1
Q
What are symptoms of Ear Infections?
A
- Pain inside the ear
- High temperature >38
- Being sick
- Lack of energy
- Difficulty hearing
- Discharge running through the ear
- Feeling of pressure or fullness inside the ear
- Itching and irritation in and around the ear
- Scaly skin in and around the ear
2
Q
What are symptoms specific to young children and babies with ear infections?
A
- Rub or pull their ear
- No reaction to some sounds
- Be irritable or restless, off their food
- Keep losing their balance
3
Q
What are red flag symptoms of Ear Infections?
A
- Very high temperature or feel hot and shivery
- Earache that doesn’t start to get better after 3 days
- Swelling around the ear
- Fluid coming from the ear
- Hearing loss or a change in hearing
- Other symptoms, like being sick, a severe sore throat or dizziness
- Regular ear infections
- Long-term medical condition – such as diabetes, or a heart, lung, kidney or neurological disease
- Weakened immune system – because of chemotherapy, for example
4
Q
How is Acute Otitis Externa treated?
A
- Treat pain with analgesia
- Treat infection with oral antibiotics if the infection is severe such as cellulitis or systemic signs of infections such as fever although its rarely indicated:
- 7-day course of flucloxacillin or clarithromycin
- Drain pus if necessary such causing severe pain
5
Q
How is Acute Otitis Media treated?
A
- Advise can last for 3 – 7 days and regular doses of paracetamol or ibuprofen for pain
- Offer antibiotic if severe or a backup antibiotic.
- Amoxicillin for 5-7 days for 500mg every 8 hours.
- Offer Co-amoxiclav if the 1st line antibiotic doesn’t work.
- If the symptoms still persist, refer to microbiology or ENT.
- Reassess if symptoms worsen rapidly
6
Q
When are patients with Acute Otitis Media admitted?
A
Admit if a severe systemic infection, if you suspect complications such as meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis or if it is a child younger than 3 months of age with temperature of 38 degrees or more
7
Q
How are patients with Recurrent Otitis Media managed?
A
Refer urgently to ENT specialist if nasopharyngeal cancer is suspected in presence of:
- Persistent symptoms and signs of otitis media with effusion between episodes due to obstruction of the eustachian tube
- Persistent cervical lymphadenopathy
- Epistaxis and nasal obstruction
Refer to ENT if person has craniofacial abnormality
8
Q
How is Acute Otitis Media with effusion treated?
A
- Acute observation over 6-12 weeks is appropriate for most children as spontaneous resolution is common
- Re-evaluate signs and symptoms of the effusion and concerns regarding the child’s hearing or language development to look for any complications as this determine whether it is appropriate to continue with active observation or refer child to ENT specialist
- Do 2 hearing test using pure tone audiometry at least for 3 months Antibiotic, Antihistamine, Mucolytics, Decongestants, Corticosteroids are not recommended
9
Q
What is the non-surgical treatment options if a patient is referred for Acute Otitis media with effusion?
A
- Observed for a period of 3 months
- Hearing aids can be given as a non-surgical alternative
- Auto inflation by nasal balloon involves blowing up a balloon via the nostril two to three times a day, thus ventilating the middle ear, equilibrating pressure, and allowing some drainage of fluid. But not used for children with an upper respiratory infection
10
Q
What is the surgical treatment options if a patient is referred for Acute Otitis media with effusion?
A
- Should be offered as an alternative to hearing aid with in children with cleft palate who have OME and persistent hearing loss.
- Factors should be considered beforehand in children with Down’s syndrome such as:
- Severity of hearing loss
- Age of the child
- Practicality of grommet insertion
- Associated risk and likelihood of early extrusion of grommet.
- Adjuvant adenectomy shouldn’t be offered in absence of persistent and/or frequent respiratory tract infections
11
Q
How are patients with grommets inserted assessed?
A
- Follow-up periodically and their hearing should be re-asse
- Advise parents that grommets cause few problems and work their way-out of the ear, normal school activities should be encouraged, holiday activities should not cause problems, swimming should be discouraged but increased infection risk.
12
Q
What are the complication of Grommets?
A
- Otorrhea
- Infection
- Tympanosclerosis
- Perforation of the tympanic membrane
- Fibrosis
13
Q
What is the parental advice for Acute otitis media?
A
- Smoking increases risk of otitis media with effusion
- When speaking to child, face them, slow the rate of speech, raise level of speech and speak clearly.
- Turn off competing auditory stimuli such as music or television.
- Daily reading helps language development and place child in front in school
14
Q
What are symptoms of BPPV?
A
- Generally rotational but sometimes sufferers, on lying down, will feel that they are falling through the bottom of the bed or, on getting up, that they are thrown back onto it.
- Provoking movement to induce BPPV are: lying flat, sitting up from lying flat, turning over in bed, looking up or bending down especially if also looking to the side
- Usually last 5 to 30 seconds
15
Q
What is the causes of BPPV?
A
- Loose chalk crystals get into the wrong part of the inner ear. Crystals should be embedded in a lump of jelly. Crystals weigh jelly down and make that part of the ear sensitive to gravity
- Lying flat can then occasionally cause of the loose debris to fall into one of the semicircular canals which is responsible for sensing rotation.
- Movement in the plane of the affected canal causes the crystals to move along the canal, stimulating it and giving the sensation of rotation
16
Q
What are investigations for BPPV?
A
Diagnosis made based on history and Hallpike test being positive which means induces vertigo and nystagmus when the affected ear is down most
17
Q
What is the management of BPPV?
A
- Get better without treatment in most cases
- Epley manoeuvre offer instant relief of symptoms in 9/10 patients
18
Q
What are symptoms of Labrynthitis?
A
- Feeling that you or your surrounding are moving or spinning. Vertigo can last for 20 minutes to 24 hours
- Feeling or being sick
- Some hearing loss
- Mild headaches
- Tinnitus
- Ear pain
- Fluid or puss leaking out of the ear
19
Q
What is the difference between Vestibular neuritis and Labyrinthitis?
A
In vestibular neuronitis, balance issues are experienced without hearing loss
20
Q
What is the cause of Labyrinthitis?
A
- Inner ear infection specifically the labyrinth which contains the cochlea and vestibular system. Usually follows a viral infection such as a cold or flu which spreads
- Infections such as measles, mumps or glandular fever that affect the rest of the body can also cause viral labyrinthitis.
- Bacterial labyrinthitis is more common in children and is a cause for concern as it can be serious.
21
Q
What is a complications of Labyrinthitis?
A
- Carries a higher risk of causing permanent hearing loss so a hearing test is recommended.
- Can be treated with a cochlear implant if there is hearing loss
22
Q
What are investigations of Labyrinthitis?
A
- Diagnosis is passed on medical history, and physical examinations.
- The ears are checked for signs of inflammation and infection.
- Hearing test are done and the eyes are checked for nystagmus
23
Q
What are symptoms of Meniere’s disease?
A
- Can last 2 or 3 hours
- Feeling like the room spinning around you, unsteady on your feet - (vertigo)
- Feeling sick or vomit
- Ringing noise inside the ear
- Ear pressure felt deep inside the ear
- Hearing loss
24
Q
How does Meniere’s Disease present?
A
- Affect people aged 20-60 years
- Can take day or two for the symptoms to disappear completely.
- May feel tired after an attack.
- Attacks occur in clusters or several times a week or they may be separated by weeks, month or years
25
How is Meniere's Disease treated?
* Admit people with severe symptoms to hospital for intravenous labyrinthine sedatives and fluids to maintain hydration and nutrition
* Refer to ENT and ideally involve the support of the multidisciplinary team
* Medications can be prescribed:
* Prochlorperazine to help relief severe nausea and vomiting
* Antihistamine to help relieve mild nausea, vomiting and vertigo
26
What are some causes of sudden hearing loss in 1 ear?
* Earwax
* Ear Infection
* Perforated Eardrum
* Meniere’s disease
27
How is earwax managed?
* Ear drops for 3-5 days to soften wax and aid removal (Olive oil or almond oil, Sodium bicarbonate)
* If symptoms persist consider ear irrigation, providing that there are no contraindications
* If irrigation is unsuccessful then there is basis for a referral to ENT after trying ear drops again for 3-5 days and instilling water into the ear to irrigate the ear
28
When can you refer to ENT before irrigation?
* There is past history of ear surgery
* Foreign body including vegetable matter in the ear canal
* There is a visible tympanic membrane perforation
* Ear drop have been unsuccessful, and irrigation is contractindicated
29
What are symptoms of perforated eardrum?
* Sudden hearing loss
* Earache
* Itching
* Fluid leaking from your ear
* High temperature of 38C or above
* Tinnitus
30
What are causes of sudden hearing loss in both ears?
* Loud noise
* Taking certain medicines
* (which ones)
31
What are causes of gradual hearing loss in one ear?
Due to something inside the ear such as:
* Fluid
* Bony growth (otosclerosis)
* Build-up of skin cells (cholesteatoma)
32
What are causes of gradual hearing loss in both ears?
* Ageing
* Exposure to loud noises over many years
33
How is Labrynthitis managed?
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Year 3: GP
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