ENT Emergencies Otological Emergencies Sariu Ali didi
Anatomy of the Ear
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
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.
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.
Necrotizing otitisexterna Sever infection of the external auditory canal. Caused by pseudomonas organisms
Risk factors : DM, immunosuppression
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
PE :On otoscopy, the external ear canal will typically have granulation tissue at the bony-cartilaginous junction
Ix : RBS, ESR, CT or MRI evidence of otitisexterna with possible bone erosion and infiltration into infratemporal soft tissues
- high dose IV Antibiotic treatment (antipseudomonalcoverage (for six to eight weeks); quinolone is the drug of choice. - Surgical debridement of devitalized tissue.
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:
Microscopic removal with specific instruments
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
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.
Acute Mastoditis Pathology :
Inflamation of the mucosal lining of antrum and mastoid air cell system.
When infection spreads beyond the mucosa – involving mastoid air cells and the bony mastoid cortex
Aetilogy: accompanying / following ASOM Organism: B hemolytic streptococcus.
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
Lat sinus thrombosis
Medical – antibiotics( amoxicillin/Ampicillin
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
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.
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
herpes family viruses have been frequency associated with sudden hearing loss
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