foul-smelling ear discharge may indicate
necrosis due to bacterial infection e.g. osteonecrosis
cholesteatoma
for family history, ask for TORCHES.
TOXoplasmosis
Rubella
CMV
HERpes Simplex
newborn with risk factors (ABCDEFG)
Asphyxia Bacterial Meningitis Congenital Perinatal Infection Defects of head and neck Elevated bilirubin Family history Gram birth weight
ear discharge
clear serous
mucoid
purulent
clear serous - from outer ear (no mucous glands)
mucoid - middle ear, mastoid
purulent - infection
conductive HL
tuning fork test (wrs)
weber - lateralized to affected ear
rinne - AC < BC
schwabach - diminished in affected ear
otalgia
*tragal, mastoid tenderness
if with otalgia, rule out chronic otitis media
tragal - acute otitis externa
mastoid - acute otitis media
aural atresia may be congenital or acquired……
congenital - failure of canalization of epithelial plug poriton
acquired - due to chronic otitis externa, or trauma of EAC
EAC stenosis due to
chronic infections –> fibrotic thickening of walls
TM embryogenesis
ectoderm - squamous layer
mesoderm - fibrous layer
endoderm - mucosal layer
8 wk AOG - ectoderm @ 1st pharyngeal groove thickens, grows toward middle ear
21 wk AOG - concha cavum = outer 1/3 of EAC, forms channel
28 wk AOG! = TM
otitis externa hx
ear manipulation with subsequent otalgia/pain on ear manipulation
otitis externa patho, etiology (localized, diffuse)
lipid layer removed by moisture or local trauma -> edema, obstruction of glands, fullness, itching… bleh
localized - s. aureus
diffus - pseudomonas
otitis externa treatment
neomycin/polymixin with steroids to relieve inflammation
quinolones from G+/-
*ear wick method
otitis externa presentation
edema, obstruction of glands, fullness, itching…
erythematous/swollen EAC
otomycosis/externa mycotica etiology (3) + factors (4)
aspergillus albicans
aspergillus niger
pitysporum
moisture
high temp
poor hygiene
immunosuppression
otomycosis/externa mycotica treatment (2)
1:1 acetic acid + isopropyl alcohol
anti-fungals (e.g. nystatin, clotrimazole)
acute otitis media
duration
etiology (3)
< 3 weeks
strep pneumoniae
h influenza
moraxella catarrhalis
*URTI?
acute otitis media presentation (4)
pain fever malaise sometimes headache
red bulging TM
stages of acute otitis media (4)
hyperemic - URTI reflux; Amoxicillin for G+
exudative - no light reflex
suppurative - perforated TM
resolution/complication
mechanical trauma EAC treatment
clean with hydrogen peroxide
mechanical trauma presentation (4)
bleeding, discharge, pain, hearing loss
TM difficult to see
barotrauma presentation
pain, fullness, dec hearing
retracted TM, blebs, sometimes perforated (give antibiotic)
*may cause hemotympanum, possible rupture
neoplasm
exostoses vs osteoma
both in bony canal?
exostoses - multiple bilateral
osteoma - single unilateral
osteosclerosis
mode of heredity
causes stiffening and fixation of what?
sign?????
autosomal dominant
stiffening and fixation of stapes
- normal PE
- dizziness, balance probs, tinnitus
- Schwartze’s sign - in minority of px; hyperemia of promontory
OAE: if sensorineural HL is present,
it is not > 40db
