Signs, Symptoms & RFs

• What is otalgia?

  Ear pain
• What is otorrhoea?

  Discharging ear
• What are the signs & symptoms of cholesteatoma?

  Gradual conductive hearing loss (due to damage to ossicles or obstruction of auditory tube)

  Persistent discharge from the ear (usually watery & smelly)

  Defect in TM full of white, cheesy material

  Some may experience slight ear pain
• What are the risk factors for cholesteatoma?

  Male

  Hx of middle ear disease

  Trauma to ear (may introduce keratinocytes to middle ear)

  Auditory tube dysfunction (following otitis media or congenital abnormalities (cleft palate & Down syndrome))
• What are the differential diagnosis of cholesteatoma?

  Otitis media w/effusion

  Otitis externa

  Tympanosclerosis

  Osteonecrosis of the external auditory canal

  Benign necrotising otitis externa

  Myringitis
• What is tympanosclerosis?

  White appearance of fibrotic scarring of TM

  Commonly seen after grommet insertion, can give the impression of a cholesteatoma deeper within the middle ear
• What is osteonecrosis of the external auditory canal?

  Rare complication of biphosphonate treatment
• What is benign necrotising otitis externa suggested by?

  Severe otologia AND

  Hx of diabetes or immunosuppression

  On otoscopy, granulations in ear
• What is myringitis?

  Inflammation of tympanic membrane (with or without granulations)
• What are the signs & symptoms of otitis media with effusion?

  Dull TM w/loss of light reflex

  Fluid w/air bubbles visible in the middle ear

  Children can have adenoidal hypertrophy & nasal blockage

  Aural fullness or pressure

  Possible hearing loss
• What are the risk factors of otitis media w/effusion?

  Childhood

  Upper resp tract infection

  Acute otitis media

  Craniofacial anomalies

  Eustachian tube dysfunction

  Genetic predisposition in children

  Daycare attendance

  Adenoid hyperplasia, adenoiditis
• Why is being a child a RF of OME?

  Eustachian tube is shorter & more horizontal in children
• Why is an upper resp infection a risk factor for OME?

  Mucosal inflammation (secondary to infection) can lead to obstruction & dysfunction of Eustachian tube → fluid accumulation in the middle ear
• Why is acute otitis media a risk factor for OME?

  Otitis media w/effusion typically follows acute otitis media once acute inflammation resolves
• Why are craniofacial anomalies a RF for OME?

  E.g. cleft palate & Down syndrome

  Predisposes to Eustachian tube dysfunction & subsequent chronic OME
• Why is Eustachian tube dysfunction a RF of OME?

  Eustachian tube plays an important role in maintaining health & function of middle ears (esp. pressure equalisation & mucociliary clearance)

  Dysfunction → increased risk of OME
• Why is daycare attendance a RF for OME?

  Increased exposure to viral pathogens, which can cause upper resp tract infections
• Why is adenoid hyperplasia is RF of OME?

  Adenoid enlargement can lead to obstruction of Eustachian tube orifices
• What are the common symptoms of an ear infection?

  Pain

  Fever

  Vomiting

  Fatigue

  Difficulty hearing

  Discharge running out of ear

  Feeling of aural pressure/fullness

  Itching/irritation in & around ear

  Scaly skin in/around ear
• What is the rate of recurrence of cholesteatoma?

  High
• What is the appearance at rest of facial palsy?

  Absence of horizontal lines of forehead on affected side (preserved in UMN lesion)

  Affected eye larger

  Lack of blink in affected eye (mostly preserved in UMN)

  Altered position or absence of naso-labial folds on affected side

  Position of affected corner of the mouth lower than the side
• What are the risk factors of facial palsy?

  Diabetes

  Pregnancy

  Ear infection

  Upper resp tract infection

  Obesity