Pathology of the Ear

Question 1

Where are conditions affecting the ear found?

Answer 1

Both adults and children, and in primary and secondary care

Question 2

What are the symptoms of ear disease?

Answer 2

Varied;

• Pain (otalgia)
• Discharge
• Hearing loss
• Tinnitus
• Vertigo
• Facial palsy

Question 3

What are the types of hearing loss?

Answer 3

• Conductive
• Sensorineural

Question 4

What are the categories of abnormalities of the pinna?

Answer 4

• Congential
• Inflammatory
• Traumatic
• Infective

Question 5

Give an example of a traumatic abnormality of the pinna?

Answer 5

Pinna Haematoma

Question 6

What causes a pinna haemotoma?

Answer 6

Blunt injury to the pinna

Question 7

Where are pinna haemotomas common?

Answer 7

In contact sport

Question 8

What is a pinna haematoma?

Answer 8

Accumulation of blood between cartilage and perichondrium

Question 9

What results from the accumulation of blood between cartilage and perichondrium in a pinna haemotoma?

Answer 9

Deprives the cartilage of its blood supply, and pressure necrosis of the tissue can occur

Question 10

What does a pinna haemotoma require?

Answer 10

• Prompt drainage
• Measures to prevent re-accumulation
• Re-apposition of two layers if necessary

Question 11

What happens if a pinna haemotoma is untreated, or poorly treated?

Answer 11

Leads to fibrosis and new asymmetrical cartilage development - cauliflower ear

Question 12

Give an example of an infective abnormality of the pinna

Answer 12

Ramsey-Hunt palsy

Question 13

What is Ramsey-Hunt palsy?

Answer 13

Facial nerve palsy caused by shingles of the facial nerve

Question 14

How common is otitis externa?

Answer 14

Very common

Question 15

What is otitis externa?

Answer 15

Infection and inflammation of the ear canal

Question 16

Do you get discharge with otitis externa?

Answer 16

May do

Question 17

How is otitis externa treated?

Answer 17

• Antibiotics
• Steroid drops

Question 18

What are the common abnormalities of the tympanic membrane?

Answer 18

• Perforation
• Bulging and redness secondary to otitis media

Question 19

What is otitis media with effusion known as?

Answer 19

Glue ear

Question 20

Is glue ear an infection?

Answer 20

No

Question 21

What happens in glue ear?

Answer 21

There is a build up of fluid and negative pressure in the middle ear

Question 22

What is the result of the fluid in glue ear?

Answer 22

Means the tympanic membrane doesn’t vibrate as well, and so decreases the mobility of TM and ossicles, thus affecting hearing

Question 23

What is dysfunctional in glue ear?

Answer 23

The Eustachian tube

Question 24

What is wrong with the Eustachian tube in glue ear?

Answer 24

It stays closed all the time

Question 25

What can glue ear predispose to?

Answer 25

Infection

Question 26

Why does glue ear predispose to infection?

Answer 26

Due to stagnant fluid in the cavirty

Question 27

How is glue ear managed?

Answer 27

* Most resolve spontaneously within 2-3 months * Some may persist, and require grommets

Question 28

What is otitis media?

Answer 28

An acute middle ear infection

Question 29

Who is otitis media common in?

Answer 29

More common in infants and children in adults

Question 30

What are the symptoms of otitis media?

Answer 30

* Otalgia * Other non-specific symptoms, e.g. temperature * Red, with or without bulging of the TM and loss of the normal landmarks

Question 31

What are the complications of otitis media?

Answer 31

* Tympanic membrane perforation * Facial nerve involvement * Mastoiditis * Intracranial complications

Question 32

What allows otitis media to cause mastoiditis?

Answer 32

The mastoid air cells communicates with the middle ear cavity, which provides a potential route for middle ear infections to spread to the mastoid bone

Question 33

What does mastoiditis require for treatment?

Answer 33

* IV antibiotics * Surgery to drain

Question 34

What are the intracranial complications of otitis media?

Answer 34

* Meningitis * Sigmoid sinus thrombosis * Brain abscess

Question 35

What is the middle ear in important anatomical relationship with?

Answer 35

The facial nerve

Question 36

What is the anatomical relationship between the facial nerve and the middle ear?

Answer 36

The facial nerve, in particular the chorda tympani branch, runs through the middle ear cavity

Question 37

How is the facial nerve seperated from the middle ear?

Answer 37

A very thin bony partition

Question 38

What is the clinical relevance of the anatomical relationship between the middle ear and the facial nerve?

Answer 38

A middle ear infection may cause a lesion of the facial nerve

Question 39

What are the pathologies of the vestibular apparatus?

Answer 39

* Vertigo * Meniere's disease

Question 40

What is vertigo?

Answer 40

*A symptom, rather than a condition itself* Sensation that you, or the environment, is moving or spinning

Question 41

Give a common cause of vertigo

Answer 41

Benign paroxysmal positional vertigo

Question 42

What can Meniere's disease affect?

Answer 42

The vestibular and cochlear components of the inner ear

Question 43

What are the symptoms of Meniere's disease?

Answer 43

* Vertigo * Hearing loss * Tinnitus * Feeling of pressure or fullness in the ear

Question 44

How common is cholesteatoma?

Answer 44

Rare

Question 45

What is the clinical feature of cholesteatoma?

Answer 45

Painless otorrhea

Question 46

What is cholesteatoma usually secondary to?

Answer 46

Chronic/recurring ear infections and blockage of ET

Question 47

What does a blockage of the ET cause?

Answer 47

A sucking, negative pressure, drawing the eardrum inwards, producing a retraction pocket at the top of the middle ear cavity

Question 48

What results from the formation of a retraction pocket in the top of the middle ear cavity?

Answer 48

Skin cells get trapped, collect, and continue to grow in this small pocket within the middle ear

Question 49

How does cholesteatoma progress?

Answer 49

*Not malignant,* but slowly grows and expands, eroding into structures; * Ossicles * Mastoid bone * Cochlea

Question 50

What is a cholesteatoma initially more likely to grow into?

Answer 50

Structures in the middle ear

Question 51

What happens to a cholesteatoma over time?

Answer 51

It may grow into and erode structures in the inner ear or into the bone of the skull, then brain

Question 52

How does the pharyngotympanic tube differ in infants?

Answer 52

It is shorter and more horizontal

Question 53

What is the result of the pharyngotympanic being shorter and more horizontal in infants?

Answer 53

* Easier passage for infection from the nasopharynx to the middle ear * Tube can block more easily

Question 54

What problems does a blockage of the pharyngotympanic tube do?

Answer 54

Compromises ventilation and drainage of middle ear, and increases risk of middle ear infection