Otoscopy / Ear pathology

Question 1

Otoscopy anatomy - label the diagram + which ear is this diagram of? (right / left)

Answer 1

Right ear / tympanic membrane - cone of light is in 4/5 o’clock position

Question 2

Answer 2

Left side because cone of light is in 7/8 o’clock position

Question 3

What position is the cone of light (light reflex) in the left ear and right ear?

Answer 3

• Left ear - 7/8 o’clock
• Right ear - 4/5 o’clock

Question 4

Diagnosis + management

Answer 4

Otitis media - bulging tympanic membrane
.
Management:
- usually self-limiting
1. Paracetamol/Ibuprofen - for temp. + pain
2. Antibiotics (immediate or delayed prescription):
- Amoxicillin 1st-line (5-7 day course)
- ( if pen allergy - erythromycin or clarithromycin)

Question 5

Spot diagnosis + management

Answer 5

Otitis media with effusion (glue ear) - fluid bubbles behind TM
.
Management:
(Refer for audiometry to establish degree of hearing loss)
1. Usually self-limiting (3 months)
2. Persistent hearing loss or recurrent otitis media with effusion –> myringotomy and grommet insertion (allows for drainage of fluid)

Question 6

Spot diagnosis + management

Answer 6

Otitis media with perforation
.
Management:
- usually spontaneously heals
1. Simple analgesia - paracetamol/NSAIDs
2. Keep ear dry - eg. cotton wool with vaseline when showering
3. Topica antibiotics (if infected) - eg. ciprofloxacin ear drops
(4. Persistent –> myringoplasty - repairs hole)

Question 7

Diagnosis + management

Answer 7

Choleastoma
.
1. Surgery - mastoidectomy

Question 8

Diagnosis + causes + treatment

Answer 8

Tympanosclerosis - a condition that causes the eardrum (tympanic membrane) to scar
.
- Causes: injury, post-surgery, infection/inflammation

Management:
- Myringoplasty OR Tympanoplasty (replaces scar tissue with graft)

(hearing aids)

Question 9

Diagnosis + Management (conservative/mild/moderate/severe)

• what about if ear canal very swollen?
• what about with a fungal infection?

Answer 9

Otitis externa (swimmer’s ear) - inflammation of the external auditory canal

• findings: erythema/oedema +/- discharge

Management:
- Keep ear dry - cotton buds with vaseline when showering

1. MILD: acetic acid 2% - has antifungal and antibacterial effects
2. MODERATE: Topical antibx + Steroid + acetic acid
   - eg. Neomycin + dexamethasone + acetic acid (eg. Otomize spray)
3. SEVERE: oral antibx

(4. Ear wick (contains topical treatment, eg. antibxs + steroids + acetic acid) - used if ear canal is very swollen)
(5. Fungal infections - clotrimazole ear drops)

Question 10

Most common causative organism in otitis externa

Answer 10

Pseudomonas aeruginosa

Question 11

What rare, but serious form of otitis external are pts with diabetes at risk of + management

Answer 11

Malignant (necrotising) otitis externa

• Urgent ENT referral + IV ciprofloxacin

Question 12

What does this otoscopy image show + what condition is this used to treat?

Answer 12

Grommet - *used to treat persistent glue ear *
- small tube inserted into the tympanic membrane to drain fluid and equalise pressure
- helps restore hearing and prevent recurrent infections

(grommets fall out spontaneously in 6–12 months)

Question 13

Spot diagnosis + management

Answer 13

Acute otitis media

Management:
- usually self-limiting
1. give paracetamol/ibuprofen for temp. + pain
2. Antibiotics (immediate or delayed prescription):
- Amoxicillin 1st-line (5-7 day course)
- (erythromycin or clarithromycin if pen allergy)

Question 14

Answer 14

Question 15

Answer 15

Otitis externa

Question 16

Diagnosis + what genetic conditions is this a feature of?

Answer 16

Low set ears
- the ears are positioned lower on the head than usual
- Low-set ears are a feature of several genetic syndromes including Down’s syndrome and Turner’s syndrome.

Question 17

Answer 17

Microtia - underdevelopment of the pinna

Question 18

Spot diagnosis

Answer 18

Anotia - a complete absence of the pinna

Question 19

Spot diagnosis + management

Answer 19

Cauliflower ear (perichondrial haematoma) - develops as a result of repeated blunt ear trauma (blunt trauma causes bleeding under the perichondrium of the pinna, stripping away the ear’s cartilage)

Management:
- Urgent care to prevent deformity
- Surgical drainage of blood
- Compressive dressing applied - to help reattach cartilage with skin
- +/- antibiotics
- keep area clean

Question 20

Spot diagnosis + management

Answer 20

Mastoiditis

Management: IV antibiotics (broad-spectrum) +/- myringotomy (for drainage of pus)

Question 21

Answer 21

Question 22

Spot diagnosis + treatment

Answer 22

Traumatic perforation

• Treatment: keep ear dry + analgesia +/- antibiotics (prevention of infection)

Question 23

Spot diagnosis + management

Answer 23

Choleastoma with large perforation

• Management: mastoidectomy

Question 24

Spot diagnosis + management

Answer 24

Tympanosclerosis

• Management: Myringoplasty OR Tympanoplasty (replaces scar tissue with graft)

(hearing aids)

Question 25

Spot diagnosis + management - hearing loss (conductive), ear fullness, tinnitus - regular user of cotton buds

Answer 25

Cerumen impaction (excessive ear wax) Management - Reassurance - *wax is normal and protective* - Ear drops (1st-line) - *olive oil OR sodium bicarbonate 5%* - If persistent --> irrigation