02_OTOLARYNGOLOGY_COMMON EAR DISEASES_DOC ALVAREZ.pdf

OTOLARYNGOLOGY COMMON EAR DISEASES Dr. Joy Alvarez | August 6, 2024 Aural speculum OUTLINE I. Basic ENT OPD Instruments II. Common Diseases of the Ext...

OTOLARYNGOLOGY COMMON EAR DISEASES Dr. Joy Alvarez | August 6, 2024 Aural speculum OUTLINE I. Basic ENT OPD Instruments II. Common Diseases of the External and Middle Ear III. Common Diseases of the Inner Ear IV. References I. BASIC ENT OPD INSTRUMENTS Otoscope Figure 5. Aural speculum Light source Figure 1. Otoscope Pneumatic otoscope Figure 6. Light source Head mirror Figure 2. Pneumatic otoscope Operating otoscope Figure 7. Head mirror II. COMMON DISEASES OF THE EXTERNAL AND MIDDLE EAR Microtia/Anotia → Congenital malformation of the ear in which the external ear (auricle) is underdeveloped and either abnormally-shaped (microtia) or absent (anotia) Figure 3. Operating otoscope Tuning fork Figure 8. Microtia Figure 4. Tuning fork Nice to Know (Bayoumy & de Ru, 2020) Tuning forks used in 512 Hz would have a balance between tactile vibration and time of tone decay in hearing tests This would provide preferable for testing in hearing, as opposed to lower frequencies for tactile stimulation mostly Figure 9. Microtia Grades. Atresia → Canal, inner, and middle ear contents Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 1 of 8  A. INFECTED PREAURICULAR SINUS Incomplete fusion of hillocks of His Located lateral and superior to the facial nerve and the parotid gland Inherited in an incomplete autosomal dominant pattern, with reduced penetrance and variable expression but can arise spontaneously Bilateral in 25-50% Bilateral more likely hereditary Figure 13. Aspiration of hematoma Figure 10. Preauricular Sinus Opening B. PERICHONDRITIS Caused by Pseudomonas aeruginosa Leads to “Cauliflower ear” Figure 14. Cauliflower ear Dr. Alvarez There would be no problem in the function, but only in appearance Figure 11. Perichondritis D. LACERATIONS C. HEMATOMA Commonly due to manipulation Commonly seen in wrestlers and boxers If minor, no intervention is necessary If untreated, may lead to “cauliflower ears” For several lacerations, exploration is done Evacuation of hematoma and pressure dressings done Prophylactic antibiotics if there is contamination of wound or Anti-Staphylococcus antibiotics given cartilage exposure Dr. Alvarez Healing would be difficult, especially if there is cartilage involved → Appropriate antibiotics must be used based on the severity of the cartilage involvement Figure 12. Hematoma Figure 15. Laceration Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 2 of 8  E. IMPACTED CERUMEN → Take kids on bathroom breaks. Cerumen produced in outer third of cartilaginous portion of ear → Change diapers in the bathroom, not poolside. canal → Wash baby bottoms thoroughly. Mixture of secretions from sebaceous and apocrine sweat → Occurring during hot, humid weather caused glands predominantly by the Pseudomonas and less often Dr. Alvarez Staphylococcus albus, E. coli, and Enterobacter In private practice, the common patient complaints was aerogenes impacted cerumen (most), ear pain, and decreased hearing → Lakes, oceans, and private pools are all potential sources of this type of infection. G. FOREIGN BODIES Figure 19. Foreign Bodies From Naregget Trans: Majority are these things harmless Some are extremely uncomfortable → Insects or sharp objects Some can rapidly produce an infection requiring an Figure 16. Impacted Cerumen emergency treatment Food or organic matter H. FOLLICULITIS Causative Agents → Staphylococcus aureus → Pseudomonas aeruginosa Patients may complain of ear pain → masakit because tulad siya ng tumutubong pimple. → The skin of the outer part of the ear is more mobile and thick, habang pumapasok sa isthmus going to the eardrum, its get Figure 17. Mechanical Extraction Under Direct Vision Irrigation thinner. kaya masakit na pagpinapasok mo q-tips F. OTITIS EXTERNA Painful, swollen, tender and narrowing of canal. Figure 20. Folliculitis J. OTOMYCOSIS Most common organisms: Aspergillus niger and Candida albicans → Sobrang kati at nakukuha siya sa mga infected pool tas Figure 18. Otitis Externa nakapasok sa tenga From Naregget Trans: → Presentation usually is aggressive kasi minsan kinakain “Swimmer’s ear” talaga yong eardrum, it is difficult to treat It is a painful condition of the visible or outer portion of the ear and ear canal. Men and women of all ages are affected equally, but children and teenagers most frequently develop this type of ear infection. Because the condition occurs most often during the summer with exposure of the ear to water while swimming, many people call it swimmer's ear. Water from a bath or shower can trigger the condition, too. Figure 21. Otomycosis Advice: → Take a shower before swimming Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 3 of 8 From Naregget Trans: Fungal infection of EAC skin Primary or secondary Symptoms Often indistinguishable from bacterial OE Pruritus deep within the ear Dull pain Hearing loss (obstructive) Tinnitus Signs Canal erythema Mild edema White, gray or black fungal debris Figure 23. Tympanosclerosis Treatment From Naregget Trans: Thorough cleaning and drying of canal The scarring of the eardrum Topical antifungals Occurs after the eardrum is injured or after surgery K. TYMPANIC MEMBRANE PERFORATION Commonly a small white area can be seen after a person has Usually due to trauma, vehicular accidents and napabayaan na had middle ear ventilation tubes. ear infections Scarring on the eardrum looks bright white. → Talaga yong eardrum, it is difficult to treat M. ACUTE OTITIS MEDIA Middle ear inflammation, 3 months → Mastoid tenderness → Sagging of postero-superior wall → Hearing loss worsens Figure 27. Coalescence and Mastoiditis RESOLUTION → Upper respiratory tract infection involves Figure 30. Otitis Media with Effusion → tympanic membrane perforation heals Ventilation Tube → can occur at any stage → Inserted in the eardrum Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 5 of 8  Figure 33. Cholesteatoma. O. COMPLICATIONS OF OTITIS MEDIA Figure 31. Ventilation Tube *Take note for shifting exam N. CHRONIC OTITIS MEDIA EXTRACRANIAL EXTRATEMPORAL Persistent infection or inflammation of the middle ear and → Subperiosteal abscess mastoid air cells >/= 3 months duration → Bezold’s abscess Typically involves perforation of the tympanic membrane with EXTRACRANIAL INTRATEMPORAL intermittent or continuous otorrhea → Labyrinthine fistulae CHRONIC SUPPURATIVE OTITIS MEDIA → Coalescent mastoiditis persistent inflammation of the middle ear or mastoid cavity with → Petrous apicitis persistent or recurrent ear discharge (otorrhea) → Facial paralysis >/= 3 months duration INTRACRANIAL → Meningitis → Brain abscess → Lateral sinus thrombosis → Epidural abscess → Otitic hydrocephalus III. COMMON DISEASES OF THE INNER EAR VERTIGO Illusion of rotational, linear or tilting movement, either self or the environment Figure 32. Chronic Suppurative Otitis Media. Dizziness can last from a few seconds to hours CHOLESTEATOMA Table 1. Signs and Symptoms of Peripheral vs, Central Vertigo Cystic lesion formed from keratinizing stratified squamous Peripheral Vertigo Central Vertigo epithelium, the matrix of which is composed of epithelium that Sudden onset Gradual onset rests on a stroma of varying thickness Intermittent with severe Constant with milder → Resulting hyperkeratosis and shedding of keratin debris symptoms symptoms usually results in a cystic mass with a surrounding Affected by head position and Unaffected by head position inflammatory reaction movement and movement Types: Nausea and vomiting more Nausea and vomiting less → Congenital frequent and severe predictable ▪ Intact tympanic membrane Motor function, gait and Motor function, gait instability → Acquired coordination typically intact and loss of coordination ▪ Perforated tympanic membrane frequent Diagnosis Lecturer’s Note: → White foul-smelling debris resistant to suctioning Kapag peripheral sa ENT siya irerefer, pero kapag central → Mastoid series: area of lucency >1 cm surrounded by refer to Neuro sclerotic bone → CT scan: blunting of scutum Table 2. Peripheral vs, Central Vertigo Causes Peripheral Vertigo Central Vertigo Basic Otorhinolaryngology (Probst, R.,et.al.) Benign Positional Decreased blood flow Congenital cholesteatoma Paroxysmal Vertigo (BPPV) Infectious diseases → a.k.a. true cholesteatoma Meniere’s Disease Traumatic brain injury → Occur anywhere in the temporal bone Ear infections (Chronic Seizures Acquired cholesteatoma otitis media) Brain tumor → Rises in connection with inflammations and ventilation Viral labyrinthitis/Viral Multiple sclerosis problems of the middle ear neuritis → Two forms: Acoustic neuroma ▪ Primary acquired cholesteatoma Ototoxic drugs − pars flaccida cholesteatoma ▪ Secondary acquired cholesteatoma − pars tensa cholesteatoma Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 6 of 8 Table 3. Characteristics of Vertigo (based on duration) MENIERE’S DISEASE Duration Etiology Disorder of the inner ear that causes: Seconds Benign Positional → Vertigo Paroxysmal Vertigo (BPPV) → Ringing of the ears (tinnitus) → Common in females → Fluctuating hearing loss aged 40 and above → Feeling of ear fullness or ear pressure Minutes Vertebrobasilar Insufficiency (VBI) Note: Transient Ischemic Attacks According to Probst et. al., the first three symptoms are the (TIA) classic clinical triad of Meniere’s Hours Meniere’s disease Acoustic neuroma From Naregget Trans Migraine At least 2/3 of major symptoms = Meniere’s Days Vestibular neuritis Table 5. AAO-NHS Criteria for Meniere’s Disease Diagnosis Vertiginous migraine Major Symptoms → Now common in children Vertigo Brainstem or Cerebellar → Recurrent, well-defined episodes of spinning or rotation stroke → Duration from 20 minutes to 24 hours → Nystagmus associated with attacks From Naregget Trans: → Nausea and vomiting during vertigo Table 4. Ototoxic Drugs → No neurologic symptoms with vertigo Drug Class Example Deafness Aminoglycoside Gentamicin, Streptomycin, → Hearing deficits fluctuate Tobramycin, Neomycin → Sensorineural hearing loss Loop Diuretics Furosemide, Bumetanide, → Hearing loss progressive, usually unilateral Ethacrynic Acid Tinnitus Platinum-based Cisplatin, Carboplatin → Variable, often low-pitched and louder during attacks chemotherapeutic agents → Usually unilateral NSAIDs → Subjective Note: BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) → Of all ototoxic drugs, aminoglycosides are the most Benign - it is not life-threatening vestibulotoxic Paroxysmal – it comes in sudden, brief spells → Cochleotoxic - kanamycin, amikacin, neomycin Positional – it gets triggered by certain head positions or movements Vertigo – a false sense of rotational movement It occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals Basic Otorhinolaryngology (Probst, R.,et.al.) BPPV → a.k.a. canalolithiasis, cupulolithiasis → Frequent cause of sudden attacks of vertigo → Women predominate over men (2:1 ratio) LARGE VESTIBULAR AQUEDUCT (LVA) Not common in practice Size: more than 1.5mm SUPERIOR SEMICIRCULAR CANAL DEHISCENCE (SCCD) The superior semicircular canal, along with the posterior and horizontal semicircular canals, are the organs in the inner ear responsible for maintaining balance In SSCD, a window, or dehiscence, opens in the tiny bone covering protecting the superior semicircular canal, exposing it to external stimuli such as loud noises and changes in pressure → These stimuli are responsible for the uncomfortable symptoms that accompany SSCD Advances in Ophthalmology and Optometry (Ediriwickrema, L. S., & Gold, D. R.) Tullio phenomenon – vertigo and nystagmus result from loud noises, is usually due to a dehiscence of the superior (also known as the anterior canal) semicircular canal Figure 34. History Taking in Vertigo Patients.[Probst et. al] dehiscence syndrome Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 7 of 8  IV. REFERENCES Alvarez, J. (2024). Common Ear DIseases. Bayoumy, A. B., & de Ru, J. A. (2020). Sudden deafness and tuning fork tests” towards optimal utilization. Practical Neurology, 20(1), 66–68. https://doi.org/10.1136%2Fpractneurol-2019-002350 Ediriwickrema, L. S., & Gold, D. R. (2017). Acquired nystagmus. Advances in Ophthalmology and Optometry, 2(1), 339–354. https://doi.org/10.1016/j.yaoo.2017.04.001 Naregget Trans (2023) Probst, R. et. al. (2006). Basic Otorhinolaryngology: A Step-by-Step Learning Guide. George Thiem Verlag. Figure 35. SCCD. OTOSCLEROSIS Hearing loss can be bilateral → Stapes fixation in the cochlea More common in women Figure 36. Normal Ear vs Otosclerosis. Trans # 2 Group 8: Santos, Simon, Tangid TC: Guillermo, Martinez 8 of 8