ENT - ears

Question 1

Features of Acute Otitis media?

Answer 1

Severe pain and tympanic membrane inflammation (erythema), usually in children

Question 2

Which part of ear is infected in Otitis Media?

Answer 2

Middle

Question 3

Most common organism causing Acute Otitis Media?

Answer 3

S pneumoniae

all URTI organisms really

Viruses include RSV and rhinovirus

Question 4

What is a sign of rupture?

Answer 4

ear pain that suddenly goes away then discharge

Question 5

What nerve is important to test in middle ear infection?

Answer 5

Facial nerve

Question 6

Management of Acute Otitis Media?

Answer 6

Painkillers first for 3 days and observe

Then amoxicillin if not improved

Question 7

Main complication of Acute Otitis Media?

Answer 7

Mastoiditis - bulgy swelling behind ear, pushing ear forward

Question 8

How to deal w Mastoiditis?

Answer 8

Admit, IV antibiotics, CT head if no improvement in 24h –> mastoidectomy definitive management

Question 9

What are the two types of chronic otitis media?

Answer 9

Mucosal (i.e. supparative) - where tympanic membrane ruptures + chronic discharge

Squamous - where tympanic membrane is pushed back - assoc w choleastoma

Question 10

Main feature of Chronic Mucosal Otitis Media?

Answer 10

Chronic discharge for over 6 weeks WITHOUT pain or fever

Question 11

First Ix for ear pain?

Answer 11

Otoscopy

Question 12

What are common causes of Chronic Mucosal Otitis Media?

Answer 12

Anything that can burst the ear:

Recurrent AOM
Trauma to ear
Previous ear surgery

Question 13

What type of hearing loss is caused by Chronic Otitis Media?

Answer 13

Conductive

Question 14

Investigation for suspected cholesteatoma?

Answer 14

CT scan of petrous temporal bone

Question 15

Treatment for uncomplicated chronic mucosal otitis media?

Answer 15

• Aural toileting techniques

- Antibiotic and steroid drops

Question 16

Who should be referred to ENT in chronic OM?

Answer 16

if symptoms >6 weeks or lots of debris

They must keep ear dry!

Question 17

Two types of surgery for large perforated tympanic membrane?

Answer 17

Myringoplasty

Tympanoplasty

Question 18

two types of squamous chronic OM?

Answer 18

Acquired - from constant negative ear pressure due to eustachian tube defect = TM retracts and forms a pocket where debris accumulates –> cholesteatoma

Congenital - epidermoid cysts in middle ear

Question 19

What will be seen on otoscopy in Squamous chronic OM?

Answer 19

pearly waxy mass

Question 20

Investigations for chronic OM?

Answer 20

otoscopy
pure-tone audiogram

If cholesteatoma suspected, CT of petrous temporal bone

Question 21

Mx of choleasteatoma?

Answer 21

surgery

Question 22

Common injuries following ear trauma?

Answer 22

Pinna Haematoma
Pinna laceration
Temporal bone fracture
Tympanic perforation

Question 23

Who is pinna haematoma common in?

Answer 23

Boxers and rugby players

Question 24

Mx of pinna haematoma?

Answer 24

drainage within 24h –> gauze and tight headband

Question 25

Surgical technique for pinna haematoma drainage?

Answer 25

Incision along helical rim of ear --> evacuate haematoma --> place dental roll on both sides of auricle --> tight mattress sutures through rolls and pinna

Question 26

Pinna lacerations things to consider?

Answer 26

All cartilage needs skin around it as skin provides blood flow Optimal wound cleaning + tetanus boosters + AB prophylaxis

Question 27

Two types of Temporal bone fractures?

Answer 27

Longitudinal - hit on side of head --> conductive hearing loss Transverse - hit on front of head --> sensorineural heaing loss and facial palsy

Question 28

Sign of basilar skull fracture?

Answer 28

"Battle sign" = crescent shape behind ear --> when the posterior auricular artery ruptures due to a basal skull fracture

Question 29

Mx of temporal bone fracture?

Answer 29

CT fine slice | Admit for observation

Question 30

Mx of Tympanic membrane perforation?

Answer 30

Uncomplicated TM perfs resolve themselves in 3 months - tell patient strictly no water in ear! Compicated or non-healing ones require surgery --> myringoplasty where autologous graft used

Question 31

Most common cause of Otitis Externa?

Answer 31

Pseudonomas aeruginosa

Question 32

Who gets Otitis Externa most?

Answer 32

swimmers and humid environements

Question 33

Features of Otitis Externa?

Answer 33

Pain! Swollen, erythematous ear canal

Question 34

Types of ear discharge?

Answer 34

White-yellow = bacterial thick white grey w spore = fungal clear grey = otitis media

Question 35

What scale for Otitis Externa severity?

Answer 35

Brighton Grading

Question 36

What is Brighton Grading scale?

Answer 36

``` 1 = tympanic membrane seen 2= partially obscured 3= no tympanic membrane 4= systemic involvement ```

Question 37

Mx of Otitis Externa?

Answer 37

Antibiotic and steroid drops Painkillers Aural toiletting

Question 38

Otitis externa with headaches is a sign of..?

Answer 38

Malignant Otitis Externa - where the OE extends into mastoid and temporal bones -urgent CT required --> debridement w IV antibiotics