Otorrhoea And Otitis Media Flashcards
(28 cards)
What are the different types of discharge from the ears and what are their causes?
Otitis externa - scanty discharge - no mucinous glands
Trauma - blood
Liquid wax
Otitis media - mucinous discharge
Chronic otitis media - granular mucosa producing seroanguinous discharge
Cholesteatoma - offensive discharge
CSF otorrhoea - trauma - halo sign on filter paper, high glucose, tau transferrin
What are the symptoms of acute otitis media?
Rapid onset pain, irritability, fever, anorexia, vomiting
Often after a viral URTI
What are the common organisms causin acute otitis media?
Pneumococcus, haemophilus, moraxella and other streps/staphs
What are the signs of acute otitis media?
Bulging tympanic membrane (causes pain)
Pain eases when TM perforates - produces purulent discharge
What is the treatment for acute otitis media? When should you consider antibiotics?
Analgaesia
60% resolve in 24hrs without antibiotics
Consider antibiotics if: systemically unwell/immunocompromised/no improvement in over 4 days/perforation/discharge/under 3 months/over 2 with bilateral
Amoxicillin/erythromycin for 5 days
What is otitis media with effusion/glue ear?
Effusion present after symptoms of acute OM have regressed
What is chronic otitis media?
Tympanic membrane perforation in the setting of recurrent/chronic middle ear infection
What are the associated symptoms of chronic otitis media?
Hearing loss
Ottorhoea
Otalgia
Fullness
What is benign/inactive chronic otitis media?
Dry tympanic membrane perforation without active infection
What is chronic serous otitis media?
Continuous serous drainage from the ear
Typically straw-coloured
What is chronic suppurative otitis media?
Chronic purulent discharge through a perforated tympanic membrane
What is the treatment for chronic otitis media?
Topical/systemic antibiotics based on swab results
Aural cleaning
Water precautions
Careful follow-up
Surgery may be required (myringoplasty; mastoidectomy)
What are the complications of chronic otitis media?
Cholesteatoma
What are the serious, but rare complications of cholesteatoma?
Meningitis Cerebral abscess Hearing loss Mastoiditis Facial nerve palsy
What is the peak age for cholesteatoma?
5-15 years
What is a cholesteatoma?
A retraction pocket of the pars tensa and flaccida caused by prolonged low middle ear pressure
Squamous cell epithelium builds up and can no longer escape the sac
Locally destructive around and beyond the pars flaccida from lytic enzymes
What are the symptoms of a cholesteatoma?
Foul discharge +/- deafness Headache Pain Facial paralysis Vertigo CNS complications
What is the treatment for cholesteatoma?
Mastoid surgery needed to make safe dry ear by removing the disease
What is mastoiditis?
Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation
What should you be wary of in mastoiditis?
Intracranial extension
How can mastoiditis be prevented?
By giving antibiotics for middle ear infections
What are the signs of mastoiditis?
Fever
Tenderness, swelling and redness behind the pinna
Protruding auricle
What imaging should be done for mastoiditis?
CT head
What is the treatment for mastoiditis?
Admit for IV antibiotics
Myringotomy
+/- definitive mastoidectomy
