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Year 4: Special Senses > Otology > Flashcards

Flashcards in Otology Deck (86)
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1

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.)

2

Describe the sensory supply to the lower lateral surface and medial surface of the pinna.

C3 – Greater auricular nerve

3

Describe the sensory supply to the superior medial surface of the pinna.

C2/C3 – Lesser occipital nerve

4

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.)

5

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.

6

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

7

Describe how you manage an external ear haematoma.

1. Urgent drainage

2. Apply a pressure dressing (to prevent reoccurrence)

8

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.

9

What symptoms will a patient with tympanic membrane perforation present with?

- Pain
- Potential conductive hearing loss

10

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

11

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

12

Name 2 causes of tympanic membrane perforation.

1. Direct or indirect trauma

2. Otitis media

13

What is a haemotympanum?

Blood in the middle ear

14

Trauma to which cranial bone would result in a haemotympanum?

Temporal

15

What type of hearing loss is a haemotympanum associated with?

Conductive

16

How would you manage a patient with a haemotympanum?

- Conservatively
- Follow- up to ensure that there is no residual hearing loss from damage to the ossicles

17

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)

18

What is malignant otitis externa?

A particularly aggressive infection where the infection spreads from the soft tissue of the ear canal into the bone.

19

Name 2 groups of patients that suffer from malignant otitis externa.

1. Diabetics

2. Immunocompromised

20

Describe how patients with malignant otitis externa present.

- Chronic ear discharge despite topical treatment

- Severe ear pain

- Sometimes cranial nerve palsies (most commonly CNVII).

21

What is the mortality rate of malignant otitis externa?

10%

22

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
infection

- 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

23

Name a topical ear drop.

Gentamicin

24

Describe the epithilial lining of the middle ear.

Pseudostratified columnar epithelium

25

Name 3 common causative organisms of acute otitis media.

1. Streptococcus pneumoniae

2. Haemophilus influenza

3. Moraxella

26

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)

- Fever

27

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)
insertion

28

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.)

29

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)

30

Describe the pathology behind active, mucosal, chronic otitis media.

It is thought to develop from an episode of acute otitis media.

After rupturing of the tympanic membrane there is a failure to heal.