Ear Disorders: Otitis Externa vs Media

Skull Fractures and Otorrhoea

• Base of skull fractures involving temporal bone can lead to CSF otorrhoea.
• Visualization of tympanic membrane may be obscured by exudate in external auditory canal.
• Distinction between acute otitis externa and acute otitis media can often be made even without tympanic membrane visibility.

Comparison of Otitis Externa and Otitis Media

• Otitis Externa:

  • Severe otalgia present; severity does not decrease with onset of otorrhoea.
  • Otorrhoea lacks mucus.
  • Very mild hearing loss.
  • Significant pain upon tragus pressure or pinna movement.

• Otitis Media:

  • Markedly reduced otalgia at onset of otorrhoea.
  • Mucopurulent discharge.
  • Mild to moderate hearing loss.
  • Pain is unrelated to movement of pinna.

Pathogenesis of Middle Ear Infections

• Chronic issues with eustachian tube dysfunction are central to middle ear infections.
• Eustachian tube functions include middle ear ventilation, pressure equalization, drainage of secretions, and protection from nasopharyngeal secretions.
• Common causes of dysfunction: obstruction or infection, often due to adenoidal hyperplasia in children.
• Congenital cysts and angiofibroma in male teenagers can obstruct eustachian tube.
• Nasopharyngeal carcinoma can manifest as a cause of eustachian tube obstruction.

Medical Management

• Controlling underlying medical issues is vital for effective treatment.
• Common treatments: medical management mainly; intravenous aminoglycosides were historically standard; ceftazidime and oral fluoroquinolones are safer alternatives.
• Malignant otitis externa management includes daily ear care and gentamicin drops; treatment lasts 6-16 weeks until recovery criteria are met.

Management of Epistaxis

• Epistaxis: bleeding from internal nose; may be life-threatening or manageable as an outpatient.
• Management requires establishing haemostasis and addressing any underlying causes.
• Blood supply: mainly through maxillary branch of external carotid artery.
• Septum blood supply: primarily from sphenopalatine branch of maxillary artery.

Epistaxis Source and Symptoms

• Nasal obstruction and bloodstained discharge common; epistaxis may occur after hawking.
• Conditions like sinusitis can present with similar aural symptoms.
• Unilateral otitis media with effusion in adolescents should raise suspicion for nasopharyngeal carcinoma.

Nasopharyngeal Carcinoma Symptoms

• Symptoms include tinnitus, otalgia, cranial nerve palsies (in 15-20% of cases, especially VI and XII).
• Tumor spread can invade cranial nerves through various foramina, potentially affecting multiple cranial nerves.
• May present with trismus and severe headaches; distant metastases noted in 20-30% of cases.

Diagnosis and Prognosis of Nasopharyngeal Carcinoma

• Evaluation via nasopharyngeal mirrors or endoscopy is conducted.
• Prognosis factors: tumor size, T stage, lymph node involvement influence treatment outcomes.
• Small cancers are highly curable with survival rates of 80%-90%, while advanced lesions have poorer prognosis.

Management of Sinusitis

• Acute sinusitis is inflammation without residual mucosal change following treatment.
• Chronic sinusitis is marked by persistent symptoms or recurrent infections within a defined timeframe.
• Normal sinus function depends on ostial patency, healthy mucociliary activity, and immune response.

Importance of Early Cancer Detection

• Persistent hoarseness beyond two weeks necessitates investigation for malignancy.
• Early laryngeal cancers often treatable with minimal morbidity; delay in diagnosis can lead to severe outcomes.

This quiz explores the differences between otitis externa and otitis media, including their symptoms and presentations. Learn to distinguish between these two common ear conditions, which may sometimes occur simultaneously. Additionally, the quiz addresses the challenges in visualizing the tympanic membrane during diagnosis.