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GP block (Y3) > Week 3: ENT 1 (common conditions of the ear) > Flashcards

Week 3: ENT 1 (common conditions of the ear) Flashcards

1
Q

Otitis externa Background

A

an inflammatory condition of the outer ear that can affect the auricle, external auditory canal and external surface of the tympanic membrane.

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2
Q

causes of otitis externa

A

bacterial

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3
Q

presentation of otitis externa

A
  • erythema of the auricle and external auditory canal with associated pain.
  • Other findings may include oedema of the auditory canal causing narrowing, regional lymphadenopathy and discharge in the ear canal
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4
Q

investigations for otitis externa

A

otoscopy

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5
Q

management of ototis externa

A
  • Self-care advice e.g. no cotton buds, keep ears clean and dry, over-the counter acetic acid ear drops
  • Aural toileting
  • Advice on analgesia
  • Consider prescribing topical antibiotic (oral if immunocompromised)with or without topical corticosteroid 7-14 days
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6
Q

otosclerosis background

A
  • One of the most common causes of acquired hearing loss in young adults
  • Ossicles fused at articulations due to abnormal bone growth particularly between base plate of stapes and oval window
    • Sound vibrations cannot be transmitted effectively to cochlea
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7
Q

causes of otosclerosis

A
  • Both genetic and environmental
  • Exact cause unknown
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8
Q

presentation of otosclerosis

A
  • Present with gradual unilateral or bilateral conductive hearing loss
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9
Q

investigation for otosclerosis

A
  • Audiometry
  • CT scan
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10
Q

management of otosclerosis

A
  • Hearing aid
  • Surgery  stapedectomy prosthetic device in middle ear to bypass abnormal bone and permit sounds waves to travel to inner ear and restore hearing
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11
Q

background menieres disease

A
  • Disorder affecting the inner ear which affects balance and hearing
  • Syndrome characterised by episodes of vertigo, fluctuating hearing loss and tinnitus
  • Associated with feeling of fullness
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12
Q

causes of menieres disease

A
  • Usually unknown
  • General view that abnormal endolymph production and / absorption is associated
  • Risk factors: autoimmunity, genetic susceptibility, metabolic disturbances, vascular factors, viral infection, head trauma
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13
Q

presentation of menieres disease

A
  • Vertigo, tinnitus, hearing loss, aural fullness
  • H and N finding normal
  • Romberg test negative
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14
Q

investigation for MD

A
  • To confirm diagnosis refer to ENT
  • Audiology assessment
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15
Q

management of MD

A
  • Reassure patient that vertigo should get better within 24hours
  • Advise not to drive when dizzy
  • Symptomatic treatment
    • Admit people with severe symptoms for IV labyrinthine sedative and fluids to maintain hydration and fluid
    • Antiemetics
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16
Q

Age related hearing loss- presbycusis background

A

Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs in most of us as we grow older

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17
Q

cause sof presbycusis

A
  • can be both S and C
  • changes in anatomical structures of the ear e.g.
    • Inner ear
    • Middle ear
    • Vestibular cochlear nerve
    • Loud noise
    • Loss of hair cells
    • Aging
    • Ototoxic drugs
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18
Q

presentation of prebycusis

A
  • Bilateral hearing loss
  • Gradual change
  • High-pitched noises hardest to hear
  • Speech sounds slurred
  • Some sounds overly loud
  • tinnitus
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19
Q

investigations for presbycusis

A
  • Otoscope
  • audiogram
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20
Q

management of presbycusis

A
  • Hearing aids
  • Assistive devices e.g. telephone amplifier
  • Training in speech reading
  • Techniques for preventing excess wax
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21
Q

Noise related hearing loss background

A
  • Permanent hearing loss caused by being around loud noises over a long time or a very loud noise e.g. explosion
  • Sensorineural
  • Shearing forces of sound energy impact on the stereocilia of hair cells of the basilar membrane of the cochlea
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22
Q

presentation of noise related hearing loss

A
  • Bilateral hearing loss
  • Aural fullness
  • Muffled speech
  • Tinnitus
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23
Q

investigations for noise related hearing loss

A
  • Rinne’s positive (AC>BC)
  • Weber lateralises to good ear
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24
Q

management of Noise related hearing loss

A

hearing aids

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25
Q

Mastoiditis background

A
  • Middle ear cavity communicates via mastoid antrum with mastoid air cells
  • Provides a potential route for middle ear infections to spread into the mastoid bone (mastoid air cells)
  • Osteomyelitis
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26
Q

causes of mastoiditis

A
  • Complication of unresolved otitis media- bacterial infection
27
Q

presentation of mastoiditis

A
  • fever,
  • irrationality,
  • swelling of the ear lobe,
  • redness and tenderness behind the ear,
  • drainage of the ear,
  • bulging and drooping of the ear.
28
Q

investigations of mastoiditis

A
  • Otoscope
  • Ear culture
  • Blood test
  • CT scan
29
Q

mastoiditis management

A
  • IV antibiotics
  • Mastoidectomy
  • Myringotomy- drain middle ear
30
Q

Dry tympanic perforation background

A

hole in the eardrum, usually heals in a few weeks and might not need any treatment

31
Q

causes of dry TP

A
  • Ear infection
  • Injury to eardrum such as foreign body
  • Changes in pressure
  • Loud noise e.g. explosion
32
Q

presentation of dry TP

A
  • Hearing loss
  • Earache
  • Itching
  • Fluid leaking
  • High temp
  • tinnitus
33
Q

investigastions for dry TP

A

otoscopy

34
Q

managmenrt of dry TP

A
  • Infection caused by perforated eardrum → antibiotics
  • Usually self limiting if small
  • If big hole → surgery for perforated eardrum
35
Q

cholesteoma background

A
  • Rare- should not be missed
  • Not a tumour or related to cholesterol
  • Potentially serious- not malignant but slowly grows and expands
    • Can erode ossicles, mastoid/petrous bone, cochlea via enzymatic action
36
Q

pathophysiology of cholesteoma

A
  • If chronically increased negative ear pressure in the middle ear – the pars flaccida will start to retract →forms a sac/pocket
  • Trapping stratified squamous epithelium and keratin → collecting in the retraction pocket
  • Proliferates forming cholesteatoma
  • Usually secondary to chronic eustachian tube (ET) dysfunction
37
Q

presentation of cholesteoma

A
  • Painless, often smell otorrhea (ear discharge) +/- hearing loss
38
Q

Acute otitis media background

A
  • is an inflammatory condition of the middle ear
  • Causes viruses and bacteria.
39
Q

presentation of AOM

A
  • Typical findings on otoscopy include a bulging red, yellow or cloudy tympanic membrane with an associated air-fluid level behind the membrane.
  • There may also be discharge in the auditory canal if the tympanic membrane has perforated.
40
Q

nvestigation of AOM

A

otoscopy

41
Q

management of AOM

A
  • Antibiotics
  • Regular analgesia
42
Q

chronic suppurative otitis media

A
  • a complication of otitis media - chronic inflammation of the middle ear and mastoid cavity, leading to tympanic perforation
43
Q

chronic suppurative otitis media presentation

A
  • Most common in childhood
  • Recurrent ear discharge (otorrhoea) through without pain or fever >6 weeks
  • History of ear problems
  • Conductive hearing loss
  • Occasional otalgia or true vertigo
44
Q

chronic suppurative otitis media otoscopic findings

A
  • Painless examination
  • Evidence of tympanic membrane perforation
  • Inflammation with otorrhea
45
Q

management of Chronic suppurative otitis media

A
  • Topical antibiotics with or without steroids, aural toileting (antiseptic ear cleaning)
46
Q

otitis media with effusion

A
  • ‘glue ear’, is a condition characterized by a collection of fluid within the middle ear space without signs of acute infection- like hearing under water
  • Due to blockage of the eustachian tube- air pressure cannot equilibrate and mucus cannot drain
47
Q

causes of otitis media with effusion

A
  • More common in children
  • Acute otitis media
  • Eustachian tube dysfunction
  • Low grade viral or bacterial infection
48
Q

presentation of acute otitis media with effusion

A
  • Hearing loss
  • Intermittent ear pain with fullness
  • Aural discharge
  • Recurrent ear infections
  • Otoscope- usually no signs of inflammation or discharge on examination
  • Straw coloured TM
  • Loss of light reflex
  • Opacification of drum
  • Fluid level (makes ossicles move less easily- like hearing under water
  • Retracted
49
Q

management of acute otitis media with effusion

A
  • Watch and wait
  • Hearing tests
  • Autoinflation→ nasal balloon → ventilating middle ear two to three times a day
  • Hearing aids
50
Q

cauliflower ear

A
  • is an irreversible condition that 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.
  • This cartilage normally relies on the perichondrium for its nutrient supply and as a result, once separated it becomes fibrotic, causing distortion of the ear’s architecture
51
Q

anotia

A

complete absence fo the pinna (congenital deformity)

52
Q

microtia

A

underdevelopment of the pinna (congenital deformity)

53
Q

low set ears

A

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.

54
Q

infective causes of pinna abnormalities

A
  • E.g. Ramsey hunt syndrome
    • Unilateral face droop and red ear with vesicles
    • Perichondritis
      • Layer which coats the cartilage and provides blood supply
      • Causes by infection introduced by ear piercings/ insect bites
      • Needs ABx
55
Q

traumatic causes of pinna abnormalities

A

pinna haematoma

56
Q

pinna haematoma

A
  • accumulation of blood between the cartilage and its overlying perichondrium from blunt injury
    • Common in contact sport
    • Subperichondrial haematoma deprive cartilage of blood supply, increase in blood build up = increased pressure= necrosis of tissue
57
Q

treatment of pinna haematoma

A
  • Drainage and prevent re-accumulation/re-apposition of two layers
    • Untreated→ fibrosis, new asymmetrical cartilage development→ cauliflower deformity)
58
Q

pathophysiology of benign paraoxysmal positional vertigo

A

Caused by crystals that forms within the tubes of the vestibular apparatus→ crystal dislodge → create movement in the fluid→ movement of stereocilia → signals via AP when we are still

59
Q

presentation of BPPV

A
  • Vertigo only (most common cause)
    • Only upsets vestibular apparatus)
    • Short lived episodes (seconds): triggered by movement of head e.g. tuning over in bed, bending down
60
Q

management of BPPV

A
  • Dix- Hallpike and Epley manoeuvres  dislodging crystals
61
Q

infections (URTI) which can affect the apparatus within the ear

A

acute labyrinthitis and acute vestibular neuronitis

62
Q

acute labyrinthitis vs acute vestibular neuronitis

A

Acute labyrinthitis

  • Involvement of all inner ear structures, associated with hearing loss/tinnitus, vomiting and vertigo

Acute vestibular neuronitis

  • Just affects the vestibular
  • No hearing disturbances or tinnitus
  • Sudden onset of vomiting and severe vertigo (lasting days)
63
Q

Causes of conductive hearing loss include

A
  • excessive ear wax
  • otitis externa
  • otitis media
  • perforated tympanic membrane
  • otosclerosis.

GP block (Y3) (39 decks)

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