Ear

Question 1

Otitis externa:

• Definition
• Causative organisms (3)
• Risk factors (6)
• Symptoms (4)
• Signs (2)
• Investigations
• Management
• Complications (2)

Answer 1

Otitis externa:

• Definition: inflamm ext auditory meatus
• Causative organisms (3): pseudom aerug, s aures, s epidermis,
• Risk factors (6): diab, swimmer, eczema, immunocomp, h aids, cotton buds
• Symptoms (4): discharge, otalgia, itchy, cond h loss
• Signs (2): tender pinna, erythema + discharge
• Investigations : mc+s
• Management : if mild acetic acid, gentamicin + hydrocort ear drops, if spreading flucloxacillin, ciprofloxacin if severe/diabetic , if due to eczema toilet/steroids, ent referral if not responding to abx
• Complications (2): malig ot externa (urgent referral + iv abx), cellulitis

Question 2

External ear trauma:

• Pinna haematoma: complication, management
• Haemotympanum: definition

Answer 2

External ear trauma:

• Pinna haematoma: same day ent for incision + drainage otherwise cauliflour deformity
• Haemotympanum: conserv

Question 3

Otitis media:

• Definition
• Causative organisms: bacterial and viral
• Symptoms (6)
• Signs
• Management
• Complications (6)

Answer 3

Otitis media:

• Definition: middle ear infection
• Causative organisms: bacterial and viral : s pneum, haem influ most common, morax, resp syno, enterov
• Symptoms (6): fever, otalgia, coryzal, h loss, non feeding, sore throat
• Signs: red bulging tm (middle ear effusion)
• Management: if systemically well nothing, if >4 days/<2 + bilat/perf/<3 months/sys unwell then 5-7 days amox
• Complications (6): perforation, mastoiditis, meningitis, abscess brain, facial nerve palsy

Question 4

Chronic otitis media:

• Types (4)
• Cholesteatoma: definition, symptoms, management, complications

Answer 4

Chronic otitis media:

• Types (4): either active (ear discharge) or inactive. Inactive - mucosal: tm perf. squamous: retraction pocket. Active - mucosal: dry perf. Active squamous: cholesteatoma
• Cholesteatoma: kerat sq cells retraction pocket in middle ear. Foul smelling discharge + h loss, facial plasy, vertigo. Needs surgery ossiculoplasty otherwise can erode into bones causing mastoiditis, perf, meningitis

Question 5

Otitis media with effusion:

• Definition
• Symptoms
• Signs
• Investigations
• Management

Answer 5

Otitis media with effusion:

• Definition : fluid in middle ear effusion due to eusch tube dysfunction
• risk factors: downs, fx, male, parent smoking
• Symptoms : around 2 years old, h loss cond, tinnitus, speech/language delay, balance problems
• Signs: retracted tm, bubbles
• Management: active observation 3 months, grommets , adenoidectomy . unilat glue ear in adult needs urgent 2ww ent for post nasal space tumour ix

Question 6

BPPV:

• Definition
• Causes (4)
• Symptoms (2)
• Investigations
• Management

Answer 6

BPPV:

• Definition : ca carbonate crystals in semicirc canals move when moving inducing abnormal stim on hair cells giving vertigo
• Causes (4): head inj, ear surg, urti, ear pathology
• Symptoms (2): sudden movement provokes 30 secs vertigo, n+v
• Investigations: dix hallpike provokes symp + when lying on affected ear causes rotatory nystagmus (not if spinal problems - fracture cervical, cervical prolapse disc)
• Management: 6 weeks watch, no driving, epley manoveures, bradt daroff exercises

Question 7

Ménière’s disease:

• Definition
• Symptoms (5)
• Investigations
• Management

Answer 7

Ménière’s disease:

• Definition : too much endolymph labryinth which increases pressure disrupting sensory signals
• Symptoms (5): vertigo, tinnitus, sens h loss, aural fullness/headache, nystagmus
• Investigations: pure tone audiogram, mri
• Management: reduce salt/choco/caffeine/chinese, prochloperazine, ent referral, inform dvla and no driving until control of symptoms. Then prevention via betahistine + vestib rehab

Question 8

Vestibular neuronitis + acute labrynthitis

• Definition
• Symptoms
• Signs
• Investigations
• Management

Answer 8

Vestibular neuronitis

• Definition : acute prolonged attack of vertigo due to inflammation of vestibular nerve (bony labyrinth in other) due to previous infection and can last up to 6 weeks
• Symptoms : prolonged vertigo worse with movement, n+v (also tinnitus + sens h loss in other)
• Signs: horizontal nystagmus
• Investigations: head impulse test eyes saccade towards unaffected side hence peripheral cause
• Management: prochlorperazine but stop after a few days as it delays recovery, vestibular rehab exercises

Question 9

Sudden onset sensorineural hearing loss:

• Causes (7)
• Investigations
• Management

Answer 9

Sudden onset sensorineural hearing loss:

• Causes (7): idiopathic, vestib schwann, stroke, migraine, ms, ototoxic meds, menieres, infection
• Investigations: mri
• Management: urgent ent referral, high dose oral steroids

Question 10

Ear red flags

Question 11

Referred ear pain sources

Question 12

Vestibular schwannoma:
- Definition
- Symptoms (4)
- Investigations
- Management

Question 13

Tinnitus:
- causes
- ix
- mx

Answer 13

• causes: idiop, menieres, otosclerosis, sudden onset sens loss, acoustic neuroma, ear wax, drugs (nsaids/aspirin), aminoglycosides, quinine, loop diuretics
• ix: mri int aud meatuses if non pulsatile, if pulsatile mra
• mx: treat cause, cbt

Question 14

Vertigo causes

Answer 14

labyrin/vestib neuronitis
bppv
menieres
acoustic neuroma
pcos
trauma
ms
ototoxicity

Question 15

Hearing loss:
- causes

Answer 15

• ear wax
• otitis media
• otitis externa
• glue ear
• menieres
• labyrinth
• acoustic neuroma
• noise damage
• drug otoxocity: gentamicin, furosemide, aspirin, quinine
• prescusbysis: age related bilat sens h loss esp high pitched due to loss cochlear hair cells + degen nerve.
• otosclerosis: auto dom where replacement normal bone by vasc spongy bone. progressive bilat conductive h loss better in low pitched + tinnitus . h aids and staphedectomy

Question 16

Perforated TM
- mx

Answer 16

• mx:
  if wet (due to infection ot media) then abx
  if dry (loud noise) then keep dry and will heal 6-8 weeks
  if still not improved then myringoplasty

Question 17

Mastoiditis
- definition
- symptoms
- mx
- complications

Answer 17

Mastoiditis
- definition: infection spreads from middle to mastoid air cells of temporal bone
- symptoms: otalgia severe, fever, tender/swelling over mastoid process, sys unwell
- mx : iv abx
- complications: facial nerve palsy, h loss, meningitis

Question 18

Tympanogram

Answer 18

A: normal bell curve
B: flat, - middle ear effusion or perf
C: peak at start - eusch tube dysfunction