Otalgia

Question 1

What is otalgia

Answer 1

Ear pain

Question 2

What does chronic otitis media include (3)

Answer 2

Otitis media with effusion, cholesteatoma, perforation

Question 3

What is otitis externa

Answer 3

Inflammation of the outer ear canal

Question 4

Name 3 bacterial causes for otitis externa

Answer 4

Staph aureus
Proteus spp
Pseudomonas

Question 5

Name 2 fungal causes of otitis externa

Answer 5

Aspergillus Niger
Candida albicans

Question 6

Name some common triggers for otitis externa

Answer 6

Water exposure, cotton buds, skin conditions

Question 7

Clinical presentation of otitis media

Answer 7

Redness and swelling of ear canal
Discharge, increased amounts of wax
Buildup can lead to hearing being affected

Question 8

How do we manage otitis externa

Answer 8

TOPICAL
ear drops

Question 9

What is acute otitis media

Answer 9

Inflammation of the middle ear

Question 10

Who usually gets acute otitis media

Answer 10

Infants and children

Question 11

What is acute otitis media commonly associated with

Answer 11

URTIs

Question 12

Most common bacteria associated with acute otitis media

Answer 12

Strep pneumo
H influenzae
Moraxella catarrhalis
Strep pyogenes

Question 13

How does infection extend in acute otitis media

Answer 13

From the throat to the ear via the Eustachian tube

Question 14

Symptoms of acute otitis media

Answer 14

Ear pain, fever, irritability, possibly hearing loss

Question 15

Clinical signs of acute otitis media

Answer 15

Inflammation
Middle ear effusion
Opaque tympanic membrane - bulging may be present
Mobility of tympanic membrane impaired

Question 16

When can you investigate acute otitis media

Answer 16

When the eardrum perforates you can take a swab

Question 17

Management of acute otitis media

Answer 17

80% resolve in 4 days
Amoxicillin or erythromycin if needed

Question 18

Complications of acute otitis media

Answer 18

Subperiosteal abscess
Sensorineural hearing loss
Vertigo
Facial palsy
Brain abscess / meningitis
Venus sinus thrombosis

Question 19

What is malignant otitis externa

Answer 19

Invasive infection of the bone surrounding the ear canal

Question 20

What bones may be affected in malignant otitis externa

Answer 20

Mastoid, temporal

Question 21

Most common cause of malignant otitis externa

Answer 21

Pseudomonas

Question 22

Risk factors for malignant otitis externa

Answer 22

Diabetes, radiotherapy to the head and neck

Question 23

What usually precedes malignant otitis externa

Answer 23

Otitis externa

Question 24

Symptoms of malignant otitis externa

Answer 24

Pain and headache that is more severe than clinical signs would suggest

Question 25

Clinical signs of malignant otitis externa

Answer 25

Granulation tissue at bone-cartilage junction of ear canal Exposed bone Facial nerve palsy

Question 26

Investigations for malignant otitis externa

Answer 26

Plasma viscosity, CRP radiological imaging Biopsy and culture

Question 27

Complication of untreated malignant otitis externa

Answer 27

Osteomyelitis progressively involves the skull and meninges DEATH

Question 28

Management of malignant otitis externa

Answer 28

Cleaning and debridement, topical antibiotics of the ear canal Long term systemic antibiotics Surgery if necessary

Question 29

Name the 6 Ts of referred pain in the ear

Answer 29

Teeth, tonsils, throat, tongue, tumour, trauma

Question 30

What is acute mastoiditis

Answer 30

Infection of the mastoid air cells

Question 31

What is acute mastoiditis a complication of

Answer 31

Acute otitis media

Question 32

Name 2 common causes of acute mastoiditis

Answer 32

Strep pneumo, h. Influenzae

Question 33

Clinical presentation of acute mastoiditis

Answer 33

Pain, tenderness and swelling behind the ear

Question 34

Investigation of acute mastoiditis

Answer 34

CT, MRI

Question 35

Management of acute mastoiditis

Answer 35

IV antibiotics Some require surgical drainage

Question 36

Complication of acute mastoiditis

Answer 36

Mastoid process can get infected, spread to the middle cranial fossa and into the brain causing meningitis

Question 37

What causes referred pain from the auriclo-temporal branch of the mandibular nerve (CN V3) to the ear

Answer 37

Lower mandibular pathology: dental TMJ lesions Inflammation on the anterior 2/3 of the tongue Tooth grinding Salivary gland disease

Question 38

What causes referred pain from the sensory branch of the facial nerve to the ear

Answer 38

Geniculate herpes + Ramsay hunt syndrome are related to palsy Sphenoid or ethmoid sinus pathology Nasal pathology

Question 39

What causes referred pain from the tympanic branch of the Glossopharyngeal nerve to the ear

Answer 39

Tonsillitis or Quincy Post-tonsillectomy Carcinoma of the posterior 1/3 of the tongue or tonsils Neuralgia of the nerve

Question 40

What causes referred pain from the auricular branch of the vagus nerve to the ear

Answer 40

Foreign body in piriform fossa Carcinoma of the piriform fossa, larynx Piriform abscess Post-cricoid carcinoma

Question 41

Where does the greater occipital nerve arise from

Answer 41

Dorsal rami of C2 and C3

Question 42

Where does the lesser occipital nerve originate from

Answer 42

Ventral ramus of C2

Question 43

Where does the greater auricular nerve arise from

Answer 43

Ventral rami of C2 and C3

Question 44

What causes referred pain from the greater auricular nerve to the ear

Answer 44

Cervical neuritis

Question 45

What causes referred pain from the lesser occipital nerve to the ear

Answer 45

Cervical spondylosis Cervical neuritis Herpes zoster