The document outlines the management of common ear disorders, focusing on clinical approaches to diagnosis and treatment, particularly in low-resource settings. It details the anatomy and physiology of the ear, various ear diseases, their presentations, and management strategies, including when to refer patients to specialists. Additionally, it emphasizes the importance of follow-up care and provides protocols for referral pathways for conditions like otalgia, vertigo, and hearing loss.
The document outlines the management of common ear disorders, focusing on clinical approaches to diagnosis and treatment, particularly in low-resource settings. It details the anatomy and physiology of the ear, various ear diseases, their presentations, and management strategies, including when to refer patients to specialists. Additionally, it emphasizes the importance of follow-up care and provides protocols for referral pathways for conditions like otalgia, vertigo, and hearing loss.
The document outlines the management of common ear disorders, focusing on clinical approaches to diagnosis and treatment, particularly in low-resource settings. It details the anatomy and physiology of the ear, various ear diseases, their presentations, and management strategies, including when to refer patients to specialists. Additionally, it emphasizes the importance of follow-up care and provides protocols for referral pathways for conditions like otalgia, vertigo, and hearing loss.
The document outlines the management of common ear disorders, focusing on clinical approaches to diagnosis and treatment, particularly in low-resource settings. It details the anatomy and physiology of the ear, various ear diseases, their presentations, and management strategies, including when to refer patients to specialists. Additionally, it emphasizes the importance of follow-up care and provides protocols for referral pathways for conditions like otalgia, vertigo, and hearing loss.
Ear Disorders For MO OBJECTIVE • Clinical approach to patients
• How to arrive at a diagnosis?
• How to manage a patient (primary management),
especially in a low resource setting
• DOs and DONTs
• When to refer and protocols to be followed at the
time of referral
• Continuum of care – regular follow-ups
ANATOMY OF HUMAN EAR EXTERNAL EAR Pinna EAC- 2.5 cm (1/3rd cartilaginous, inner 2/3rd Bony) TM
MIDDLE EAR • Tympanic cavity & Mastoid air cells. • It contains 3 bones, 2 muscles and 1 Eustachian tube. INNER EAR • Semi-circular canals • Vestibule • Cochlea PHYSIOLOGY OF HEARING DISEASES OF THE EXTERNAL EAR 1. Impacted Ear Wax : Cerumen- desquamated keratin mixed with lipid and peptide secretions from sebaceous and ceruminous glands, respectively. It is bacteriostatic. Presentation: Blocked ear • Decreased hearing • Earache • Tinnitus • Giddiness • Reflex cough (due to stimulation of the Vagus nerve) DISEASES OF THE EXTERNAL EAR
Management: · Drops containing paradichlorobenzene 2%, for hard wax.
· Syringing
· Instrumental manipulation: using Jobson- Horne probe/ cerumen
hook. 2. TRAUMA TO PINNA
Pinna laceration Pinna hematoma:
•Trauma with sharp object: laceration of • Boxer’s ear or wrestler ear skin/cartilage. • Sub perichondrial collection of blood •Management: b/w perichondrium & cartilage. •Wash wound thoroughly • Shearing action on pinna. •Necrotic tissue debrided Management: •Repair/ skin flap • Drainage: Aspiration or incision •Tetanus booster • Broad-spectrum antibiotics •Broad spectrum antibiotic 3. DISEASES OF EXTERNAL AUDITORY CANAL EAC Injury:
EAC Infection: (Otitis Externa) Bacterial, Fungal or Viral.
Fungal Otitis Externa/ Otomycosis
Bacterial Otitis Externa/ Furunculosis
Diffuse Otitis Externa/ Swimmer’s Ear
Malignant Otitis Externa/ Necrotizing Otitis
Externa
Viral Otitis Externa Herpes Zoster Oticus
EAC INJURY EXTERNAL AUDITORY CANAL INFECTION FUNGAL OTITIS EXTERNA/ OTOMYCOSIS Fungal • Most Common type.
• Most common organism: Aspergillus Niger followed
by Candida.
• Management: Ear toileting and topical antifungal
for at least 3 weeks. BACTERIAL OTITIS EXTERNA/ FURUNCULOSIS Most Common organism is Staphylococcus aureus
Severe pain – increases with jaw movement
On pressing the tragus, patient complain pain-Tragal Sign.
Management: Antibacterial antibiotic- Amoxicillin plus Clavulanic acid
• 10% Ichthammol-glycerine pack in EAC to reduce oedema.
For pain management -Tab Diclofenac (adult), Syp. Ibugesic (children).
Viral Otitis Externa / Herpes Zoster Oticus DISEASE OF TYMPANIC MEMBRANE (TM) Normal TM: Shiny and pearly grey in color. Bright cone of light in the anteroinferior quadrant
Retracted TM: • Dull and lusterless • Cone of light is absent • Handle of malleus appears small • Seen as a result of negative intra-tympanic pressure when the Eustachian tube is blocked. Myringitis bullosa: • Painful condition • Formation of hemorrhage blebs • Caused by virus or Mycoplasma pneumoniae. Traumatic Rupture • Due to hairpin, matchstick, or unskilled removal of foreign body • Other causes include a sudden change in the air pressure, e.g. slap, sudden blast near the ear, forceful Valsalva, Pressure by fluid e.g. diving, water sport or forceful stringing, and Fracture of the temporal bone
Perforation of TM: • Management depends on the location of perforation which might be central, attic or marginal. May be associated with long- standing infections like CSOM. Immediate referral to higher center should be done in such cases.
Consultation with an ENT specialists is advisable for diseases
involving the tympanic membrane as it has a wide spectrum of underlying causes. DISEASES OF THE MIDDLE EAR ACUTE OTITIS MEDIA (AOM)- STAGES CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) Chronic inflammation of the mucoperiosteal lining of the middle ear cleft. Types: a. Safe / tubotympanic b. Unsafe / atticoantral Symptoms & Signs: Ear discharge, HL, TM Perforation, tinnitus Complications: 1) Extra-cranial 2) Intra-cranial Investigations: 1) Oto microscopy / Oto endoscopy 2) Aural swab 3) Biochemical & other Lab investigations 4) Pure tone Audiometry 5) X-ray / CT-scan / MRI of the mastoids. Treatment: 1) Ear toileting 2) Topical antibiotics 3) Systemic Antibiotics REFERRAL PATHWAY FOR CSOM SEROUS OTITIS MEDIA FACIAL NERVE PALSY Bell’s Palsy • Most common cause- idiopathic
• Oral steroid (1 mg/kg prednisolone)- gradual tapering over 21 day period
• Antiviral like acyclovir within 72 hours
• Vitamin B supplements
• Physiotherapy (facial massage and exercise)
FACIAL NERVE PALSY
Ramsay Hunt Syndrome
• Reactivation of latent Varicella Zoster Virus (HZV) in the geniculate ganglion
• Pain, vesicles over the ear canal
• Extension to VIII nerve- hearing loss and vertigo
• Other cranial nerves might get involved
• Prognosis- poorer
• Consult ENT Specialist before initiation of treatment.
EAR ACHE (OTALGIA) Causes: • Primary otalgia: cause within the ear itself • Secondary otalgia: Pain referred from another place having same sensory innervation. (Referred Otalgia)
Treatment: • Find the cause and treat accordingly. • Analgesic:
Indications for referral to ENT specialist:
• Pain not responding to analgesic • Any visible injury, bleeding, signs of trauma, any visible mass in EAC REFERRAL PATHWAY FOR EAR PAIN VERTIGO REFFERAL PATHWAY IN VERTIGO HEARING LOSS WHO Classification: Types: • Conductive hearing loss (CHL) –
middle ear problem
• Sensorineural hearing loss (SNHL)
– ear nerve problem
• Mixed type Things to check before referring: REFFERAL PATHWAY IN CASE OF HEARING LOSS FOREIGN BODY IN EAR REFERRAL PATHWAY FOR FOREIGN BODY EAR PUTTING IN THE DROPS Position the head so that the ear faces upward. If the bottle has a dropper, draw some liquid into the dropper. For adults, gently pull the upper ear up and back. Gently pull the earlobe up and down to allow the drops to run into ear. Wipe away any extra liquid with a tissue or clean cloth. Thank You
