ENT 18/5/2020 Flashcards
(37 cards)
causes of referred otalgia
- dental pathology
- TMJ dysfunction
- infection of pharynx
- Ramsey Hunt syndrome
- oropharyngeal malignancy (posterior 1/3rd tongue)
otological causes of otalgia
- acute otitis media
- otitis externa
- furunculosis
- necrotising otitis externa
common causative organisms of otitis externa
- Pseudomonas aeruginosa
- Strep epidermidis
- S. aureus
- Aspergillus (fungal)
features of otitis externa
- progressive ear pain
- purulent discharge
- erythematous/swollen ear canal
- itchy EAM
- may cause mild hearing loss
management of otitis externa
- water precautions
- acetic acid
- microsuction
- topical antibiotic (often with steroid) = gentamicin/ciprofloxacin
- for fungal = clotrimazole 1% for 14 days+
features of a furuncle
- staphylococcal abscess on hair follicle in ear canal
- very tender
- dry ear
- sometimes visible abscess, often too tender for exam
treatment of furunculosis
- irrigation and debridement
- oral flucloxacillin
what is necrotising otitis externa
- osteomyelitis of the EAM and bony tympanic membrane, which can spread along skull base
- usually caused by Pseudomonas aeruginosa
- typically affects elderly diabetics
- exacerbated by antibiotic resistance
features of necrotising OE
- severe otalgia
- purulent discharge
- granulations visible
- may be visible bone
causes of acute otitis media
- viral (RSV, rhinovirus, parainfluenza)
- bacterial (S. pneumoniae, H. influenzae, Moraxella catarrhalis)
features of acute otitis media
- middle ear inflam (bulging, red ear drum)
- rapid onset earache (rapidly relieved pain with discharge suggests perforated eardrum)
- preceding URTI
acute otitis media management
- avoid antibiotics if possible - only if child very unwell/not improving after 72 hrs
- delayed prescription role
- 5 day course amoxicillin if prescribed
- grommet may be used in recurrent
- in perforation, stick to water precautions and should heal within 3 months
complications of otitis media
- hearing loss
- perforated tympanic membrane
- mastoiditis (can lead to meningitis/intracranial abscess)
- cholesteatoma (can lead to facial palsy, vertigo)
otitis media with effusion (glue ear)
chronic mucoid/serous effusion in the tympanic cavity in absence of infection lasting for > 3 months
- conductive hearing loss (pure tone audiometry and tympanometry should be organised)
- feeling of pressure without pain in ear
- intact tympanic membrane (may see fluid level)
chronic suppurative otitis media
persistent drainage from the middle ear through a PERFORATED tympanic membrane lasting >6 weeks
- bacterial infection following perforation
- recurrent ear discharge
- absence of fever or ear pain
- conductive hearing loss (pure tone audiometry and tympanometry should be organised if language problems)
- check for cholesteatoma
management of chronic suppurative otitis media
referral to ENT where they will do:
- ear rinse
- topical antibiotic (ciprofloxacin) and steroid drops (dexamethasone)
- surgery may be required
management of otitis media with effusion (glue ear)
watchful waiting (50% cases resolve within 3 months), ENT referral if language problems or non-resolving
- non surgical = hearing aid, autoinflation (older children)
- surgical = myringotomy and/or grommet
Meniere’s disease features
usually middle aged adults
- triad of
> vertigo
> tinnitus
> sensorineural hearing loss
- sensation of aural fulness common
- episodes last minutes to hoursmanagement of Meniere’s
ENT referral
acute: buccal or intramuscular prochlorperazine
prevention: betahistine and vestibular rehabilitation exercises, salt restriction
features of vestibular schwannoma/acoustic neuroma
CN8 - vertigo - unilateral sensorineural hearing loss - unilateral tinnitus CN5 - absent corneal reflex CN7 - facial palsy
bilateral seen in NF2
vestibular schwannoma/acoustic neuroma management
investigation with MRI of cerebellopontine angle
- surgery
- radiotherapy
- observation
features of benign paroxysmal positional vertigo
average age = 55yrs
- vertigo triggered by change in head position (often when rolling over in bed or looking upwards)
- episode lasts 10-20s
- positive Dix-Hallpike manoeuvre (rotary nystagmus)
management of benign paroxysmal positional vertigo
commonly self-resolving after few weeks to months
- epley manoeuvre can relieve symptoms
- vestibular rehabilitation lessons for patient to do at home (eg. Brandt-Daroff exercises)
labyrinthitis vs vestibular neuritis
labyrinthitis
- vestibular nerve AND labyrinth affected
- vertigo exacerbated by movement
- hearing loss
- tinnitus
vestibular neuronitis
- vestibular nerve only
- only vertigo (no hearing loss) and lasts hours/days
BOTH
- usually viral so may be preceded by URTI symptoms + may have N+V
- often horizontal nystagmus towards the unaffected side
