1
Q
What is the cause of acute otitis media?
A
- Streptococcus pneumoniae and haemophilus influenzae
- Upper respiratory tract infection transmitted by eustachian tube to nasopharyngeal disrupts
- nasopharyngeal microbiome which leads to a secondary bacterial infection
2
Q
What is the clinical presentation of acute otitis media?
A
- Child with Otalgia (ear pain) or pulling/ rubbing their ear
- Recent URTI, fever, vomiting
- Purulent ear discharge/ otorrhoea if tympanic membrane perforation
3
Q
What are the investigations for acute otitis media?
A
- Swab for pus in tympanic membrane perforation
- Otoscopy
4
Q
What is the otoscopy results for acute otitis media
A
- loss of light reflex indicating bulging drum from fluid buildup
- erythema and perforation may also be seen
5
Q
What is the management for acute otitis media?
A
- Self limiting in most cases
- Amoxicillin
- Erythromycin
6
Q
What are the criterias for prescribing antibiotics in acute otitis media?
A
- Symptoms for 4 days +
- Systemically unwell but not requiring admission
- Immunocompromised or high risk of complications due to other conditions
- Younger than 2 years of age w/ bilateral otitis media
- Otitis media with perforation and/ or discharge
7
Q
What are the complications of otitis media?
A
- Mastoiditis (infection spreads to mastoid)
- Labyrinthitis
- facial palsy, meningitis, brain/ intracranial abscess
- Glue ear (also known as otitis media with effusion, chronic, hearing loss)
8
Q
What is otitis media with effusion? List the cause and symptoms
A
- Middle ear canal filled with fluid due to unknown cause but most follow acute otitis media
- Hearing loss
- Secondary speech and language delay
9
Q
What is the treatment for glue ear/ otitis media with effusion?
A
- Initial review and check up again in 3 months
- Grommet insertion: allow air to pass through middle ear (mimic eustachian tube function)
- Adenoidectomy
10
Q
What conditions are considered chronic otitis media/ discharging ear? Define each
A
- Otitis media with effusion
- Perforation of tympanic membrane with otorrhea for 6 weeks +
- Cholesteratoma: squamous metaplasia in the middle ear erodes surrounding bones
11
Q
What are the clinical presentations of chronic otitis media?
A
- Chronic discharge
- Little pain, Reduced hearing
- Conductive hearing loss w/ flat tympanogram and infected ear will hear better
12
Q
What is cholesteatoma? Give typical patient profile
A
- Abnormal collection of squamous epithelial cells in middle ear (non-cancerous)
- invade local tissue and nerves, can erode bones, predispose to infection
- 10-20 year old, increased risk in congenital cleft palate patients
13
Q
What is the pathophysiology of cholesteatoma?
A
- Eustachian tube dysfunction (closes) leads to negative air pressure in middle air
- Portion of tympanic membrane gets sucked in (squamous epithelial from the outer tympanic membrane) and proliferates inside the middle ear
14
Q
What are the symptoms of cholesteatoma? Why do these symptoms occur
A
- Unilateral recurrent/ non-resolving discharge
- Unilateral hearing loss
- Local invasion: vertigo, facial nerve palsy
15
Q
How does cholesteatoma cause hearing loss? What type is it?
A
- Hearing loss due to auditory ossicles damage
- ossicles conduct sound from tympanic membrane to inner ear thus, conductive hearing loss
16
Q
What is the investigation and result for cholesteatoma?
A
- Otoscopy: Whitish debris/ Attic crust in the uppermost part of ear drum
- CT scan to confirm diagnosis and MRI scan to assess invasion
17
Q
What is the management for cholesteatoma?
A
Refer to ENT for surgical removal
Mastoidectomy + tympanoplasty
18
Q
What is Meniere’s disease? What are the causes
A
- Long term inner ear disorder causing recurrent vertigo + hearing loss+ tinnitus
- Excessive buildup of endolymph in labyrinth of inner ear which causes increased pressure in labyrinth and disrupt sensory signals
19
Q
What are the symptoms of meniere’s disease?
A
- vertigo, tinnitus, Hearing loss (dizzy spell)-> Unilateral, minutes to hours/ episode, sensorineural
- feeling of fullness of ear, nystagmus
- 40-50 year old
20
Q
How is meniere’s disease diagnosed? What are the results
A
- Clinical by ENT specialist
- Audiology: unilateral sensorineural pattern affecting lower frequencies first
21
Q
How is meniere’s disease diagnosed?
A
- Prochlorperazine (antiemetic) buccal or intramuscular for acute attacks
- Betahistine (anti-vertigo) as prophylaxis to reduce frequency of attacks
- Inform DVLA (truck drivers)
- Majority self dissolved in 5-10 years but will leave a degree of hearing loss
22
Q
What is the cause and location of vestibular schwannoma/ acoustic neuroma?
A
- benign tumors of schwann cells surrounding auditory/ vestibulocochlear nerve (innervate inner ear)
- Location: cerebellopontine angles of the brain
(Schwann cells: provide myelin sheath that surround neurons in the peripheral nervous system)
23
Q
What are the types of vestibular schwannoma/ acoustic neuroma?
A
Unilateral
bilateral (associated w/ neurofibroma type 2)
24
Q
What are the various presentations of vestibular schwannoma/ acoustic neuroma? (depends on the nerve)
A
- CN VIII (vestibulocochlear): vertigo, unilateral sensorineural hearing loss and tinnitus (ringing)
- CN V (facial): absent corneal reflex (blink reflex)
- CN VII (trigeminal): facial palsy
25
What is the investigation for vestibular schwannoma/ acoustic neuroma?
- MRI of cerebellopontine angle
- Audiometry: sensorineural hearing loss (downward curve) where air conduction will be louder than bone conduction
26
What is the treatment and risks for vestibular vestibular schwannoma/ acoustic neuroma?
- Surgery, radiotherapy or observation
- Injury of vestibulocochlear nerve (hearing loss and dizziness)
- Injury of facial nerve (facial weakness)
27
Which organisms are likely to cause bacterial acute tonsillitis?
- Group A strep/ strep. Pyogenes
- Haem influenzae, staph aureus, strep pneumoniae
28
What are the likely causes of viral infection?
- EBV, rhinovirus, influenza, parainfluenza
- Accounts for majority of acute tonsillitis
29
What are the symptoms in both viral and bacterial tonsillitis?
Sore throat, dysphagia
Fever
swollen tonsils
30
What are the symptoms more unique to bacterial tonsillitis?
- Lymphadenopathy
- Rapid onset of symptoms (within 3 days)
- Last around one week and need antibiotic to settle
- More severe pain and fever
31
What are the symptoms more unique to viral tonsillitis?
- Gradual onset of symptoms
- Resolve on its own within a week, paracetamol helps with pain
- Less tonsil exudate
- Coryzal symptoms: runny nose, cough, body aches
32
What are the investigations for acute tonsillitis
- Clinical exam and history taking
- feverPAIN or Centor to determine whether its bacterial and if antibiotic
33
What is the feverPAIN scoring system?
34
What is the treatment for acute bacterial tonsillitis?
- Bacterial: penicillin/ clarithromycin if fever pain is 2-3
- Difficulty breathing: admit for hospital for IV fluids, antibiotic and steroids
- Severe and recurrent: Tonsillectomy
35
What is the treatment for acute viral tonsillitis?
Self care and analgesics
36
What are the early complications of acute tonsillitis?
Otitis media
Peritonsillar abscess
37
What are the late complications of acute tonsillitis (both are related to bacterial)
- Rheumatic fever (fever + arthritis + pericarditis 3 weeks post strep A)
- Glomerulonephritis (haematuria, albuminuria, edema, 1-3 weeks post strep A )
38
What is EBV? What group does it generally target?
Ebstein barr virus- apart of herpes causing persistent infection in epithelial cells
Targets young adults
39
What is the classic triad of EBV?
Fever + pharyngitis + lymphadenopathy
Sore throat, tonsillitis, coryzal symptoms
splenohepatomegaly
Maculopapulo rash (when given amoxicillin by accident)
40
What is the diagnosis for EBV?
Heterophil antibody test/ monospot test
FBC: atypical lymphocytes in peripheral blood
41
What is the treatment for EBV?
self limiting: bed rest and paracetamol
Avoid physical activity for 4 weeks due to risk of splenic rupture
