6921010
Description
Flashcards by Andrew Street, updated more than 1 year ago
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Created by Andrew Street
about 8 years ago
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| Question | Answer |
| What is AOM, who are particularly predisposed to it, & why? | * Inflammation of the middle ear * Most common infxn in children (90% will have had 1 or more infxn's by 2 YO) * Children have shorter, more horizontal Eustachian tube allowing easier spread of infxn from nose/pharynx ENTAAG p23. |
| What is a typical presentation of AOM & what are the S & Sx? | * Often preceded by viral URTI * Otalgia * Fever * Deafness * Otorrhoea * Mastoid may be tender & swollen * Children may be fractious, awake at night * OE - bulging tympanic membrane ENTAAG p23. |
| Otitis media - note bulging tympanic membrane that obscures structures of middle ear. | |
| Complications, Rx, & Mx of AOM. | * Complications - infxn may become chronic; spread to mastoid (mastoiditis), inner ear, facial nerve (facial palsy),or brain; sensorineural hearing loss (caused by toxins); vertigo; perforation of tympanic membrane. * Rx & Mx: > Analgesia > ABx's - eg co-amoxiclav PO > When infxn has cleared always recheck tympanic membrane * If recurrent infxn (>5 infxn in 6/12) consider grommets or prolonged ABx course ENTAAG p23 & OHOENTS p94. |
| What is otitis media with effusion (OME) & what is it commonly known as? | The persistence of fluid in the middle ear for >3/12. Caused by exposure to infxn & non-functioning Eustachian tube. V common in children. AKA glue ear. Don't confuse with chronic suppurative otitis media - chronic middle infxn with perforated tympanic membrane. OHOENTS p97 & ENTAAG p27. |
| S & Sx of OME. | * Decreased hearing * Recurrent ear infxn's * Poor speech development * Failing performance at school * Antisocial behaviour What otoscopic sign is shown on the next card? OHOENTS p97. |
| Retracted tympanic membrane. | |
| What is the Mx & Rx of OME? | * Initially wait & see - most cases resolve within a few months. Use good communication skills eg facing the child when talking, getting their attention before speaking, etc * If OME persists: > Hearing aid - consider social implications for a child > Insertion of grommets OHOENTS p97 & ENTAAG p27. |
| Cholesteatoma. | |
| What is cholesteatoma & what are the complications? | Squamous epithelium from the external ear migrates into the middle ear and collects as a mass. Can become erosive eating into bone & soft tissue - serious condition! Complications: * Progressive hearing loss * Acute mastoiditis * Labyrinthitis * Facial palsy * Meningitis * Intracranial abscesses * Venous sinus thrombosis ENTAAG p25. |
| S & Sx of cholesteatoma. | Suspect if perforated tympanic membrane with: * Persistent smelly discharge * No improvement with drops * Severe hearing loss * Dizziness * Unexplained neurological S & Sx ENTAAG p25. |
| Mx & Rx of cholesteatoma. | Suspected cholesteatoma needs referral to ENT surgeons. Initial Rx: * Aural toilet * Microscopy & suction * Topical ABx/steroid (eg Sofradex) drops for 10/7 * Review @ 1/12 * Audiometry * CT scan of temporal bone If DS is established Sx is likely to be required. OHOENTS p100. |
| What is otitis externa & what are some risk factors? | Inflammation/infxn of the skin of the external auditory canal. May be caused by trauma (eg from cotton bud cleaning, foreign body) becoming infected (commonly Pseudomonas & Staphylococcus spp). Risk factors: * Swimmers & surfers * Daily hairwashers * Diabetics * People with skin conditions eg psoriasis, eczema ENTAAG p21 & OHOENTS p82. |
| S & Sx of otitis externa & Rx. | S & Sx: * P * Itching * May be discharge Rx: * Cleaning of ear canal eg suctioning * Keeping ear dry * ABx/steroid drops ENTAAG p21. |
| What is malignant/necrotising otitis externa & how does it present? | Progressive osteomylitis of the temporal bone resulting from otitis externa. Those compromised immunity are at risk (eg poorly controlled DM). Pt's CO severe, deep seated P unresponsive to analgesia. ^Risk of morbidity if untreated. ENTAAG p21. |
| Rx of malignant/necrotising otitis externa. | * Regular aural toilet * Systemic & topical ABx's * Surgical debridement ENTAAG p21. |
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