Pathology Flashcards
(16 cards)
Otitis Media
Inflammation of the middle ear due to Infection extends from the throat to the ear via the Eustachian tube
* Common in children
* Viral but can be bacterial
* - Commonly associated with URTIs
- Most common bacteria: H. influenzae, Strep. pneumoniae, Strep. pyogenes
- If chronic - Pseudomonas aeruginosa, Staph. aureus, fungal
Symptoms and complications of Otitis Media
- Fever
- Pain
- May have Sensorineural hearing loss
- Tinnitus
- Vertigo
- Facial palsy
- Venous sinus thrombosis
Clinical signs, management and investigation for Otitis Media?
Signs:
- Ear appears inflamed
- Middle ear effusion may be present
- Opaque tympanic membrane
- Bulging typanic membrane may be present
- Impaired Mobility of tympanic membrane Management:
- 80% resolve in 4 days without antibiotics
- Amoxicillin/erythromycin if indicated
Investigation
- Generally clinical diagnosis
- Swab of pus if eardrum perforates
Cholesteatoma?
Growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process; non-cancerous but destructive and expanding
Patho-
- The keratin becomes trapped and builds
- As it expands, it erodesفرسایش می دهد surrounding bone
-common in any age group
- Acquired (most common) - caused by chronic otitis media or perforated tympanic membrane
- Congenital - proliferation of embryonic rest
- History of frequent ear surgery is a key risk factor
Clinical presentation, Investigation and Mx of Cholesteatoma?
Clinical presentation
- May be asymptomatic in its early stages
- Unilateral discharge
- Associated conductive hearing loss may also occur
Investigation
Otoscopy
- Retraction visible before development of cholesteatoma
- Examination show a defect in the tympanic membrane full of cheesy, white material
Mx
Mastoid surgery to remove the sac of debris, reconstruction
Vestibular Schwannoma?
Rare, benign tumour of the CN VIII nerve sheath that arises in internal auditory meatus
- Equal sex distribution
- Aetiology unknown but may be associated with extensive exposure to excessively lound noise
- If bilateral and young, consider neurofibromatosis type 2
Pathology of Vestibular Schwannoma?
- Associated with vestibular portion of CN VIII
- Occur within temporal bone, represent 80-90% of cerebellopontine angle tumours
- 95% are sporadic and unilateral
- Gross appearance - circumscribed tan/white/yellow mass
- Histology - encapsulated, two growth patterns (Antoni A and Antoni B)
Clinical presentations, Mx and Investigation?
Clinical representation
- Progressive sensorineural unilateral hearing loss and tinnitus
- Imbalance in larger tumours
- Facial numbness can occur due to compression of the trigeminal nerve as the tumour enlarges
Investigation
MRI
Mx
- Surgical excision is the definitive management
- Small lesions that are not growing may be monitored (MRI) - initially with a 6 month interval
Allergic Rhinitis?
IgE-mediated allergic reaction (type I hypersensitivity)
### Intermittent
- Symptoms <4 days per week or symptoms for <4 weeks
- Grass pollen, tree pollen, fungal spores
Persistent
- Symptoms >4 days per week AND >4 week duration
- House dust mite, cat, dog
Clinical presentation, Mx and Investigation of Allergic rhnitis?
Clinical presentation:
- Sneezing, nasal itching, nasal discharge and nasal congestion
- Allergic crease indicates repeated itching of nose
Investigation
- Skin prick test
- Measure blood IgE
Mx
1. Allergen avoidance
2. Symptomatic therapy
1. Anti-histamines e.g. cetirizine
2. Topical corticosteroids e.g. beclometasone
3. Topical steroids + antihistamines
3. Immunotherapy for selected patients - LTR blockers e.g. montelukast
4. Surgery for specific indications for relief of obstruction e.g. diathermy for mucosal hypertrophy
Non-Allergic Rhinitis?
Inflammation of the inside of the nose that is not caused by an allergy
- Infection - usually viral infection such as a cold
- The lining of the inside of the nose becomes swollen and inflamed, usually because of swollen blood vessels and fluid building up in the tissues of the nose
- This swelling blocks the nasal passages and stimulates the mucus glands in the nose, resulting in the typical symptoms of a blocked or runny nose
- Vasomotor rhinitis - caused by parasympathetic overdrive within the nose (autonomic dysfunction)
- Can be triggered by chemical irritants, changes in weather, excess humidity or a very dry atmosphere, and stress
- Occupational rhinitis - symptoms only occur in the workplace due to inhaled irritants only being present at work e.g. latex, wood dust
- Hormonal rhinitis - pregnancy, hormone medication (HRT, contraceptive pill)
- Drug-induced rhinitis - ACEi, β-blockers, NSAIDs, cocaine
Clinical presentation, Mx and Investigation of non-allergic rhinitis?
Clinical presentation
- Rhinorrhoea
- Sneezing
- Itchy nose
- Nasal congestion
Mx
- Depends on cause
- Supportive management of viral infection
- Avoidance of triggers if relevant
- Consider anticholinergics e.g. ipratropium for vasomotor rhinitis
Complications:
- Sinusitis
- Nasal polyps
Sinusitis?
Symptomatic inflammation of the paranasal sinuses, usually followed by a viral respiratory tract infection and is defined by symptoms that last for less than 12 weeks
-Can spread fro rhinitis but can sread from dentition
-Most common organisms include strep. pneumonae, H. infuenzae and Moraxella catarrhalis
Clinical presentation, Mx and Investigation of sinusitis?
Clinical presentation
- In adults, it is diagnosed by the presence of nasal blockage or nasal discharge with facial pain/pressure (or headache) and/or reduction of the sense of smell
- Severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
Investigation
Clinial diagnosis
Mx
- Analgesics and nasal decongestants
- Saline irrigation
- Consider prescribing a high-dose nasal corticosteroid if a person has had symptoms for around 10 days or more with no improvement
- Antibiotics for severe/deteriorating cases of >10 days duration - treat secondary bacterial infection
- Phenoxymethylpenicillin first line
- Doxycycline second line - contraindicated in children
Complications of sinusitis?
- Spread of infection into important structures
- Spread of infection from sinuses to orbit - cellulitis, periosteal abscess, orbital abscess
- Thrombosis of retinal vein or cavernous sinus - infection spreads into superior saggital sinus and patient becomes very unwell
Types og HL?
Sensorineural HL:
* loss is the most common type of hearing loss
* Occurs when the inner ear, hair cells in the cochlea
* result of aging, exposure to loud noise, injury, disease, certain drugs or an inherited condition.
* typically not medically or surgically treatable; however, hearing aids can be beneficial.
Conductive HL:
* most common in children
* occurs in the outer or middle ear where sound waves are not able to carry all the way through to the inner ear.
* Sound may be blocked by earwax or a foreign object located in the ear canal; the middle ear space may be impacted with fluid, infection or a bone abnormality; or the eardrum may have been injured.
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