Dr Melanie Souter. Consultant Otolaryngologist/Otologist Christchurch Public Hospital Christchurch. 12:00-12:15 Ears Made Easy

Transcription

1 Dr Melanie Souter Consultant Otolaryngologist/Otologist Christchurch Public Hospital Christchurch 12:00-12:15 Ears Made Easy

2 Ears made Easy Dr Melanie Souter Otology / Otolaryngology CDHB, nine (CHCHORL)

3 Goals Simple anatomical approach to common ear problems in General Practice General rules to help identify which part of the ear is involved Current threshold for surgical intervention of common conditions

4 The Ear

5 Ears Challenge is that most of it we cant see Symptoms may be common to several parts of the ear eg blockage But some symptoms are suggestive of specific anatomical locations Always have a normal comparison the other ear

6 External Ear Only part you can really see Common things include Otitis extern/exostoses/infection Compare the normal side if unilateral

7 Otitis Externa Pain++ Pseudomonas, staph, sometimes fungal Related to water exposure Blocked but no hearing loss or tinnitus Micro swab Strict water Precautions (blu-tak) Topical drops Follow up in a few days with micro results

8 Other complicating factors Exostoses More prone to Otitis externa Don t like to stay out of the water! Harder to clear infection as often full of debris Do not get hearing loss until complete occlusion Recurrent infections are the indication for surgery

9 Malignant Otitis Externa Painful Otitis externa failing to settle on standard treatment Almost always immuno-compromised; eg diabetes, immunosuppressive meds Almost always Pseudomonas Refer acutely can lead to skull base osteomyelitis

10 Malignancy Skin lines the ear canal therefore Squamous cell carcinoma is possible Other rare malignancies Generally present like a non-healing otitis externa, often painful May have other actinic skin changes/previous SCC Refer for biopsy

11 Middle Ear Middle ear space/tympanic Membrane Ossicular chain Eustachian tube Facial nerve

12 Middle Ear Tympanic Membrane may indicate the middle ear status Always compare to the other side?normal comparison Symptoms: Blockage, pain (infection), Hearing loss. No tinnitus or imbalance

13 Acute Otitis Media Who to treat? Under 2 years Over 2 years failure to resolve with conservative (24-48hrs later still pain, AOM, fever) High risk children eg imunocompromised, syndromic What to treat with? 70-90mg/kg/day Amoxycillin big dose! 5-7 days Follow up

14 Threshold for ventilation tubes > 1 episode of AOM every 2 months, for 6 months or longer Bilateral OME > 3 months duration 70% of fluid will resolve naturally within 3 months, but after that only 10% over 12 months Unilateral OME > 6 months duration

15 Other Middle Ear Pathology Cholesteatoma Hearing loss, history of middle ear disease, maybe discharge, often attic region Audiogram useful, treatment is surgery Eustachian tube dysfunction Blocked, pressure related symptoms, nasal steroid spray may help, otherwise essentially rule out other causes for symptoms. Audiogram useful

16 Inner Ear Cochlear Vestibular apparatus Nerves cochlea, vestibular, facial

17 Symptoms Hearing loss, Tinnitus, Imbalance = inner ear or beyond pathology Ear examination normal Audiogram is very useful to determine middle ear vs inner ear source Tuning fork tests

18 Sudden Sensorineural hearing loss Symptoms: Hearing loss (may feel blocked!), tinnitus =/- imbalance Weber opposite ear Rinne + (air conduction > bone conduction) if can hear tuning fork at all Audiogram ASAP important and refer acutely

19 Sudden SNHL - treatment Steroids within 24hrs of onset of symptoms 60mg/day prednisone 5 days then reduce over 5 days (10 days total) Refer acutely Intra-tympanic Dexamethasone (daily for 5 days) routinely if no response to oral steroid

20 Other Inner Ear pathology Acute Vestibular Syndrome imbalance +/- hearing loss with it. Treat as sudden hearing loss, if vertigo severe and needs hospital admission then see acutely soon to have regular acute vestibular clinic Vestibular schwannoma/acoustic Neuroma Asymmetrical hearing loss, sudden hearing loss, unilateral auditory symptoms, Audiometric guidelines for referral, need MRI, (They are uncommon and we pick up lots of incidental findings on the MRI s!!)

21 Key Points Always use the other ear for comparison where you can Micro swab and water precautions are most important for Otitis Externa Blocked ears can be anything external/middle/inner Hearing loss is generally middle ear or inner ear pathology Hearing loss/tinnitus/balance = inner ear Audiograms are essential for diagnosis and management, and helpful to be included with referral

22 Questions?