Presentation is loading. Please wait.

Presentation is loading. Please wait.

Otology Dave Pothier St Mary’s 2003. Anatomy Not a big place Lots of bits NB concepts only.

Similar presentations


Presentation on theme: "Otology Dave Pothier St Mary’s 2003. Anatomy Not a big place Lots of bits NB concepts only."— Presentation transcript:

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

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

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 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 unsafe

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

33 Pathogens Pseudomonas Staph Aureus Mixed growth

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

35 Rx 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


Download ppt "Otology Dave Pothier St Mary’s 2003. Anatomy Not a big place Lots of bits NB concepts only."

Similar presentations


Ads by Google