in to the middle cranial fossa through the petrosquamous fissure - osteomyelitis
What is the most common cause of otitis media?
Also haemophilus influenza
What is the management of acute otitis media?
Analgesia - regular paracetamol and ibuprofen
Amoxicillin 5/7 if systemically unwell, younger than 2 and bilateral, perforation and or discharge in to the canal, immunocompromised, symptoms for more than 4 days and not resolving
What is the presentation of glue ear?
Recurrent ear infections
Speech and language delay
Behavioural problems may be noted at school - shouting, not paying attention, poor concentration
What is meant by glue ear?
Eustachian tube dysfunction, causing poor ventilation of the middle ear cavity leading to asterile non-purulent tricky and sticky effusion. The middle ear cannot equalise with the atmosphere because the tube doesn't open properly. The mucous membrane continuously absorbs the air in the middle ear cavity and the tube causing a negative pressure within. This causes retraction of the tympanic membrane.
What is the management of glue ear?
Parental reassurance and advice
Wait and wait approach for 12 weeks as spontaneously resolution is common - whilst checking speech development
Hearing aids can be offered
Surgery - grommets and consider adeniodectomy
What happens in cholesteatoma?
Blockage of the Eustachian tube leads to negative middle ear pressure, causing retraction pockets. Dead skin cells accumulate in the pockets, forming a necrotic mass of dead skin. It can cause erosion of Middle ear structures and bone via lytic enzymes
What is meant by otosclerosis?
Autosomal dominant condition causing progressive bilateral conductive hearing loss due to replacement of normal bone by vascular spongy bone around the stapes. The stapes becomes fixed at the oval window.
What happens if the stapedius muscle becomes paralysed?
Loss of protective action against loud noises
Why might a middle ear tumour result in abnormal sensations of taste?
Damage to the chorda tympani branch that supples special taste to the anterior 2/3 of the tongue
What is the presentation of otosclerosis?
Progressive bilateral hearing loss
Loss of low frequency sounds
Patients can often hear better in noisy surroundings
There may also be tinnitus, but the tympanic membrane is normal
What are the management options in otosclerosis?
Conservative - hearing aid
Surgical - stapedectomy - replacement of the stapes with a prosthesis