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.
  • Otological Emergencies

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