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Otology

Otology. Dave Pothier St Mary’s 2003. Anatomy. Not a big place Lots of bits NB concepts only. External ear. Internal structures. Hearing. Conductive. Sensorineural. The ‘otitises’. Acute Suppurate Otitis Media Chronic Suppurative Otitis Media

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Otology

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  1. Otology Dave Pothier St Mary’s 2003

  2. Anatomy • Not a big place • Lots of bits • NB concepts only

  3. External ear

  4. Internal structures

  5. Hearing Conductive Sensorineural

  6. The ‘otitises’ • Acute Suppurate Otitis Media • Chronic Suppurative Otitis Media • Otitis Media with Effusion / Secretory Otitis Media • Adhesive Otitis Media +/- Cholesteatoma

  7. ASOM • Common ear infection • Pus in middle ear • Organisms from ET • Pain, fever, deafness • Often perforated TM

  8. Organisms • Strep pneumoniae • Haemophilus Influenzae

  9. Complications: Intracranial • Meningitis • Intracranial abscess • Sigmoid/lateral sinus thrombosis Extracranial • Mastoiditis and sequelae • Facial nerve palsy • Labyrithitis • Sensorineural hearing loss

  10. Sequelae • Glue ear • TM perforation • Adhesions • Tympanosclerosis • Ossicular erosion

  11. Rx Conservative / medical / surgical • Observe • Analgesia • Antibiotics (Amoxil) • +/- myringotomy

  12. Mastoiditis • Spread of infection to mastoid air cells form middle ear cleft – serious disease; easy spread to important structures • From ASOM / cholesteatoma

  13. Signs • Unwell • Deaf • ASOM • Ear protruding Not always reliable

  14. Rx • Resus • Admit • IV abx • Early surgery if no response

  15. Glue ear / SOM / OME NOT INFECTIVE NOT INFECTIVE NOT INFECTIVE NOT INFECTIVE NOT INFECTIVE NOT INFECTIVE NOT INFECTIVE

  16. Glue ear / SOM / OME • Caused by ETD (Eustacian tube dysfunction) • Negative MEP • Effusion of fluid in Middle ear • No pain, no fever, not unwell • Deafness, poor development of speech, behaviour

  17. Rx • Cons / Medical / Surgical Watch & wait Hearing Aid Ventilation tube

  18. Conservative • Hearing loss in context • Speech / developmental issues • Follow-up • Seasonal • Self limiting

  19. Hearing aid • Effective • Compliance

  20. Ventilation tubes (grommets)

  21. NB NO ANTIBIOTICS

  22. Cholesteatoma What is it? Keritinising squamous epithelium in middle ear cleft

  23. Cholesteatoma • How? Congenital (rare) Aquired - primary (retraction) - secondary (implantation)

  24. ‘Conveyor belt’ Skin migrates from umbo outwards across TM and out along canal

  25. Pars flaccida ( 2 layers ) Pars tensa ( 3 layers)

  26. Eustacian tube dysfunction Negative MEP Retraction of pars flaccida RP fills with debris Infection Erosion and spread

  27. Cholesteatoma

  28. Complications • Same as ASOM + mastoiditis • But more insidious • Slow erosion more common

  29. Rx Conservative / medical / surgical Conservative - microsuction, review Medical – antibiotic drops Surgical – cortical mastoidectomy

  30. mastoidectomy

  31. CSOM unsafe • Perforation of TM • Follows a slow to heal ASOM • May be active or inactive • Safe / Unsafe perforation • Mucosal or cholesteatoma Similar principles to cholesteatoma safe

  32. Otitis Externa Inflammation of EAM +/- infection TM debris

  33. Pathogens • Pseudomonas • Staph Aureus • Mixed growth

  34. Trauma Cotton buds Fingers H20 in ear Eczema Narrow canals Causes

  35. Rx • Microsuction / aural toilet • Microsuction / aural toilet • Topical Topical antibiotic drops • Water precautions Leave oral / IV until specialist review

  36. Malignant OE Often in immunocompromised + Diabetics Not mitotic! Aggressive OE – cranial nerve palsies Base of skull disease Emergency referral for surgery and Abx

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