ENT - Mastoiditis, Cholesteatoma, Otosclerosis

Question 1

Mastoiditis - what is it?

Answer 1

Mastoiditis typically develops when an infection spreads from the middle to the mastoid air spaces of the temporal bone

Question 2

Mastoiditis - clinical features?

Answer 2

• otalgia: severe, classically behind the ear
• swelling, erythema and tenderness over mastoid process
• external ear may protrude forwards
• history of recurrent otitis media
• fever
• typically very unwell
• ear discharge - if eardrum perforated

Question 3

Mastoiditis - diagnosis?

Answer 3

Clinical diagnosis typically

CT - if complications are suspected

Question 4

Mastoiditis - managment?

Answer 4

• IV antibiotics

Question 5

Mastoiditis - complications?

Answer 5

• facial nerve palsy
• hearing loss
• meningitis

Question 6

Cholesteatoma - what is it?

Answer 6

Cholesteatoma is an abnormal collection of squamous epithelial cells in the middle ear

It is non-cancerous but can invade local tissues and nerves and erode the bones of the middle ear

It can predispose to significant infections

Cholesteatoma has nothing to do with cholesterol or a tumour

Question 7

Cholesteatoma - age of onset most commonly

Answer 7

10-20 years old

Question 8

Cholesteatoma - main clinical features?

Answer 8

• foul-smelling, non-resolving discharge
  
  • hearing loss - Unilateral conductive hearing loss

Question 9

Cholesteatoma - what features can occur from local invasion?

Answer 9

Other features are determined by local invasion:

• vertigo
• facial nerve palsy
• cerebellopontine angle syndrome

Question 10

Cholesteatoma - what do you see on otoscopy?

Answer 10

• ‘attic crust’ - seen in the uppermost part of the ear drum
  
  • abnormal build-up of whitish debris or crust in the upper tympanic membrane

Question 11

Cholesteatoma - what investigations can be used to confirm diagnosis and what is the managment?

Answer 11

A CT head used to confirm

MRI - assess invasion and damage to local soft tissues

Treatment involves surgical removal of the cholesteatoma

Question 12

Otosclerosis - what is it?

Answer 12

Otosclerosis is a condition where there is remodelling of the small bones in the middle ear, leading to conductive hearing loss

Oto- refers to the ears, and -sclerosis means hardening

Replacement of normal bone by vascular spongy bone

It causes a progressive conductive deafness due to fixation of the stapes at the oval window, mainly affects the base of the stapes

Question 13

Otosclerosis - age of onset commonly?

Answer 13

It usually presents 20-40 years old

Question 14

Otosclerosis - inheritance pattern?

Answer 14

It can be inherited in an autosomal dominant pattern

Question 15

Otosclerosis - clinical features?

Answer 15

• conductive deafness
• tinnitus
• normal tympanic membrane - 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
  
  • unilateral or bilateral
• positive family history

Question 16

Otosclerosis - what sounds is it harder for patients to hear, high or low picthed?

Answer 16

It tends to affect the hearing of lower-pitched sounds more than higher-pitched sounds

Female speech may be easier to hear than male speech (due to the generally higher pitch)

This is the reverse of the pattern seen in presbycusis

Question 17

Otosclerosis - investigations?

Answer 17

Audiometry is the initial investigation of choice, Otosclerosis will show a conductive hearing loss pattern

High-resolution CT scans can detect bony changes

Otoscopy is normal

Question 18

Otosclerosis - management?

Answer 18

• Conservative, with the use of hearing aids
• Surgical (stapedectomy or stapedotomy)