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Y2 ENT > Otalgia, Ear discharge, Hearing loss > Flashcards

Otalgia, Ear discharge, Hearing loss Flashcards

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1
Q

What is otitis externa

A

Inflammation of the outer ear canal
Aka swimmer’s ear

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2
Q

Causes of otitis externa

A

Bacterial infections (S aureus, Proteus spp, pseudomonas aeruginosa)
Fungal infections (aspergillus, candida)
Triggers (water, cotton buds, skin conditions)

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3
Q

What are the bacterial causes of otitis externa

A

S aureus
Proteus spp.
Pseudomonas aeruginosa

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4
Q

What are the fungal causes of otitis externa

A

Aspergillus
Candida

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5
Q

Common causative pathogens of otitis externa

A

Pseudomonas
S aureus

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6
Q

What are the common triggers of otitis externa

A

Water
Cotton buds
Soap, shampoo
Skin conditions - eczema, seborrheic dermatitis, psoriasis

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7
Q

Symptoms of otitis externa

A

Redness, swelling of outer ear canal
May be itchy
May become sore and painful
May have discharge
Hearing loss if canal is blocked by discharge / swelling

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8
Q

Management of mild otitis externa

A

Topical acetic acid
Keep ear dry

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9
Q

Management for severe otitis externa

A

Topical antibiotics or anti fungal +/- steroids drops if more severe

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10
Q

Which topical antibiotic drop to use for bacterial cause of severe otitis externa

A

Topical gentamicin
Add steroids if cellulitis develops

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11
Q

Which topical anti fungal drop is used for fungal causes of severe otitis externa

A

Topical clotrimazole
Add steroids if cellulitis develops

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12
Q

management of otitis externa caused by eczema

A

Topical steroid drops

Avoid topical antibiotics because it can cause local sensitivity

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13
Q

Management of otitis externa when there is significant swelling

A

Use pope wick to apply topical antibiotics - pope wick ensures that the antibiotic ear drops are in constant contact with the inflamed ear canal

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14
Q

When is oral antibiotics indicated in otitis externa

A

Cellulitis beyond ear canal
Very significant swelling hence Wick cannot be inserted
Immunocompromised
Diabetics

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15
Q

What is acute otitis media

A

Inflammation of the middle ear due to infection

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16
Q

Who does acute otitis media commonly affect

A

Infants and children after viral URTI

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17
Q

How does a viral URTI cause acute otitis media

A

The infection travels up to the ear via Eustachian tube

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18
Q

Why are children more susceptible to acute otitis media after viral URTI

A

Children’s Eustachian tube is shorter and less angled, making it easier for pathogens to enter the middle ear cavity

Children have immature immune system

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19
Q

Causes of acute otitis media

A

Bacterial
Viral

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20
Q

Bacterial causes of acute otitis media

A

Strep pneumoniae (most common)
H. influenza

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21
Q

Viral causes of acute otitis media

A

RSV
Rhinovirus
Adenovirus
Influenza virus

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22
Q

Symptoms of otitis media in children

A

Fever
Irritability
Difficulty feeding
Holding / tugging ear

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23
Q

Symptoms of otitis media in adults

A

Fever
Otalgia
Hearing loss

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24
Q

Clinical signs of otitis media

A

Middle ear effusion
Feeling of aural fullness -> discharge and relief of pain when tympanic membrane perforates
Diffuse erythema
May have Bulging of tympanic membrane

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25
Investigations for acute otitis media
Clinical Swab if tympanic membrane perforates
26
Management of acute otitis media
Admit any children under 3 months with a temperature of 38 or more Paracetamol, ibuprofen Most resolve without antibiotics Delayed antibiotic prescribing strategy - if symptoms don't improve after 4 days Immediate antibiotic prescription to children who are unwell but do not need admission / perforated TM
27
When should you admit a patient with acute otitis media
Children under 3 months with a temperature of >38 Children with suspected complications of acute otitis media
28
When are antibiotics used in otitis media
Delayed - if symptoms do not improve after 3-4 days Immediate
29
When is immediate antibiotic prescription indicated for otitis media
Symptoms not improving after 4 days Unwell but does not need admission Immunocompromised Children under 2 with bilateral AOM Otitis media with perforation
30
Complications of acute otitis media
Facial palsy Mastoiditis Petrositis Labrynthitis Vertigo Brain abscess Meningitis Sigmoid sinus thrombosis
31
What is mastoiditis
When the infection (otitis media) spreads into the mastoid air spaces of temporal bone
32
Why can otitis media cause mastoiditis
Because infection can spread to mastoid air cells via aditus to mastoid antrum (an opening at posterior wall of middle ear cavity)
33
Signs of mastoiditis
Erythematous Swelling behind the ear, pushing the auricle outwards and forwards
34
Investigations for mastoiditis
CT MRI
35
Management of mastoiditis
IV antibiotics Surgical drainage
36
Mastoiditis secondary to otitis media can further lead to
Meningitis
37
What is petrositis
When the infection spreads into the apex of petrous temporal bone
38
Petrositis secondary to otitis media can develop into a serious syndrome. What is the clinical triad of this syndrome
Gradenigo syndrome Otitis media + Facial pain + Diplopia (due to abducens nerve (CN VI) palsy
39
Why can otitis media cause petrositis
Due to petrous part of temporal bone being the roof of middle ear cavity
40
Clinical signs of meningitis
High fever Non-blanching rash Photophobia Neck stiffness Headache Vomiting
41
What is labrynthitis
Inflammation of the semicircular canals in inner ear cavity
42
Symptoms of labrynthitis
Vertigo Nausea Imbalance Vomiting
43
What is sigmoid sinus thrombosis
When infection from the adjacent mastoid spreads into the venous wall and forms a thrombus
44
Symptoms of sigmoid sinus thrombosis
Swinging pyrexia Meningitis Sepsis
45
What is malignant otitis externa
Invasive infection of the bone surrounding the outer ear canal - mastoid and temporal bones
46
Most common cause of malignant otitis externa
Pseudomonas aeruginosa
47
Risk factors for malignant otitis externa
Diabetes Radiotherapy to head and neck
48
Symptoms and signs of malignant otitis externa
Severe pain, headache Pain on chewing Facial nerve palsy - weakness in muscles of face Exposed bone in ear canal Granulation tissue in external canal
49
What does granulation tissue in malignant otitis externa look like
red/purple fleshy tissue Usually on the floor of ear canal
50
Investigations for malignant otitis externa
Bloods - CRP, plasma viscosity Imaging Biopsy and culture
51
Management of malignant otitis externa
Refer to ENT Topical ciprofloxacin
52
Describe the sensory innervation of the auricle
Auriculotemporal branch of trigeminal CN V3 - medial superior part of concha Greater auricular nerves C2 C3 - Lateral and anterior surface of helix Lesser auricular nerves C2 C3 - Posterior surface of helix Facial nerve - small parts of concha
53
Describe the sensory innervation of the external ear canal
Auriculotemporal branch of trigeminal nerve - superior and anterior Auricular branch of vagus nerve - inferior and posterior
54
Describe the sensory innervation of the external surface of tympanic membrane
Auricular branch of vagus CN X - posteroinferior of tympanic membrane Facial nerve -posterosuperior of tympanic membrane Auriculotemporal branch of CN V3 - anterior of tympanic membrane
55
Describe the sensory innervation of the internal surface of tympanic membrane
Tympanic branch of glossopharyngeal nerve
56
Describe the sensory innervation of the middle ear cavity
Tympanic branch of Glossopharyngeal nerve CN XI
57
Nerves that causes referred otalgia
Trigeminal CN V3 (auriculotemporal) Vagus CN X Sensory branch of Facial nerve CN VII Glossopharyngeal CN IX Spinal nerves C2 C3
58
Glossopharyngeal nerve provides general sensory innervation to
Middle ear cavity Internal surface of tympanic membrane Eustachian tube Oropharynx Nasopharynx Posterior 1/3 of tongue
59
What pathologies can cause referred otalgia due to glossopharyngeal nerve
Tonsillitis Post-tonsillectomy Pharyngitis Carcinoma at posterior 1/3 of tongue
60
Mandibular division of trigeminal nerve CN V3 provides general sensory innervation to
External ear canal and area above concha External surface of tympanic membrane Lower lip Chin Anterior 2/3 of tongue Lower molar, incisor, canine teeth and gingiva Parotid gland
61
Which nerve provides special sensory innervation to the tongue
Anterior 2/3 - lingual nerve (branch of facial nerve) Posterior 1/3 - glossopharyngeal (provides both general sensory and special sensory)
62
What pathologies can cause referred otalgia due to auriculotemporal trigeminal nerve CN V3
Dental abscess Dental caries Infection / piercing of anterior 2/3 of tongue Infection of salivary glands
63
Facial nerve gives sensory innervation to
External ear External surface of tympanic membrane Ethmoid sinus Maxillary sinus Nasal mucosa
64
Pathologies that can cause referred otalgia due to facial nerve
Sinusitis Nasal pathology - foreign Bodies
65
Vagus nerve provides sensory innervation to
Laryngopharynx and larynx External ear and surface of TM
66
Pathologies that causes referred otalgia due to vagus nerve
Foreign bodies in piriform fossa Carcinoma of piriform fossa Carcinoma of larynx Piriform abscess
67
What is chronic otitis media
A group of conditions that causes inflammation of the middle ear cavity for 3 months or more
68
Conditions consisted in chronic otitis media
Benign chronic otitis media Chronic secretory otits media (glue ear) Chronic suppurative otitis media
69
What is benign chronic otitis media
Dry tympanic membrane perforation without chronic infection
70
What is chronic secretory otitis media (glue ear)
Inflammation of the middle ear + accumulation of fluid without symptoms and signs of acute inflammation (often asymptomatic)
71
What is chronic suppurative otitis media
Persistent purulent drainage through the perforated tympanic membrane
72
Complications of chronic otitis media
Hearing loss Perforation Cholesteatoma Mastoiditis Meningitis Labrynthitis
73
What is cholesteatoma
Growth of keratinising squamous epithelium cells in middle ear that can erode into mastoid air cells
74
Cholesteatoma commonly occurs in
young patients 5-15 years old
75
Cholesteatoma can be acquired or congenital. What are the causes of each
Acquired - due to chronic otitis media or perforated tympanic membrane Congenital - proliferation of fragment embryonic tissue that has been retained
76
Histology of cholesteatoma will show
Squamous epithelium with a lot of keratin production Inflammatory infiltrates
77
Symptoms of cholesteatoma
May be asymptomatic Foul smelling discharge Headache Otalgia Conductive hearing loss
78
otoscope findings for cholesteatoma
Otoscopy - visible retraction before development of cholesteatoma - defect in tympanic membrane full of cheesy white material at the top
79
Management for cholesteatoma
Mastoid surgery
80
Complication of mastoidectomy
Facial nerve palsy
81
Complications of cholesteatoma
Facial nerve palsy Vertigo Meningitis Intracranial abscess Sigmoid sinus thrombosis
82
Risk factors for otitis media with effusion (glue ear)
Day care Older siblings Smoking household Recurrent URTI Craniofacial abnormalities (Down syndrome) Prematurity Immunodeficiency
83
Otitis media with effusion most commonly occurs in
Children 2-8 years old , but can occur at any age
84
Cause of otitis media with effusion
Eustachian tube dysfunction - fluid builds up due to blocked Eustachian tube unable to drain it from middle ear cavity to the nasal cavity
85
Cause of otitis media with effusion in adults
Rhinosinusitis Nasopharyngeal carcinoma or lymphoma (causes Eustachian tube dysfunction)
86
How does nasopharyngeal carcinoma cause Eustachian tube dysfunction
Block / narrow the Eustachian tube
87
Otitis media with effusion is often preceded by
Recurrent URTI Recurrent otitis media Frequent nasal obstruction
88
Is otitis media with effusion an infection
No, it is not but it can be a consequence of an infection
89
Symptoms of otitis media with effusion in children
Often asymptomatic No otalgia Hearing loss can lead to poor school performance, behavioural problems, speech delay, impact on balance
90
Hearing loss in children can have a huge impact on them. What are the consequence of hearing loss in children
Poor school performance Delayed speech development Behavioural problems Poor balance
91
Investigations for otitis media with effusion
Otoscopy Tuning fork tets Audiometry Tympanometry
92
What would otoscope show in a patient with otitis media with effusion
Visible fluid / bubbles = effusion Retraction of tympanic membrane - due to Eustachian tube dysfunction causing decreased pressure in ear Altered tympanic membrane color Reduced mobility of tympanic membrane
93
What does tympanometry measure
How well the tympanic membrane moves
94
What pattern would tympanometry show in a patient with otitis media with effusion
Flat tracing = stiff tympanic membrane
95
What pattern would audiometry show for otitis media with effusion
Conductive hearing loss
96
What is conductive hearing loss
Hearing loss due to obstruction of sound waves at any point in the outer ear and foot plate of stapes in the middle ear
97
What pattern does conductive hearing loss cause on audiometry
Difference between bone conduction and air conduction at least 10db Bone conduction > air conduction
98
Management of otitis media with effusion
Generally self limiting - resolves after 3 months Review at 3 months (otoscope, hearing assessment) Refer Down syndrome patients w OME to ENT Surgery if indicated
99
When is surgery indicated for otitis media with effusion
Persistent glue ear (over 3 months) Conductive hearing loss > 25dB Speech / language problems Developmental / behavioural problems
100
Surgical management for Otitis media with effusion
Grommets Grommets + adenoidectomy
101
Complications of grommets
Infection Early extraction Retention Persistent perforation
102
Causes of conductive hearing loss
Otitis media with effusion Ear wax Perforation of tympanic membrane Chronic suppurative otitis media Ear infections Otosclerosis Cholesteatoma
103
What is otosclerosis
Hereditary disorder in which new bony deposits occur within the stapes footplate and the cochlear
104
Otosclerosis causes a distinct pattern on audiometry. What is the pattern
Conductive hearing loss pattern + Carhart's notch at 2000Hz - an apparent loss of bone conduction at 2000Hz
105
Risk factors of otosclerosis
Female Pregnancy Family history
106
Why is otosclerosis more common in females
Linked to high oestrogen level
107
Effect of pregnancy on otosclerosis
Can be triggered / deteriorate rapidly during pregnancy
108
Symptoms of otosclerosis
Gradual hearing loss
109
Investigations for otosclerosis
Audiometry - conductive hearing loss pattern + Carhart's notch at 2000Hz
110
Management for otosclerosis
Hearing aids Stapedectomy
111
Perforated tympanic membrane is most commonly seen in
Young patients with acute otitis media
112
Causes of perforated tympanic membrane
Otitis media Sudden negative pressure - scuba diving Insertion of foreign objects Acoustic trauma - exposure to loud noises Trauma
113
Symptoms of perforated tympanic membrane
Sudden severe pain Followed by bleeding, hearing loss, tinnitus
114
Investigations for perforated tympanic membrane
Otoscope Audiometry
115
Perforated tympanic membrane causes what pattern on audiometry
Conductive hearing loss
116
Management of perforated tympanic membrane
Usually self limiting Surgery if patient is symptomatic with recurrent discharge
117
What is sensorineural hearing loss
Hearing loss due to malfunction / disease within the cochlea or auditory nerve (inner ear)
118
What is the auditory nerve that is usually affected in sensorineural hearing loss
Vestibulocochlear nerve CN VIII
119
Function of vestibulocochlear nerve
Transmit sound information from the cochlea to the brain Balance and equilibrium
120
Causes of sensorineural hearing loss
Presbycusis Noise-induced hearing loss Congenital infections Kernicterus (brain damage due to hyperbilirubinaemia) Meningitis Drugs Vasculopathy
121
What are the congenital infections that can cause sensorineural hearing loss
Rubella CMV
122
What are the drugs that cause sensorineural hearing loss
Gentamicin - aminoglycosides Overdose NSAID Cisplatin (chemo) Vincristine (chemo)
123
What vasculopathy can cause sensorineural hearing loss
Stroke TIA
124
What is the pattern shown on audiometry for sensorineural hearing loss
Significant hearing loss No difference in bone / air conduction
125
Most common cause of sensorineural hearing loss
Presbycusis
126
What is presbycusis
Degenerative disorder of cochlea
127
how does presbycusis cause sensorineural hearing loss
Loss of outer hair cells Loss of ganglion cells Atrophy of stria vascularis
128
What is stria vascularis
Region in cochlea for blood supply, production of endolymph and maintenance of ion composition
129
Describe how do we hear sounds
1. Sound waves causes vibration of tympanic membrane 2. The vibrations are transferred through the ossicles in middle ear 3. Then to the footplate of stapes which vibrates in oval window of cochlea 4. This causes vibration and movement of perilymph 5. The movement of perilymph causes vibration in the cochlear duct which activates the organ of corti 6. organ of corti converts that mechanical stimuli into neural stimuli (action potentials) -> cochlear nerve -> vestibulocochlear nerve 7. Vibrations are dampened at round window
130
Describe the anatomical course of vestibulocochlear nerve
Exit the cranium via internal acoustic meatus then splits into 2 parts -> cochlear and vestibular nerves The vestibular nerve innervates the vestibular system The cochlear nerve innervates the cochlea
131
Function of vestibulocochlear nerve
Hearing Balance (because it innervates the vestibular system)
132
Describe how do we coordinate balance
Utricle and saccule detect linear movement change of the head 3 semicircular canals detect rotational movements of the head As your head moves, the endolymph fluid in the vestibular system moves and triggers the hair cells in ampulla -> trigger APs to vestibular nerve -> vestibulocochlear nerve back to brain
133
what are the 3 semicircular canals
Horizontal Superior Posterior
134
Movement detected by each semicircular canal
Horizontal - head rotation in transverse plane ; head from side to side Superior - head rotation in sagittal plane ; nodding head Posterior - head rotation in coronal plane ; moves head to touch shoulder / doing a cartwheel
135
What is vestibulo-ocular reflex
Reflex that allows images to be stabilised when the head is turning by moving eyes in the opposite direction
136
Vestibulo-ocular reflex is regulated by
Vestibular system - vestibular nerve, semicircular canals and otoliths (utricle and saccule)
137
Where is the perilymph of cochlea located at
Scala vestibuli Scala tympani
138
How does the organ of corti detect stimuli
Receptor hair cells at the basilar membrane of cochlear duct
139
Another name for cochlear duct
scala media
140
Presentation of presbycusis
Gradual hearing loss
141
Features on audiometry for presbycusis
- sensorineural hearing loss - higher frequencies affected the most
142
Management for presbycusis
High-frequency specific hearing aid
143
Causes of noise induced hearing loss
Damage to the cochlea due to - Shooting without ear protectors - Industrial noise
144
Features on audiometry for noise induced hearing loss
Sensorineural hearing loss Dip at 4000Hz
145
What is vestibular schwannoma
Benign tumour of vestibulocochlear nerve CN VIII nerve sheath that arises in internal auditory meatus
146
What structures pass through the internal auditory meatus
Vestibulocochlear nerve Facial nerve Labyrinthine artery and vein
147
What is labyrinthine artery
Branch of artery from the circle of Willis
148
Causes of vestibulocochlear schwannoma
Extensive exposure to excessively loud noise Neurofibromatosis type 2
149
Clinical presentation of vestibulocochlear schwannoma
Gradual unilateral hearing loss Imbalance Facial nerve palsy
150
Investigations for vestibulocochlear schwannoma
Audiometry - sensorineural MRI
151
Management for vestibulocochlear schwannoma
Surgery Small lesions may be monitored in 6 months interval
152
Most common tumour of the ear
Squamous cell carcinoma

Y2 ENT (7 decks)

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