ENT Diseases, a Picture Quiz

Bulging Tympanic Membrane

Acute Otitis Media

Distorted cone of light

Left ear

Treat with penicillin, amoxycillin, co-amoxiclav

Caused by: Streptococcus pneumoniae, haemophilus influenzae, moraxella catarhalis, GAS or S. aureus

Caused by: Klebsiella, Strep pneumoniae, pseudomonas aeruginosa

Blue tympanic membrane

Due to blood behind the eardrum

Not a serious complication of acute otitis media

Perforation is seen

Direct contact between keratinizing squamous epithelium in external meatus and mucoperiosteum of middle ear damaged by inflammation

Tx: Remove matrix, perimatrix, eroded bone

Can progress to labryinthitis, meningitis , brain abscess

Does not require surgery

Fetid otorrhea, purulent

No perforation is observed

Chronic otitis media

Due to Late treatment of acute otitis media

Can see parts of the ossicular chain

Tx: Clean, irrigate, local antibiotics, may need mastoidectomy, tympanoplasty

Fever, lymphadenitis, pain

Cellulitic form can extend to parotid, mastoid, skull base

Can be mistaken for mastoiditis

Caused by: humidity, psoriasis, seborrhoea, trauma, swimming

Pinna haematoma

Causes: nasopharyngeal obstruction, otitis barotrauma, COM, epistaxis

Causes: nasopharyngeal obstruction, otitis barotrauma, AOM, allergic rhinitis

Symptoms: Deafness, tinnitus occasionally

Uncommon in small children

Leads to sensorineural deafness

To drain the pus

One can go swimming

Extrudes in about 6-9 months

Requires a 2nd surgery to remove

Used to treat glue ear

Presentation: Pyrexia, tenderness, swelling of post auricular region, bulging drum

Presentation: Pyrexia, tenderness, swelling of post auricular region, retracted drum

Acute otitis externa may be mistaken for this

Tx: IV antibiotics- amoxycillin, metronidazole
Cortical mastoidectomy

Not a clinical emergency

Can result in subperiosteal abscess, bezolds abscess in neck, zygomatic mastoiditis over zygoma

Left ear

Can see the lateral handle of the malleus

Pearly gray membrane

Drum is red and bulging

Cone of light is anteroposterior

White lesion may be due to scarring of TM

Perforation of TM

Cone of light reflex is preserved

Tympanoplasty is always indicated