Ear Disease

• Fill in the blanks

  A) Pinna

  B) External auditory canal

  C) Tympanic membrane

  D) Eustachian tube

  E) Cochlea

  F) Semicircular canals

  
• Fill in the blanks

  A) Helix

  B) Tragus

  C) Antihelix

  D) Antitragus

  E) Lobule

  F) Helix

  G) Auricular tubercle

  H) Crus

  I) Crura

  
• Fill in the blanks

  A) Cone of light

  B) Eustachian tube

  C) Umbo

  D) Handle of malleus

  E) lateral process

  F) malleus

  G) Pars flaccida

  
• What is shown in the image?

  Normal ear/tympanic membrane

  
• Fill in the blanks

  A) Malleus

  B) Incus

  C) Stapes

  
• Fill in the blanks

  A) Scala vestibuli

  B) Scala media

  C) Tectorial membrane

  D) Basilar membrane

  E) Scala tympani

  F) Organ of Corti

  G) Spiral ganglion

  
• Fill in the blanks

  A) Cochlea

  B) Saccule

  C) Utricle

  D) Semicircular canals

  E) Endolymphatic duct

  
• What is shown in the image?

  Otitis externa

  
• Cone of light should be anterior & inferior.
• What is acute otitis externa?

  External ear infection

  More common in adults

  Frequent swimmers can be prone to OE
• How does acute otitis externa present? What is the treatment?

  Presents with itch & pain

  Treatment

  • cleaning (microsunction)
  • topical ear drops (ciprofloxacin +/- dexamethosone)
  • swab
  • advise aural hygiene
• What is shown in the image?

  Otitis media

  
• What is acute otitis media?

  Middle ear disease (behind tympanic membrane)

  More common in children

  Usualy follows upper respiratory tract infection

  
  

  Inflammation in middle ear -> increased pressure -> pain -> perforation -> discharge & relief from pain
• Why is acute otitis media more common in children?

  Eustachian tube is wider, shorter & more horizontal

  Immature immune system
• Fill in the blanks

  A) Foramen lacerum

  B) Petrous apex

  C) Internal auditory meatus

  
• What is important in an ear history?

  Otalgia (ear pain) <- red flag

  Discharge/bleeding (<- red flag)

  Hearing change

  Tinnitus

  Vertigo/dizziness

  Aural fullness (pressure in ear)
• What is the treatment of acute otitis media?

  Pain reflief

  Delayed antibiotics (48-72 hrs)

  Surgery (if complications)
• What is necrotising otitis externa?

  Form of osteomyelitis of temporal bone

  Can erode bone & spread to skull base (cranial nerve palsies)

  Almost always pseudomonas infection

  RFs: diabetes, immunosuppression, elderly age, ear syringing

  PRESENTATION: persistent severe pain

  MANAGEMENT: systemic antibiotics, topical antibiotic drops, regular microsuction, diabetes control
• What is cholesteatoma?

  Presence of skin in the middle ear

  Accumulation of benign keratinizing squamous cells in the middle ear -> cells are hyperproliferating & secrete enzymes (locally destructive)

  More common in males

  Keratin debris can become infected -> chronic ear discharge
• What is the treatment of cholesteatoma?

  Surgery
• What is shown in the image?

  Cholesteatoma

  
• What are the 2 types of cholesteatoma?

  Congenital -> persistent epithelial cell left in middle ear during embryonic growth

  Acquired -> Eustachian tube dysfunction -> TM retraction -> affects keratin migration -> trapped keratin
• What is exotosis?

  Surfer's ear

  Bilateral

  Periosteal reaction to repeated cold water exposure

  Risk of wax impaction

  
• What is shown in the image?

  Exostosis

  
• What is osteoma?

  Benign bony neoplasms

  Usually incidental, solitary & unilateral

  
• What is shown in the image?

  Osteoma

  
• What are the complications of acute otitis media?

  Perforation

  Hearing loss

  Vertigo

  Intra-cranial infection

  Acute mastoiditis

  CN VII palsy
• What is acute mastoiditis?

  Inflammation of lining of mastoid air cells

  PRESENTATION: tender, boggy, swollen mastoid process

  MANAGEMENT: agressive IV antibiotics, may require cortical mastoidectomy

  
• What is shown in the image?

  Foreign body in ear canal

  Battery (right image) is an emergency

  
• What is BPPV?

  Benign paroxysmal positional vertigo

  Common -> caused by dislidgement of otoconia (crystalloid debris) -> otoconia move with gravity, causes fluid in semicircular canals to move -> sensation of movement
• How is BPPV diagnosed?

  Dix Hallpike Test
• How is BPPV treated?

  Epley Manouevre +/- Brandt Daroff Exercises
• What is vestibular neuronitis?

  Inflammation of vestibular nerve

  PRESENTATION: persistent continuous vertigo

  Often precedes viral symptoms
• What is labyrinthitis?

  Inflammation of entire labyrinthine apparatus

  PRESENTATION: continuous vertigo & hearing loss
• What must you rule out with persistent vertigo?

  Central causes (posterior circulation stroke or tumour)
• What is shown in the image?

  Vestibular Schwannoma (Acoustic Neuroma)

  
• What are the presenting symptoms of vestibular schwannoma?

  Unilateral sensorineuronal type hearing loss (sudden or progressive)

  Unilateral tinnitus

  Vertigo

  Facial weakness
• What is vestibular schwannoma?

  Benign tumour of myelin sheath

  Arises from vestibular portion of CN VIII

  May be associated with Neurofibromatosis Type 2

  
• What is tinnitus?

  Hallucination of sound

  Common

  Concern if it becomes bothersome

  Unlateral persistent tinnitus -> may indicate vestibular schwannoma

  Associated with presbycusis, Meniere's etc.
• What is shown in the image?

  Otitis Externa