Otological Emergencies
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  • Definitions of sudden hearing loss have been based on severity, time course, audiometric criteria, and frequency spectrum of the loss. Abrupt as well as rapidly progressive losses have been included under a single definition of sudden hearing loss. Awakening with a hearing loss, hearing loss noted over a few days, selective low- or high-frequency loss, and distortions in speech perception have all been classified as sudden hearing losses.

Transcript

  • 1. ENT Emergencies
    Otological Emergencies
    Sariu Ali didi
  • 2. Anatomy of the Ear
  • 3. Ear emergencies include
    Sudden Sensory neural Hearing loss
    Middle Ear
    Trauma to TM
    AOM
    Acute mastoiditis
    Pinna:
    Perichondritis
    Auricular Hematoma
    EAC:
    Foreign body
    Malignant OtitisExterna
  • 4. Auricular Hematoma
    Collection of blood between the cartilage and its perichondrium.
    The haematoma prevents proper oxygenation of the cartilage, resulting in necrosis and a cauliflower ear.
    Complications:
    Infection
    Cauliflower ear
    Rx :
    aspiration with an 18-gauge needle or incision and drainage
    compressive dressing for a week to allow the cartilage to readhere to the perichondrium.
    Coverage with an antistaphylococcal antibiotic is recommended.
  • 5. Perichondritis
    Ifection secondary to hematomas, laceration or surgical incision.
    Organism: pseudomonas and mixed
    Sx : Red, hot, painful pinna
    Abcess can form btwnprichondrium and cartliage leading to necrosis of cartilage.
    Rx : systemic antibiotics
    local application of 4%alluminium acetate compression.
  • 6. Necrotizing otitisexterna
    Sever infection of the external auditory canal.
    Caused by pseudomonas organisms
    • Risk factors : DM, immunosuppression
    • 7. infection spreads to the temporal bone – osteomyelitis of the temporal bone
    It can readily spread to the base of skull leading to fatal complications( multiple cranial nv palsies) if it isnt adequately treated.
    Facial Nvpasly common.
    • Water exposure and irrigation of the auditory canal (usually for cerumendisimpaction) have been implicated as causative factors
    • Hx: Disproportionately severe pain esp at night
    • 8. PE :On otoscopy, the external ear canal will typically have granulation tissue at the bony-cartilaginous junction
    • 9. Ix : RBS, ESR, CT or MRI evidence of otitisexterna with possible bone erosion and infiltration into infratemporal soft tissues
    • 10. Rx :
    - high dose IV Antibiotic treatment (antipseudomonalcoverage (for six to eight weeks); quinolone is the drug of choice.
    - Surgical debridement of devitalized tissue.
  • 11. Foreign body in the ear
    • Emergency when associated with vertigo, profound hearing loss and/ or facial parallysis
    Do not irrigate organic material or with a perforation
    Methods of removal:
    • Forceps removal
    • 12. Syringing
    • 13. Suction
    • 14. Microscopic removal with specific instruments
    • 15. small children - may put objects such as pips, beads and paper clips in their ears.
    Adults may get foreign bodies like toothpicks.
    Foreign bodies in ears are more often seen in the mentally disturbed
  • 16. Isects should be killed first( olive oil)
    Then try syringing with warm water
    Unskilled attempts at removal of FB may lacerate the meatal lining , damage tympanic membrane or the ossicles.
  • 17. Acute Mastoditis
  • 18. Acute Mastoditis
    Pathology :
    • Inflamation of the mucosal lining of antrum and mastoid air cell system.
    • 19. When infection spreads beyond the mucosa – involving mastoid air cells and the bony mastoid cortex
    Aetilogy:
    accompanying / following ASOM Organism: B hemolytic streptococcus.
  • 20. Symptoms
    Fever with systemic sx
    Otorrhea – increasing
    Pain behind the ear
    Signs
    Mastoid :
    Obliteration of retroauricularsulcus
    Postauricular swelling with erythema
    Mastoid tenderness
    Ear :
    Ear pushed forwards & downwards
    Ear discharge - pulsatile
    Sagging of post sup wall
    TM perforation
    Investigation
    FBC- leucocytosis
    ESR – elavated
    X-ray Mastoid – clouding of air cells due to the collection of exudate in them.
    Ear swab C/S
    Complications
    Management
    • Medical – antibiotics( amoxicillin/Ampicillin
    • 30. Surgery
    • 31. Myringotomy
    • 32. Simple I&D
    • 33. Cortical mastoidectomy
  • Sudden sensorineural hearing loss
    sensorineural hearing loss of greater than 30 dB over 3 contiguous pure-tone frequencies occurring within 3 days' period.
    Usually it presents as unilateral loss of hearing; bilateral involvement is rare
  • 34. Pathophysiology
    Causes include:
    • infections
    • 35. trauma (e.g.head injury)
    • 36. immunological (e.g.Cogan's syndrome)
    • 37. toxins
    • 38. ototoxic drugs
    • 39. multiple sclerosis
    • 40. Ménière's disease
    4 theoretical pathways
    Labyrinthine viral infection
    Labyrinthine vascular compromise
    Intracochlear membrane ruptures
    Immune-mediated inner ear disease.
  • 41. Evaluation
    Rule out others conditions
    Normal tm
    Audiometry test (pta, abr)
    Hrct, mri (tumor, multiple sclerosis)
    Vestibular test (prognosis)
    Blood ix. - esr, coagulation profiles, blood sugar, serologic test - syphilis, ana etc.
  • 42. management
    Treatment has been controversial due to the lack of a definite cause
    many experience spontaneous recovery within the first 3 days.
    few recover gradually over a 1 or 2 weeks
    15 percent experience a gradually worsening hearing loss
    many methods have been used
    • oral corticosteroid therapy
    shown to be effective in few studies
    • hyperbaric oxygen
    • 43. antivirals
    herpes family viruses have been frequency associated with sudden hearing loss
    • vasodilators
  • THANK YOU
  • 44. REFERANCES
    Diseases of ear nose and throat PL Dhingra
    http://www.gpnotebook.co.uk
    http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_4_number_1_37
    http://www.ncbi.nlm.nih.gov/pmc/articles