Flashcards in Otology Deck (86)
Describe the sensory supply to the upper lateral surface of the pinna.
CN V3 – Auriculotemporal nerve.
(NOTE: The auriculotemporal nerve is a branch of the mandibular nerve (V3) that runs with the superficial temporal artery and vein.)
Describe the sensory supply to the lower lateral surface and medial surface of the pinna.
C3 – Greater auricular nerve
Describe the sensory supply to the superior medial surface of the pinna.
C2/C3 – Lesser occipital nerve
Describe the sensory supply to the External Auditory Meatus.
Auricular branch of vagus (CN 10).
(NOTE: often termed the Alderman's nerve or Arnold's nerve.)
Describe how you manage an external ear laceration.
Clean and allow simple primary closure of the skin with sutures, ensuring that any exposed cartilage is covered with skin.
Describe how you manage an external ear bite.
1. Appropriate history (to ascertain likely organism for potential infection)
2. Irrigate the wound
3. Leave wound open
4. Prescribe appropriate antibiotics
Describe how you manage an external ear haematoma.
1. Urgent drainage
2. Apply a pressure dressing (to prevent reoccurrence)
Describe the pathology behind a cauliflower ear deformity.
There is trauma to the external ear leading to a pinna haematomas.
This causes disruption in the blood supply to the cartilage. Normally, the cartilage obtains nutrients via diffusion from vessels in the overlying perichondrium, and a disruption can therefore lead to a vascular necrosis and a subsequent cauliflower appearance to the ear.
What symptoms will a patient with tympanic membrane perforation present with?
- Potential conductive hearing loss
Describe how you would manage a patient with an acute tympanic membrane perforation.
- Watch and wait (most perforations will heal by themselves)
- Advise patients to follow water precautions
Describe how you would manage a patient with a chronic (after a period of 6 months or more) tympanic membrane perforation.
Myringoplasty to repair the tympanic membrane
Name 2 causes of tympanic membrane perforation.
1. Direct or indirect trauma
2. Otitis media
What is a haemotympanum?
Blood in the middle ear
Trauma to which cranial bone would result in a haemotympanum?
What type of hearing loss is a haemotympanum associated with?
How would you manage a patient with a haemotympanum?
- Follow- up to ensure that there is no residual hearing loss from damage to the ossicles
How do patients with otitis external present?
- Painful ear
- Discharge from the ear
- Itchy ear
- Hearing loss ( from the discharge present in the ear canal)
What is malignant otitis externa?
A particularly aggressive infection where the infection spreads from the soft tissue of the ear canal into the bone.
Name 2 groups of patients that suffer from malignant otitis externa.
Describe how patients with malignant otitis externa present.
- Chronic ear discharge despite topical treatment
- Severe ear pain
- Sometimes cranial nerve palsies (most commonly CNVII).
What is the mortality rate of malignant otitis externa?
Describe how you would manage patients with malignant otitis externa.
- Swab discharge
- Microsuction of pus/debris which enables the drops to get to the source of the
- In severe infection, a wick may be used to help hold the canal open and to allow
topical treatment to diffuse through
- Aggressive treatment with iv antibiotics as
well as topical treatment for an extended period of time to eradicate infection
Name a topical ear drop.
Describe the epithilial lining of the middle ear.
Pseudostratified columnar epithelium
Name 3 common causative organisms of acute otitis media.
1. Streptococcus pneumoniae
2. Haemophilus influenza
Describe how a patient with acute otitis media may present.
- Ear Pain (in young children this may be
evident by ear pulling)
- Discharge (the tympanic membrane may rupture with the pus from the middle ear
discharging into the ear canal)
Describe how you would manage a patient with acute otitis media.
- Conservative: Most patients can be managed conservatively with analgesia
- Medical: In severe or persistent cases oral antibiotics may be required
- Surgery: Recurrent AOM may be helped by grommet (ventilation tube)
What is meant by squamous, active, chronic otitis media?
Active (discharging) squamous disease is also known as cholesteatoma.
(NOTE: Inactive (not discharging) squamous COM is a retraction pocket which may develop into active disease.)
What is meant by active mucosal chronic otitis media?
Chronic discharge from the middle ear travels through a tympanic membrane perforation.
(NOTE: inactive mucosal disease is where there is a tympanic membrane perforation but no active infection/discharge)