OTOLOGY SUMMARIES
Microsoft Office User
[COMPANY NAME] [Company address]
,ACOUSTIC NEUROMA
PRESENTATION PATHOPHYSIOLOGY
Typically aged 40-60 years with gradual onset of Benign tumours of Schwann cells surrounding the
- Unilateral SNHL (usually presenting vestibulocochlear nerve
symptom) They occur at the cerebellopontine angle (sometimes
- Unilateral tinnitus referred to as cerebellopontine angle tumours)
- Dizziness or imbalance Usually unilateral
- Sensation of fullness in the ear
- May be associated with CN VII palsy if Can be bilateral – associated with neurofibromatosis
tumour is large enough type II
INVESTIGATION MANAGEMENT
PTA Conservative – monitoring if there are no symptoms
- SNHL or treatment is inappropriate
MRI/CT to establish diagnosis and features Surgical – to remove tumour
Radiotherapy to reduce growth
Risks of treatment: vestibulocochlear nerve injury
(permanent hearing loss or dizziness), CN VII injury
(facial weakness)
, ACUTE OTITIS MEDIA
RISK FACTORS PATHOPHYSIOLOGY
- Lack of breastfeeding as baby Acute onset inflammation of middle ear (usually
- Attending nursery/day care infective)
- +ve FHx OM with effusion (OME) may be consequence of AOM
- Age between 6-18 months but is regarded as a separate condition
- Exposure to smoking
Occurs at all ages, more common in infancy
AETIOLOGY
URTI causes inflammation of upper airways and SIGNS AND SYMPTOMS
obstruction of eustachian tube. Ascending
- Otalgia
infection results in hyperaemia of the middle ear
- Reduced hearing in affected ear
mucosa with production of purulent exudate
- Irritability
Viral infections cause 2/3 cases: RSV, rhinovirus, - Vomiting
enterovirus - Fever
Bacterial causes : S. pneumoniae, H. influenzae, - Ear pulling/tugging
M. catarrhalis Otoscopy
- Bulging TM (loss of light reflex)
Injected TM
- Perforation +/- purulent discharge
COMPLICATIONS - Secondary OE
Intratemporal - Erythema
- Tympanosclerosis (white patch on ear
drum due to scarring)
- Hearing loss
- OME INVESTIGATIONS
- TM perforation Consider swab for MC&S
- Mastoiditis CT/MRI if complications are suspected
- Labyrinthitis
- CN VII palsy (rare)
Intracranial
- Meningitis MANAGEMENT
- Intracranial abscess Analgesia and anti-pyrexials
- Lateral sinus thrombosis If failure to improve within 24-48 hours consider oral
- Cavernous sinus thrombosis abx
- Subdural empyema
- 5-7 day course of amoxicillin
- Co-amoxiclav if no improvement
Give immediate abx if patient has significant
comorbidities, is systemically unwell or
immunocompromised
Delayed abx: if symptoms have not improved or have
worsened
Microsoft Office User
[COMPANY NAME] [Company address]
,ACOUSTIC NEUROMA
PRESENTATION PATHOPHYSIOLOGY
Typically aged 40-60 years with gradual onset of Benign tumours of Schwann cells surrounding the
- Unilateral SNHL (usually presenting vestibulocochlear nerve
symptom) They occur at the cerebellopontine angle (sometimes
- Unilateral tinnitus referred to as cerebellopontine angle tumours)
- Dizziness or imbalance Usually unilateral
- Sensation of fullness in the ear
- May be associated with CN VII palsy if Can be bilateral – associated with neurofibromatosis
tumour is large enough type II
INVESTIGATION MANAGEMENT
PTA Conservative – monitoring if there are no symptoms
- SNHL or treatment is inappropriate
MRI/CT to establish diagnosis and features Surgical – to remove tumour
Radiotherapy to reduce growth
Risks of treatment: vestibulocochlear nerve injury
(permanent hearing loss or dizziness), CN VII injury
(facial weakness)
, ACUTE OTITIS MEDIA
RISK FACTORS PATHOPHYSIOLOGY
- Lack of breastfeeding as baby Acute onset inflammation of middle ear (usually
- Attending nursery/day care infective)
- +ve FHx OM with effusion (OME) may be consequence of AOM
- Age between 6-18 months but is regarded as a separate condition
- Exposure to smoking
Occurs at all ages, more common in infancy
AETIOLOGY
URTI causes inflammation of upper airways and SIGNS AND SYMPTOMS
obstruction of eustachian tube. Ascending
- Otalgia
infection results in hyperaemia of the middle ear
- Reduced hearing in affected ear
mucosa with production of purulent exudate
- Irritability
Viral infections cause 2/3 cases: RSV, rhinovirus, - Vomiting
enterovirus - Fever
Bacterial causes : S. pneumoniae, H. influenzae, - Ear pulling/tugging
M. catarrhalis Otoscopy
- Bulging TM (loss of light reflex)
Injected TM
- Perforation +/- purulent discharge
COMPLICATIONS - Secondary OE
Intratemporal - Erythema
- Tympanosclerosis (white patch on ear
drum due to scarring)
- Hearing loss
- OME INVESTIGATIONS
- TM perforation Consider swab for MC&S
- Mastoiditis CT/MRI if complications are suspected
- Labyrinthitis
- CN VII palsy (rare)
Intracranial
- Meningitis MANAGEMENT
- Intracranial abscess Analgesia and anti-pyrexials
- Lateral sinus thrombosis If failure to improve within 24-48 hours consider oral
- Cavernous sinus thrombosis abx
- Subdural empyema
- 5-7 day course of amoxicillin
- Co-amoxiclav if no improvement
Give immediate abx if patient has significant
comorbidities, is systemically unwell or
immunocompromised
Delayed abx: if symptoms have not improved or have
worsened
