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Otitis media - Coggle Diagram

- - - - lateral 1/3 is cartilaginous
      - medial 2/3 is bony tunnel
      - sensory innervation
        
        Anterior and superior walls
        
        Auriculotemporal nerve
        
        Posterior and inferior walls
        
        Auricular branch of vagus nerve
        
        minor sensory inputs by facial nerve
    - - Lesser occipital nerve
        
        C2
      - Auriculotemporal nerve
        
        CNV3
      - Greater auricular nerve
        
        C2
  - - - bony labyrinth
        
        Vestibule
        
        central part of bony labyrinth
        
        3 semicircular canals
        
        posterior
        
        lateral
        
        anterior
        
        cochlea
        
        bony structure that twists on itself to 2 and 1/2 - 2 and 3/4 times around a central modiolus
    - - membranous labyrinth
        
        continuous ducts and sacs
        
        filled with endolymph
        
        float in perilymph (CSF)
        
        4 ducts
        
        3 semicircular
        
        1 cochlear
        
        2 canals
        
        scala vestibuli
        
        scala tympani
        
        2 sacs
        
        utricle
        
        saccule
    - - in the petrous part of the temporal bone
  - - - ossicles
        
        Incus
        
        Stapes
        
        malleus
    - - Tensor tympani
      - Stapedius
    - - lower part
        
        covered by tympanic membrane
      - upper part
        
        is bony lateral wall of the epitympanic recess
    - - thin layer of bone separates middle ear from middle cranial fossa
    - - thin layer of bone separates from internal jugular vein
      - near the medial border tympanic branch of glossopharyngeal nerve enters
    - - only partially complete
      - lower part
        
        bony partition between tympanic cavity and mastoid air cells
      - upper part
        
        epitympanic recess has opening (aditus) to mastoid antrum
    - - superiorly
        
        opening for pharyngotympanic tube
        
        opening for canal containing tensor tympani muscle
      - lower part
        
        foramen for exit of chorda tympani nerve
        
        foramen for sympathetic input for tympanic plexus
    - - oval window
      - round window
      - prominence of lateral semicircular canal
      - prominence of facial canal
      - promontory
      - tympanic plexus
  - - - connective tissue
        
        Mesoderm
      - mucus membrane
        
        Endoderm
      - Skin
        
        Ectoderm
    - - posterior 1/2
        
        branch of vagus nerve
      - Anterior 1/2
        
        Auriculotemporal nerve
- - - - help to determine if it is conductive or sensorineural hearing loss
- - - - chronic
        
        same as acute diffuse
        
        but symptoms persists for more than 6 weeks
      - Acute
        
        diffuse
        
        causes
        
        E.coli
        
        staphylococcus aureus
        
        Pseudomonas aeruginosa
        
        typically seen in swimmers
        
        rapid onset (48h)
        
        symptoms
        
        ear pain (can be severe)
        
        itchiness in the ear canal
        
        discharge of liquid or pus
        
        tenderness of the tragus or pinna or diffuse ear edema or erythema or both
        
        some degree of temporary hearing loss
        
        treatment
        
        antibiotics
        
        ear toilet
        
        analgesic
        
        localized
        
        causes
        
        Staphylococcus aureus
        
        bacterial skin infection develops in a hair follicle or oil gland (furuncle)
        
        also known as furunculosis
        
        usually in the lateral 1/3
        
        symptoms
        
        severe pain
        
        discharge - purulent
        
        tender on moving pinna pressing or tragus
        
        hearing loss
        
        treatment
        
        ear toilet
        
        antibiotics
        
        analgesic
      - otomycosis
        
        fungal
        
        Aspergillus niger (90%)
        
        Candida albicans
        
        Aspergillus fumigatus
        
        bacteria can combine with the fungi and make the infection more complicated
        
        mostly affect people
        
        who live in worm or tropical areas
        
        with diabetes
        
        immunocompromised
        
        with chronic illness
        
        symptoms
        
        pain
        
        irritation
        
        discharge sometimes
        
        watery with odor
        
        fungal mass might be seen
        
        treatment
        
        cleaning
        
        anti-fungal drops
        
        keep ear dry
      - malignant
        
        necrotizing
        
        causes
        
        Staphylococcus aureus
        
        Pseudomonas aeruginosa (95%)
        
        invasive bacterial infection that involves the external auditory canal and skull base
        
        occurs in immunocompromised and diabetic patients
        
        facial nerve involvement
        
        life threatening
        
        symptoms
        
        purulent discharge
        
        Excruciating pain
        
        facial nerve palsy
        
        treatment
        
        antibiotics
        
        control diabetes
        
        surgical
  - - - acute
        
        usually lasting less than 6 weeks
        
        symptoms
        
        otorrhea
        
        hearing loss
        
        fever
        
        irritability
        
        vomiting
        
        anorexia
        
        cough
        
        pulling or rubbing of the ear
        
        treatment
        
        antibiotics
        
        analgesics
        
        surgical
      - chronic
        
        suppurative
        
        with drainage of fluid through a perforated tympanic membrane
        
        non suppurative
        
        no otorrhea
        
        last more than 6 weeks
        
        common in children 3-6 years
      - Usually occurs after a sore throat, cold, or upper respiratory infection
        
        nasopharynx infection
        
        tympanopharyngeal tube infection
        
        middle ear infection
      - bacterial
        
        streptococcus pneumonia
        
        Haemophilus influenzae
        
        moraxella catarrhalis
        
        group A streptococcus
      - viral
        
        respiratory syncytial virus (RSV)
        
        Rhinovirus
        
        Parainfluenza virus
        
        influenza virus
- - - - otolith organ
        
        utricle
        
        maculae
        
        lined with vestibular hair cells
        
        saccule
  - - - semicircular canals
        
        Posterior
        
        ampulla
        
        lined with vestibular hair cells
        
        1 large kinocilium and a cluster of stereocilia
        
        bending of the stereocilia toward the kinocilium
        
        1 more item...
        
        bending of the stereocilia away from the kinocilium
        
        1 more item...
        
        Lateral
        
        Anterior
- - - - systemic pain relief
        
        Acetaminophen
        
        Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
        
        Ibuprofen
      - localized pain relief
        
        Amethocaine
        
        Benzocaine
        
        Lidocaine
      - Decongestants and antihistamines should not be used
        
        due to lack of benefit and increased risk of adverse effects
  - - - observation with initiation of antibiotic therapy if the symptoms and signs worsen or fail to improve after 48 to 72 hours.
      - immediate treatment with antibiotics
- - - - can be
        
        congenital
        
        complication of chronic ear infections
- - - - vibration of tympanic membrane
        
        vibration of ossicles
        
        vibration of oval window
        
        fluid movement within cochlea
        
        vibration of basilar membrane
        
        bending of cilia of hair cells of organ of corti
        
        2 more items...
        
        the sound energy is amplified by the lever action of the ossicles and the concentration of sound waves from the large tympanic membrane onto the small oval window
        
        air-filled external and middle ears
        
        fluid-filled inner ear
- - - - microscopic examination
        
        Squamous or ciliated columnar epithelium containing
        
        histiocytes
        
        lymphocytes
        
        plasma cells
        
        eosinophils
        
        mott cells
        
        granulation type tissue
        
        mast cells
        
        neutrophils
        
        cholesterol granulomas
        
        multinucleated giant cells
        
        tympanosclerosis
      - Gross appearance
        
        Polypoid, soft / rubbery, pink / tan / red lesion
      - causes
        
        chronic inflammation
        
        cholesteatoma
        
        tumor
        
        foreign object
- - - - tympanic membrane
      - middle ear
      - external auditory canal
      - by using the otoscope