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Common Ear Complaints

Common Ear Complaints. Michael Airlie – 4 th Year Student. Introduction. Otalgia/vertigo Causes History taking Case History Examination Management Questions. Otalgia.

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Common Ear Complaints

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  1. Common Ear Complaints Michael Airlie – 4th Year Student

  2. Introduction • Otalgia/vertigo • Causes • History taking • Case • History • Examination • Management • Questions

  3. Otalgia http://ih2.redbubble.net/work.7314846.1.flat,550x550,075,f.exotic-ear-rings-maasai-or-masai-woman-east-africa-by-carole-anne-fooks.jpg

  4. Causes • Otitis Externa • Pain, itching, tragal tenderness, may have some discharge • Acute Otitis Media • Most common in children, but can occur in adults • Chronic Otitis Media • Not usu assoc w pain, and so may suggest cholesteatoma

  5. Causes • Furuncle in EAM • Throbbing pain, assoc w diabetes • Temporo-mandibular joint dysfunction • Earache, facial pain, crepitus • Referred pain from head/neck • Neoplastic/inflammatory. Suggested by normal otoscopy. Requires laryngoscopy • Neoplasm of ear • Rare • Trauma • Worthwhile asking

  6. OtalgiaHx • Pattern • Onset, assoc symptoms etc • Past ear problems? • Chronic otitis media, hx effusion • Recent infections/illness? • Sore throat, cold/flu, sinusitis • PMHx • Eczema, atopy, psoriasis, surgery • Social Hx • Swimmer, cotton bud use

  7. Case 1 • 48 yr old male attends GP complaining of pain and irritation in his right ear. • Painful, esp to touch • Itchy • Feels slight pressure in R ear

  8. Differential • Otitis Externa • Otitis Media • Furuncle in EAM

  9. History • Returned from holiday in Spain w. itchy, waxy ear • Tried to clean w cotton buds but got worse • No hx fever or illness • No prev otalgia or ear symptoms • Unremarkable PMHx

  10. Examination • Tragal tenderness • Erythema on pinna around EAM • Small volume discharge visible • TM not visible on otoscopy due to swelling in EAM, meatal debris visible, no boils noted • R sided conductive hearing loss

  11. http://www.oidonarizygarganta.es/2010/04/otitis-externa/

  12. http://www.entbristol.co.uk/images/otoscopy/otoscopy_09.jpg

  13. Management • Topical steroids • Abx in moderate to severe cases, or if steroids alone fail • May require referral for aural toilet • Educate patient about predisposing factors • May need to use a wick for application of topical Rx

  14. Complications • Necrotising Otitis Externa • Osteomylitis caused by OE • 50% get facial nerve palsy • IX and XII may also be affected • Affects immunocompromised pts, esp elderly diabetics • Spread of infection • Mastoiditis, chondritis • Chronic Otitis Externa

  15. Vertigo http://www.killerhiphop.com/wp-content/uploads/2010/05/dizzee-rascal.jpg

  16. Definition • Vertigo – “an illusion of movement, often rotary, of the patient and his surroudings” • Oxford Handbook Clin Med 8th Ed • Patient often describes rising/falling/tilting of the floor • Always worse on movement • Important to differentiate from unsteadiness or lightheadedness

  17. Causes • Benign Paroxysmal Positional Vertigo (BPPV) • Rotational vertigo <1min, occurs on movement • Vestibular Neuronitis • Acute vertigo & n+v, self-limiting • Meniere’s Disease • Vertigo lasting hours with fluctuating hearing loss and tinnitus • Psychogenic

  18. Causes • Drugs and alcohol • Aminoglycosides, loop diuretics... • Central Causes • Due to disorder of the brainstem or cerebellum • Acute ischaemia, vertebro-basilar insufficiency, migraine, posterior fossa tumour, multiple sclerosis • Vertical nystagmus on Hallpike test, no latency

  19. Vertigo Hx • Pattern • Where, when, how long, onset, precipitating factors, assoc symptoms • Previous Ear Problems • PMH • CV/psych problems, migraine • Drug Hx • Ototoxic drugs

  20. Case 2 • 59 yr old female presets to GP w 3 month hx dizziness • Becomes dizzy when rolling over in bed, rising from a chair or bending down • Worse in last month • No assoc symptoms

  21. Differential • BPPV • Postural hypotension • Vertebrobasilar disease • Drugs and alcohol • Other central causes

  22. Case 2 • PMHx • Hypertension • Varicose veins (surgery ‘08) • Fam Hx • Dad died MI at 60, nothing else • Drug Hx • Furosemide (dose 5/52 ago) • Social Hx • Smoker; 10/day 40 years. No alcohol

  23. Examination • BP • Sitting = 142/98, standing = 140/98 • Hallpike test • Latency, horizontal nystagmus and reversal • Otology unremarkable • Plan • Change furosemide for thiazide • Review in 2 weeks

  24. Hallpike Test http://dizziness.webs.com/bppv.htm

  25. Follow Up • Dizziness better, but still persists • Still occurs on movement • No new symptoms/features • Hallpike test same as before • Diagnosis - BPPV

  26. Management • Watchful waiting • May spontaneously resolve in months • Positional Manoeuvres • Epley or Seymont manoeuvres • Aim to move particles into utricle where they don’t stimulate hair cells • Anti-emetic e.g cyclozine • Vestibular sedative e.g betahistine • No evidence for either over manoeuvres

  27. Questions? Thank you for listening

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