Summary of otology conditions (ENT) relevant for medical school finals. Contains information about clinical features of each condition, as well as relevant diagnostic tests and investigations, risk factors, causes and management guidelines.
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,ACOUSTIC NEUROMA
PRESENTATION PATHOPHYSIOLOGY
Typically aged 40-60 years with gradual onset of Benign tumours of Schwann cells surrounding the
- Unilateral SNHL (usually presenting vestibulocochlear nerve
symptom) They occur at the cerebellopontine angle (sometimes
- Unilateral tinnitus referred to as cerebellopontine angle tumours)
- Dizziness or imbalance Usually unilateral
- Sensation of fullness in the ear
- May be associated with CN VII palsy if Can be bilateral – associated with neurofibromatosis
tumour is large enough type II
INVESTIGATION MANAGEMENT
PTA Conservative – monitoring if there are no symptoms
- SNHL or treatment is inappropriate
MRI/CT to establish diagnosis and features Surgical – to remove tumour
Radiotherapy to reduce growth
Risks of treatment: vestibulocochlear nerve injury
(permanent hearing loss or dizziness), CN VII injury
(facial weakness)
, ACUTE OTITIS MEDIA
RISK FACTORS PATHOPHYSIOLOGY
- Lack of breastfeeding as baby Acute onset inflammation of middle ear (usually
- Attending nursery/day care infective)
- +ve FHx OM with effusion (OME) may be consequence of AOM
- Age between 6-18 months but is regarded as a separate condition
- Exposure to smoking
Occurs at all ages, more common in infancy
AETIOLOGY
URTI causes inflammation of upper airways and SIGNS AND SYMPTOMS
obstruction of eustachian tube. Ascending
- Otalgia
infection results in hyperaemia of the middle ear
- Reduced hearing in affected ear
mucosa with production of purulent exudate
- Irritability
Viral infections cause 2/3 cases: RSV, rhinovirus, - Vomiting
enterovirus - Fever
Bacterial causes : S. pneumoniae, H. influenzae, - Ear pulling/tugging
M. catarrhalis Otoscopy
- Bulging TM (loss of light reflex)
Injected TM
- Perforation +/- purulent discharge
COMPLICATIONS - Secondary OE
Intratemporal - Erythema
- Tympanosclerosis (white patch on ear
drum due to scarring)
- Hearing loss
- OME INVESTIGATIONS
- TM perforation Consider swab for MC&S
- Mastoiditis CT/MRI if complications are suspected
- Labyrinthitis
- CN VII palsy (rare)
Intracranial
- Meningitis MANAGEMENT
- Intracranial abscess Analgesia and anti-pyrexials
- Lateral sinus thrombosis If failure to improve within 24-48 hours consider oral
- Cavernous sinus thrombosis abx
- Subdural empyema
- 5-7 day course of amoxicillin
- Co-amoxiclav if no improvement
Give immediate abx if patient has significant
comorbidities, is systemically unwell or
immunocompromised
Delayed abx: if symptoms have not improved or have
worsened
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