Flashcards in Ear Pathology Deck (16):
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 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)
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 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 acute otitis media?
How does it present?
INFECTION of the middle ear
Earache and bulging red tympanic membrane (pus or fluid in the middle ear)
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 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 happens if the stapedius muscle becomes paralysed?
Loss of protective action against loud noises
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 happens in glue ear?
Eustachian tube dysfunction. 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 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
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
How can blockage of the Eustachian tube lead to retraction of the tympanic membrane?
When the tube is occluded, residual air in the tympanic cavity is absorbed in to mucosal blood vessels. This lowers the pressure in the tympanic cavity and the membrane is retracted
What is the most common cause of otitis media?
Also haemophilus influenza