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Question 1

Osteomas/ exostoses - «Swimmers ear» - ETIOLOGY

Answer 1

Cold water?

Question 2

Osteomas/ exostoses - «Swimmers ear» - SYMPTOMS

Answer 2

Painless, no symptoms. Incidental finding.

Question 3

Osteomas/ exostoses - «Swimmers ear» TREATMENT AND COMPLICATIONS

Answer 3

• Tx: Cannaloplasty. Can become problem: Cerumen might get caught between an osteoma and tympanic
membrane causing hearing trouble.

Question 4

Anatomical complications seen

Answer 4

Minor birth defect, like pre-auricular dimple might
indicate more severe medial ear congenital
malformations. Also remember that abnormally
shaped ears => USG abdomen as kidney/ GU
problems often are associated
• Epitympanic recess = attic of middle ear. During exam
if he points to it he might want the answer mastoid air
cells)

Question 5

Otosclerosis - Cause/definition

Answer 5

Inability of staples to move due to calcifications seen in primary disease of otic capsule. Female:Male ratio = 2:1. Tend to progress after pregnancy.1% of white population suffers from it.

Question 6

Otosclerosis - Symptoms

Answer 6

Progressive hearing loss, tinnitus, vestibular symptoms(+/-), neg. Rinne-test in the affected ear. Weber-test positive. Normal looking tympanic membrane.

Question 7

Otosclerosis - Treatment & Prognosis

Answer 7

Always offer hearing aid-device. Surgery -> Stapes mobilization/stapedectomy/stapedotomy. Prognosis: very good. Risk of total hearing loss w/stapedectomy.

Question 8

Hearing loss - tests

Answer 8

1. Weber test: to assess cochlear function. Points to side with bone conductance, and away from side w/sensineuronal hearing loss. 2. Rinne test: for bone conductance. Normal ear: AC> BC - Positive test. When BC>AC - negative test -> Indicated a problem within the middle ear. 3. Eustachian tube patency: Do Valsava meneover(Tympanic membrane bulge outwards (Never do this if patient has sore throat as it might transmit bacterias into middle ear). or 4.Toynbee’s test(Swallow-tympanic membrane bulges inward) -> problems may indicate small hole in tympanic membrane.

Question 9

Otitis externa - Pathognomic sign

Answer 9

Pain when you put pressure on tragus

Question 10

Otitis externa - Causes

Answer 10

1. Herpes oticus
2. Erysipelas
3. Bacterias
4. Fungal

Question 11

Otitis externa - Predisposing factors

Answer 11

1. Narrow external canal
2. Increased sweating
3. Bathing in hot climate
4. Eczema
5. Psoriasis
6. Ear syringing

Question 12

Otitis externa - Symptoms

Answer 12

1. Pain
2. Fulness
3. Itching
4. Discharge
   Exam: tenderness, erythema, edema, discharge, narrowed ear canal.

Question 13

Acute otitis media - Causes

Answer 13

1. S.Pneumoniae (35%)
2. H.Influenzae (25%)
3. M.Catarrhalis (15%)
   - > Usually lasts 1-5d, typically children, and frequently bilateral. Children at increased risk due to a shorter and more horizontal eustachian tube.

Question 14

Acute otitis media - Symptoms

Answer 14

Variable otalgia, pressure sensation, hearing loss, hyperemia, exudation, suppuration, resolution, fever. Tympanic membrane red + infiltrated. Abnormal light reflex. Tympanic membrane might rupture which produces a relief of pain. Also accounts for discharge.

Question 15

Acute otitis media - Treatment

Answer 15

Analgesia + antibiotics: penicillin/cephalosporin ->aimed to improve function of eustachian tube. Might try antihistamines and steroids too. Avoid water. If membrane still bulge after antibiotic treatment - do myringotomy. -> Always follow up! until membrane is OK! and hearing is back. Look for reservoir for infection: nose, sinuses or nasopharynx. Mastoid air cells might harbour some pathogens too. -> If more than 3x in 6months = recurrent AOM.

Question 16

Acute otitis media - Complications

Answer 16

Acute mastoiditis

Question 17

Chronic otitis media - Causes

Answer 17

1. Granulation tissue
2. Polyps
3. Cholesteatoma
4. Late/ineffective tx of AOM.
5. Upper airway sepsis
6. Lowered resistance
7. Virulent infection (e.g. measles)

Question 18

Chronic otitis media - Symptoms

Answer 18

Discharge, hole in tympanic membrane, hearing loss

Question 19

Chronic otitis media - Treatment

Answer 19

Usually do conservative treatment first - ciprofloxacin ear drops/regular aural toilet/myringoplasty. If it doesnt help? Do surgery to remove cause and try to restore middle ear ossicles chain to regain hearing = ossiculoplasty. Must do tympanoplasty at least. Possibility of patients needing prosthesis of ossicles. Also possible to change existing ossicles shape. PORP = partial ossicles replacement proosthesis or TORP (total).

Question 20

Chronic otitis media - Complications

Answer 20

Cholesteatoma - might erode into scull base, cochlea(labyrinthitis) or facial nerve canal (facial nerve palsy = not same as Bell’s palsy).

Question 21

Otitis externa - Treatment

Answer 21

1. Aural toilet
2. Dressing that should be kept until healing(up to 10d) - change once a day.
3. 8% aluminium acetate
4. 10% itchammol in glycine
5. Ointments for fungus/aminoglycosides
6. Avoid water/be careful with showers.
   - > If the cause is narrow ear canal - meatoplasty might work.

Question 22

Serous otitis media/Glue ear - Cause

Answer 22

2ndary to closed eustachian tube - f.eks by large adenoids.

Question 23

Serous otitis media/Glue ear - Symptoms

Answer 23

Yellow liquid behind intact tympanic membrane > 3 months, that can vary from thin to mucoid(mucoid = more chronic process).

Question 24

Serous otitis media/Glue ear - Predisposing factors

Answer 24

Winter, child, acute otitis media, large adenoids, passive smoking, nasal allergy, early exposure to pathogens, cleft palate, Down’s syndrome, mucociliary dysfunction(even though CF patients dont tend to have a lot of AOMs or problem in general).

Question 25

Serous otitis media/Glue ear - Treatment

Answer 25

Ventilation tube = grommet(dren) that is put through tympanic membrane. Treat also underlying cause if suspected one. In adults -> ALWAYS order CT to exclude nasopharyngeal cancer.