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Y2 - Head N Neck > Lecture 10 - Anatomy + Ear Conditions > Flashcards

Lecture 10 - Anatomy + Ear Conditions Flashcards

1
Q

What is infection of the pinna called?

A

Perichondritis

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2
Q

What is the problem with perichonditis of the pinna?

A

Since its made of cartilage its heals poorly

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3
Q

What is the name of the condition where theres unilateral facial drooping and vesicles in the ear/pinna?

A

So a facial nerve palsy with red ear vesicles

Ramsay Hunt syndrome

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4
Q

What is Ramsay-Hunt syndrome?

A

When theres a facial nerve palsy leading to unilateral facial droop and there’s red ear vesicle

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5
Q

What is the stage that occurs before cauliflower ear?

A

Pinna haemotoma

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6
Q

What is a Pinna haemotoma?

A

When blood accumulates between teh cartilage of the pinna and the overlying perichondrium

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7
Q

What is perchondrium?

A

The layer that sits on top of cartilage

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8
Q

What is the pathology of a Pinna Haematoma?

A

Blunt trauma leads to shearing of perichondrium from the cartilage
Cartilage relies on the perichondrium for its blood supply
Leads to its necrosis
Also pressure necrosis from the build up of blood between the cartilage and perichondrium

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9
Q

How does a pinna haemotoma lead to cauliflower deformity if left untreated?

A

The necrosis/ischaemic damage to the cartilage leads to fibrosis/repair of the cartilage in an uncontrolled

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10
Q

How is pinna Haematoma treated preventing cauliflower deformity?

A

Drain ear
Prevent the reaccumlation of fluid by bringing the 2 layers (cartilage and perichondrium)

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11
Q

Go to the last slide, what is the condition in picture 1?

A

This is the external acoustic meatus, its been narrowed since its inflammed

Otitis externa (due to infection)

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12
Q

What is the normal cause of inflammation of the External Acoustic Meatus?

A

Infection

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13
Q

What are the 2 main bacterial infections that cause Acute Otitis Externa?

A

Staphylococcus aureus
Pseudomonas aeruginosa

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14
Q

What are the symptoms of Acute Otitis Externa?

A

Otalgia
Custard like discharge
Can have hearing loss depending on extent of inflammation

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15
Q

What are some risk factors for Acute Otitis Externa?

A

Injury to External acoustic meatus like itching

Swimming/warm weather

Skin problems like eczema

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16
Q

How is Acute Otitis Externa treated?

A

Ear drops (topical antibiotic)
+
Steroid depending on how inflammed it is

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17
Q

What is a potentially life threatening complication of Otitis Externa?

A

Necrotising Otitis Externa

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18
Q

What is Necrotising Otitis Externa?

A

Where the infection from otitis externa spreads to the the ossicles, temporal bone and skull base (OSTEOMYELITIS)

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19
Q

What are the symptoms of Necrotising Otitis Externa?

A

Severe Otalgia (CANT SLEEP)
Hearing loss
Can get Cranial nerve symptoms

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20
Q

What are the risk factors for Necrotising Otitis Externa?

A

Old
Male
Immunocomprimised
Diabetic

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21
Q

What investigations are often done if suspecting Necrotising Otitis Externa?

A

CT temporal bone to see how far osteomyelitis spread

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22
Q

How is Necrotising Otitis Externa treated?

A

IV antibiotics
Can be oral sometimes with ear drops

Lots of analgesia

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23
Q

What is a very common infection of the middle ear in children?

A

Acute otitis media

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24
Q

Why is Acute otitis media common in babies and young children to 4yrs?

A

Short Eustachian/pharyngotympanic tube which opens to large adenoids (bigger in young children)

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25
What are some symptoms of Acute Otitis media (middle ear infection)?
Otalgia Fever Can have red tympanic membrane Can have non specific signs in infants like pulling on ear
26
What is the treatment of Acute Otitis Media?
Usually resolves in 3 - 1week Analgesia Back up Abx prescription if doesn’t resolve
27
What are some potential complications of Acute Otitis Media (middle ear infection)?
Tympanic membrane perforation Facial nerve involvement Life threatening: Mastoiditis Meningitis Sigmoid sinus thrombosis Brain abscess (posterior cranial fossa)
28
How does Mastoiditis present?
Signs + symptoms of Acute Otitis Media Unwell + pyrexia Oedema around mastoid No longer sharp angle behind ear (sticks out) Pinna pushed down and forward
29
What is Otitis media with effusion/Glue ear?
NOT AN INFECTION Where inflammatory fluid accumulates in the middle ear which affects the hearing
30
What is the pathology of of Glue Ear/Otitis media with effusion?
Dysfunction of the pharyngotympanic tube leads to increased -ve pressure in the middle ear drawing TM inwards, leads to inflammatory fluid accumulating This decreases the mobility of the TM and ossicles causing hearing loss
31
How does Otitis media with effusion/glue ear present?
Child well Hearing loss
32
Who does otitis media with effusion/glue ear occur most in?
Infants + kids Pharyngotympanic dysfunction more likely in kids
33
How is Otitis media with effusion (glue ear) managed?
Most spontaneously resolve after 2-3 months If persists and impedes speech and language development at school Grommets are implanted
34
What are Grommets and how do they help with Otitis media with effusion (glue ear)?
The are a tympanostomy tube which basically acts as an extra Eustachian tube so that pressures can be equalised
35
What is a Cholesteatoma?
When the pars flaccida gets pulled inwards meaning dead skin gets stuck here This dead skin then eats through anything it comes into contact with Its no a tumour and has nothing to do with cholesterol
36
Why are Cholesteatomas very bad?
Grows into middle ear and beyond
37
What are the signs and symptoms of a Cholesteatoma?
Could smelling discharging ear Progressive hearing loss (depends on extent of Cholesteatoma) Other signs and symptoms depending on structures affected
38
What is the treatment for a Cholesteatoma?
Surgical treatment called a mastoidectomy Which is risk to the facial nerve
39
What sign can be seen on the tympanic membrane indicating a Cholesteatoma?
Abnormalities at the attic/pars flaccida
40
What condition does this patient have? 4yr old Hearing deteriorated over month Otherwise well
Otitis media with effusion/glue ear
41
What condition does this patient have? 22yr old 3 day history of left ear otalgia Itchy + otorrhoea
Acute otitis externa
42
What condition does this patient have? 72yr old Severe otalgia + otorrhoea for last 2-3 weeks which is worsening Otalgia preventing sleep Over counter analgesia not working Type 2 DM
Necrotising otitis externa
43
What structures can be affected in the inner ear?
Cochlea and/or vestibular apparatus
44
What is the term to describe age-related hearing loss?
Presbycusis
45
What is thought to be the mechanism for presbycusis (age related hearing loss)?
Sensorineural Sterocilia degenerate (maybe due to noise or drugs like vancomycin) Bilateral and gradual
46
How is Presbycusis treated?
Hearing aids
47
What is the condition where only vertigo is experienced?
Benign Paroxysmal Positional Vertigo (BPPV)
48
What part of the ear is affected in Benign Paroxysmal Positional Vertigo (BPPV)?
Semicircular canals which are part of the vestibular apparatus of the inner ear
49
How does Benign Paroxysmal Positional Vertigo present?
Episodes of short lived vertigo that occur with changing positions/movement of head
50
What causes Benign Paroxysmal Positional Vertigo (BPPV)?
Otoliths that normally reside in the utricle and saccule move into the semicircular canals So movemtn of the head moves these crystals which leads to the fluid moving causing your brain to think you’re moving
51
How is Benign Paroxysmal Positional Vertigo (BPPV) diagnosed and treated?
Head moved to trigger the vertigo episode (Dix-Hallpike manoeuvre) Head moved to move the crystals back into the utricle and saccule from the semi circular canals (Epley manoeuvre)
52
What is Menieres Disease?
Where the vestibular and cochlear apparatus are affected Causes episodes of a triad of symptoms
53
What is the triad of symptoms indicating Menieres Disease?
Vertigo Tinnitus Hearing loss Episodes Usually unilateral
54
What is though to be the cause of Menieres Disease?
Thought that the endolymph sac is not draining enough of the fluid from the vestibulocochlear apparatus
55
What is another term for the inner ear?
Labyrinth
56
What is Acute Labyrinthitis?
Infection of all inner ear structures
57
What are the symptoms of Acute labyrinthitis?
Hearing loss Tinnitus Vomiting Vertigo
58
What is acute vestibular neuronitis?
Infection of vestibular neurones
59
What are the symptoms of acute vestibular neuronitis?
Sudden onset vomiting and severe vertigo Hearing fine and no tinnitus
60
What is a major risk factor for developing acute labyrinthitis and acute vestibular neuronitis?
Prior history of Upper repsiratory tract infection
61
What is suspected and what must be done immediately if a patient has sudden onset unilateral hearing loss?
Sudden sensorineural hearing loss (SSNHL) Refer to ENT specialist or Emergency department Since earlier identified and treated with steroids more likely for hearing to improve
62
What are the 2 types of hearing loss?
Conductive Sensorineural
63
What can cause conductive hearing loss?
Pathology involving external or middle ear Otosclerosis Otitis media with effusion Acute otitis media Wax
64
What is Otosclerosis?
When theres a gradual conductive hearing loss over years Where extra bony growths happen at the synovial joints of the ossicle bones reducing vibrations
65
How does Otosclerosis present?
Gradual hearing loss bilaterally (can be unilateral early on) Normally well but tinnitus can occur
66
How is otosclerosis treated?
Hearing aids Surgical replacement of ossicles (stapes replaced with prosthesis )
67
What is sensorineural hearing loss?
Pathology involving inner ear or CN VIII
68
What are some causes of sensorineural hearing loss?
Age related hearing loss (presbycusis) Noise related hearing loss Ménière’s disease Ototoxic meds like vancomycin Acoustic neuroma Sudden sensorineural hearing loss
69
What is an acoustic neuroma?
Benign slow growing posterior cranial fossa tumour on the Schwann cells of CN VIII
70
What can be some signs and symptoms of an Acoustic neuroma?
Unilateral hearing loss Tinnitus + vertigo (vestibulocochlear) Numbness, pain or weakness down one half of face (Trigeminal + facial nerve) Since it can compress different structures around here Can also compress brainstem and cerebellum
71
How is an acoustic neuroma diagnosed?
MRI
72
How is an acoustic neuroma managed?
Observe since grows slow Surgery Or radiation
73
What condition does this patient have? 55yrs old 1month smelly discharge from ear Hearing loss in same ear No pain Other wise well Ear problems as kid and needed grommets
Cholesteatoma
74
What condition does this patient have? 65yrs old Hearing loss in both ears Gradual Otherwise well and no symptoms
Presbycusis

Y2 - Head N Neck (24 decks)

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