Ear Disorders: Otitis Externa vs Media

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Questions and Answers

What must be assumed for any adult patient with persistent hoarseness for more than two weeks?

They may have a laryngeal infection.

They have a benign condition.

They have a malignancy until proven otherwise. (correct)

They are experiencing vocal fatigue.

Which examination method is NOT used to assess the larynx?

Flexible fiber-optic nasolaryngoscopy

Indirect laryngoscopy using a mirror

CT scan imaging (correct)

Rigid telescope (70 degree)

What are common presenting features of advanced laryngeal cancer?

Chronic cough and fever.

Loss of appetite and weight loss.

Dyspnoea and stridor. (correct)

Hoarseness and sore throat.

In which type of laryngeal cancer are cervical nodal metastases more common?

Supraglottic cancer. Signup and view all the answers

Where does the lesion typically arise in cases of laryngeal cancer?

The anterior one-third of the vocal cords. Signup and view all the answers

What is the primary medical management for patients with deteriorating conditions despite therapy?

Adequate medical therapy Signup and view all the answers

Which antibiotic therapy avoids nephrotoxicity and ototoxicity in patients undergoing treatment?

Ceftazidime Signup and view all the answers

What is the expected duration for treatment in cases of malignant otitis externa?

6 to 16 weeks Signup and view all the answers

Which artery is primarily responsible for the blood supply of the nasal septum?

Sphenopalatine branch of the maxillary artery Signup and view all the answers

How is the venous drainage of the anterior areas of the nasal cavity conducted?

To the facial vein Signup and view all the answers

What is the clinical significance of fluid and electrolyte monitoring in patient management?

To avoid hypovolaemia or circulatory shock Signup and view all the answers

What can cause epistaxis to become a life-threatening condition?

Severe hypovolaemia or circulatory shock Signup and view all the answers

What is typically monitored before discontinuing treatment for malignant otitis externa?

Normal white blood cell count and ESR Signup and view all the answers

What characterizes the discharge in acute otitis media?

Mucopurulent Signup and view all the answers

Which symptom is not typically associated with acute otitis externa?

Mucus in otorrhea Signup and view all the answers

What is a common source of obstruction to the eustachian tube in children?

Adenoidal hyperplasia Signup and view all the answers

What role does the eustachian tube play in ear health?

Ventilates and equalizes pressure in the middle ear Signup and view all the answers

What effect does nasopharyngeal carcinoma have on the eustachian tube?

Obstructs the ostium of the eustachian tube Signup and view all the answers

Which symptom indicates that otitis media may coexist with another condition?

Markedly reduced otalgia with discharge Signup and view all the answers

How does the pain associated with acute otitis externa typically respond to movement?

Increases with pinna movement Signup and view all the answers

What is a significant factor that adversely affects the prognosis of nasopharyngeal carcinoma?

Size of the tumor Signup and view all the answers

Which of the following is NOT a function of the eustachian tube?

Transport of sensory signals Signup and view all the answers

What is the 5-year survival rate for patients with nasopharyngeal cancer?

57% Signup and view all the answers

What defines acute sinusitis?

Inflammation resolving without residual mucosal change Signup and view all the answers

Which of the following criteria indicates chronic sinusitis in children?

Mucosal change on CT after medical therapy Signup and view all the answers

What initiates sinusitis according to the provided content?

Obstruction of the ostiomeatal complex Signup and view all the answers

Which statement is true regarding the development of the paranasal sinuses?

Only the maxillary sinus grows significantly after tooth eruption. Signup and view all the answers

What is a critical factor in the normal physiology of the paranasal sinuses?

Patency of the ostia Signup and view all the answers

Which factor is least likely to affect the prognosis of nasopharyngeal carcinoma?

Patient's dietary habits Signup and view all the answers

What symptom is commonly associated with nasal obstruction in patients with nasopharyngeal carcinoma?

Bloodstained postnasal discharge Signup and view all the answers

Which cranial nerves are most frequently involved in cases of nasopharyngeal carcinoma?

VI and XII Signup and view all the answers

What condition may result from obstruction of the eustachian tube due to nasopharyngeal carcinoma?

Otitis media with effusion Signup and view all the answers

What is a potential consequence of nasopharyngeal carcinoma spreading along the internal carotid artery?

Compression of cranial nerves III, IV, and V Signup and view all the answers

What percentage of nasopharyngeal carcinoma cases may display distant metastases?

20-30% Signup and view all the answers

Which diagnostic method can be used to assess the nasopharynx?

Nasopharyngeal mirrors or endoscopes Signup and view all the answers

In the presence of unilateral otitis media with effusion in an adult, what should be suspected?

Nasopharyngeal carcinoma Signup and view all the answers

Which symptom indicates possible cranial nerve involvement due to nasopharyngeal carcinoma?

Severe headaches Signup and view all the answers

Study Notes

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.

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Description

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.