Osteomas/ exostoses - «Swimmers ear» - ETIOLOGY
Cold water?
Osteomas/ exostoses - «Swimmers ear» - SYMPTOMS
Painless, no symptoms. Incidental finding.
Osteomas/ exostoses - «Swimmers ear» TREATMENT AND COMPLICATIONS
• Tx: Cannaloplasty. Can become problem: Cerumen might get caught between an osteoma and tympanic
membrane causing hearing trouble.
Anatomical complications seen
Minor birth defect, like pre-auricular dimple might
indicate more severe medial ear congenital
malformations. Also remember that abnormally
shaped ears => USG abdomen as kidney/ GU
problems often are associated
• Epitympanic recess = attic of middle ear. During exam
if he points to it he might want the answer mastoid air
cells)
Otosclerosis - Cause/definition
Inability of staples to move due to calcifications seen in primary disease of otic capsule. Female:Male ratio = 2:1. Tend to progress after pregnancy.1% of white population suffers from it.
Otosclerosis - Symptoms
Progressive hearing loss, tinnitus, vestibular symptoms(+/-), neg. Rinne-test in the affected ear. Weber-test positive. Normal looking tympanic membrane.
Otosclerosis - Treatment & Prognosis
Always offer hearing aid-device. Surgery -> Stapes mobilization/stapedectomy/stapedotomy. Prognosis: very good. Risk of total hearing loss w/stapedectomy.
Hearing loss - tests
- Weber test: to assess cochlear function. Points to side with bone conductance, and away from side w/sensineuronal hearing loss. 2. Rinne test: for bone conductance. Normal ear: AC> BC - Positive test. When BC>AC - negative test -> Indicated a problem within the middle ear. 3. Eustachian tube patency: Do Valsava meneover(Tympanic membrane bulge outwards (Never do this if patient has sore throat as it might transmit bacterias into middle ear). or 4.Toynbee’s test(Swallow-tympanic membrane bulges inward) -> problems may indicate small hole in tympanic membrane.
Otitis externa - Pathognomic sign
Pain when you put pressure on tragus
Otitis externa - Causes
- Herpes oticus
- Erysipelas
- Bacterias
- Fungal
Otitis externa - Predisposing factors
- Narrow external canal
- Increased sweating
- Bathing in hot climate
- Eczema
- Psoriasis
- Ear syringing
Otitis externa - Symptoms
- Pain
- Fulness
- Itching
- Discharge
Exam: tenderness, erythema, edema, discharge, narrowed ear canal.
Acute otitis media - Causes
- S.Pneumoniae (35%)
- H.Influenzae (25%)
- M.Catarrhalis (15%)
- > Usually lasts 1-5d, typically children, and frequently bilateral. Children at increased risk due to a shorter and more horizontal eustachian tube.
Acute otitis media - Symptoms
Variable otalgia, pressure sensation, hearing loss, hyperemia, exudation, suppuration, resolution, fever. Tympanic membrane red + infiltrated. Abnormal light reflex. Tympanic membrane might rupture which produces a relief of pain. Also accounts for discharge.
Acute otitis media - Treatment
Analgesia + antibiotics: penicillin/cephalosporin ->aimed to improve function of eustachian tube. Might try antihistamines and steroids too. Avoid water. If membrane still bulge after antibiotic treatment - do myringotomy. -> Always follow up! until membrane is OK! and hearing is back. Look for reservoir for infection: nose, sinuses or nasopharynx. Mastoid air cells might harbour some pathogens too. -> If more than 3x in 6months = recurrent AOM.
Acute otitis media - Complications
Acute mastoiditis
Chronic otitis media - Causes
- Granulation tissue
- Polyps
- Cholesteatoma
- Late/ineffective tx of AOM.
- Upper airway sepsis
- Lowered resistance
- Virulent infection (e.g. measles)
Chronic otitis media - Symptoms
Discharge, hole in tympanic membrane, hearing loss
Chronic otitis media - Treatment
Usually do conservative treatment first - ciprofloxacin ear drops/regular aural toilet/myringoplasty. If it doesnt help? Do surgery to remove cause and try to restore middle ear ossicles chain to regain hearing = ossiculoplasty. Must do tympanoplasty at least. Possibility of patients needing prosthesis of ossicles. Also possible to change existing ossicles shape. PORP = partial ossicles replacement proosthesis or TORP (total).
Chronic otitis media - Complications
Cholesteatoma - might erode into scull base, cochlea(labyrinthitis) or facial nerve canal (facial nerve palsy = not same as Bell’s palsy).
Otitis externa - Treatment
- Aural toilet
- Dressing that should be kept until healing(up to 10d) - change once a day.
- 8% aluminium acetate
- 10% itchammol in glycine
- Ointments for fungus/aminoglycosides
- Avoid water/be careful with showers.
- > If the cause is narrow ear canal - meatoplasty might work.
Serous otitis media/Glue ear - Cause
2ndary to closed eustachian tube - f.eks by large adenoids.
Serous otitis media/Glue ear - Symptoms
Yellow liquid behind intact tympanic membrane > 3 months, that can vary from thin to mucoid(mucoid = more chronic process).
Serous otitis media/Glue ear - Predisposing factors
Winter, child, acute otitis media, large adenoids, passive smoking, nasal allergy, early exposure to pathogens, cleft palate, Down’s syndrome, mucociliary dysfunction(even though CF patients dont tend to have a lot of AOMs or problem in general).
