🔥 Diseases and Disorders of the Ear 🔥

I. External Ear Disorders

1. Otitis Externa (Swimmer’s Ear)

• Definition: Inflammation of the external auditory canal, commonly due to bacterial or fungal infections.
• Causes:
  • Bacterial: Pseudomonas aeruginosa, Staphylococcus aureus.
  • Fungal: Aspergillus, Candida.
  • Excessive moisture, Trauma (cotton buds, earplugs).
• Symptoms:
  • Ear pain (otalgia), swelling, itching, discharge, decreased hearing.
• Diagnosis: Otoscopy – swollen, red ear canal, possible discharge.
• Treatment:
  • Antibiotic ear drops (Ciprofloxacin, Neomycin).
  • Fungal – Clotrimazole or Nystatin ear drops.
  • Keep ear dry.

2. Foreign Body in Ear

• Common in: Children (beads, insects, cotton, paper).
• Symptoms: Pain, fullness, hearing loss, ear discharge.
• Management:
  • Insects: Instill mineral oil or lidocaine to kill insect, then remove.
  • Solid objects: Removed with forceps under otoscope guidance.
  • Do not irrigate organic materials (e.g., beans), as they swell.

3. Impacted Cerumen (Earwax Blockage)

• Definition: Accumulation of hardened earwax blocking the ear canal.
• Symptoms:
  • Conductive hearing loss, fullness, tinnitus.
• Management:
  • Softening agents (Olive oil, Hydrogen Peroxide 3%).
  • Ear irrigation (Warm saline or water).
  • Avoid cotton swabs (Push wax deeper).

4. Furunculosis (Boil in Ear Canal)

• Definition: Painful bacterial infection of a hair follicle in the ear canal.
• Cause: Staphylococcus aureus.
• Symptoms: Pain, swelling, redness, pus discharge.
• Treatment:
  • Warm compress.
  • Antibiotics (Flucloxacillin, Amoxicillin).
  • Analgesics for pain.

II. Middle Ear Disorders

1. Otitis Media (Middle Ear Infection)

• Definition: Infection of the middle ear, common in children.
• Types:
  • Acute Otitis Media (AOM): Bacterial/viral infection with pus collection.
  • Chronic Otitis Media (COM): Recurrent infection with eardrum perforation.
• Causes: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
• Symptoms:
  • Ear pain, Fever, Hearing loss, Fullness, Ear discharge (if perforated).
• Diagnosis:
  • Otoscopy – Red, bulging tympanic membrane.
• Treatment:
  • Amoxicillin (First-line antibiotic).
  • Myringotomy (Ear tube insertion for drainage).
  • Analgesics (Paracetamol, Ibuprofen).

2. Mastoiditis

• Definition: Infection of the mastoid bone due to untreated otitis media.
• Symptoms:
  • Severe ear pain, Swelling behind ear, Fever, Pus discharge.
• Diagnosis: CT scan – Fluid collection in mastoid air cells.
• Treatment:
  • IV antibiotics (Ceftriaxone).
  • Mastoidectomy (Surgical drainage).

3. Perforation of Eardrum (Tympanic Membrane Rupture)

• Causes:
  • Infection (Chronic otitis media).
  • Trauma (Loud explosion, Foreign object, Barotrauma).
• Symptoms: Sudden hearing loss, Pain, Tinnitus, Bloody discharge.
• Treatment:
  • Self-healing (most cases).
  • Surgical repair (Tympanoplasty) if large perforation.
  • Avoid water entry (Use earplugs).

III. Inner Ear Disorders

1. Presbycusis (Age-Related Hearing Loss)

• Definition: Gradual, bilateral sensorineural hearing loss due to aging.
• Symptoms:
  • Difficulty hearing high-frequency sounds.
  • Trouble understanding speech in noisy environments.
• Management:
  • Hearing aids.
  • Cochlear implants (for severe cases).

2. Labyrinthitis

• Definition: Inflammation of the labyrinth (inner ear) due to viral/bacterial infection.
• Symptoms:
  • Severe vertigo, Nausea, Vomiting, Hearing loss, Tinnitus.
• Diagnosis: Clinical, MRI (to rule out stroke).
• Treatment:
  • Antivertigo drugs (Meclizine, Diazepam).
  • Steroids (if inflammation is severe).

3. Meniere’s Disease

• Definition: Chronic inner ear disorder causing vertigo, hearing loss, tinnitus.
• Cause: Excess endolymph (fluid) in the inner ear.
• Symptoms (Triad):
  • Episodic vertigo (lasting hours).
  • Fluctuating hearing loss.
  • Tinnitus (Ringing in the ear).
• Diagnosis: Audiometry, Vestibular tests.
• Treatment:
  • Diuretics (Reduce fluid buildup).
  • Low-sodium diet.
  • Antivertigo drugs (Meclizine, Diazepam).

4. Otosclerosis

• Definition: Abnormal bone growth in the middle ear causing conductive hearing loss.
• Cause: Hereditary (Autosomal dominant).
• Symptoms:
  • Progressive hearing loss.
  • Paracusis of Willis (Better hearing in noisy environments).
• Diagnosis: Audiometry (Conductive hearing loss).
• Treatment:
  • Hearing aids.
  • Surgery (Stapedectomy – Replace stapes bone).

IV. Types of Deafness

1. Conductive Deafness

• Cause: Blockage in sound conduction to inner ear.
• Examples: Otitis media, Otosclerosis, Impacted cerumen, Eardrum perforation.
• Management: Treat underlying cause (Hearing aids, Surgery).

2. Sensorineural (Neural) Deafness

• Cause: Damage to cochlea or auditory nerve.
• Examples: Presbycusis, Labyrinthitis, Meniere’s disease, Acoustic Neuroma.
• Management: Cochlear implants, Hearing aids.

🔥 High-Yield Key Points for Competitive Exams

✅ Most common cause of otitis externa: Pseudomonas aeruginosa.
✅ Gold standard test for Meniere’s disease: Audiometry.
✅ Best treatment for otitis media in children: Amoxicillin.
✅ First-line drug for vertigo in labyrinthitis: Meclizine.
✅ Surgical treatment for otosclerosis: Stapedectomy.
✅ Most common cause of conductive hearing loss: Otitis media.
✅ Most common cause of sensorineural hearing loss: Presbycusis.

📝 Competitive Exam Practice MCQs

1. What is the most common cause of conductive deafness?

a) Presbycusis
b) Otosclerosis
c) Otitis media
d) Labyrinthitis
✅ Answer: c) Otitis media

2. Which drug is commonly used for Meniere’s disease?

a) Amoxicillin
b) Meclizine
c) Ceftriaxone
d) Prednisolone
✅ Answer: b) Meclizine

🔥 Tumors of the Ear & Auditory Nerve + Eustachian Tube Insufflation –

I. Tumors of the Ear & Auditory Nerve

Ear tumors can be benign or malignant and may affect the external ear, middle ear, inner ear, or auditory nerve (vestibulocochlear nerve – CN VIII).

1. External Ear Tumors

✅ Benign Tumors:

• Sebaceous Cysts: Painless, slow-growing lumps.
• Keloids: Excessive scar tissue after trauma.
• Osteomas/Exostoses: Bony outgrowths (common in swimmers).
• Papillomas: Wart-like growths from HPV infection.

✅ Malignant Tumors:

• Squamous Cell Carcinoma (SCC):
  • Most common malignant tumor of the external ear.
  • Risk Factors: Chronic sun exposure, HPV, Smoking.
  • Symptoms: Ulcerated, non-healing lesions with pain.
  • Diagnosis: Biopsy, CT scan.
  • Treatment: Surgical excision, Radiation therapy.
• Basal Cell Carcinoma (BCC):
  • Slow-growing, painless, pearly lesions.
  • Treatment: Mohs surgery (Micrographic surgery).

2. Middle Ear Tumors

✅ Benign Tumors:

• Glomus Tumor (Paraganglioma)
  • Most common benign tumor of the middle ear.
  • Symptoms: Pulsatile tinnitus, Conductive hearing loss, Red mass behind eardrum.
  • Diagnosis: MRI, CT scan, Biopsy.
  • Treatment: Surgical removal, Radiation therapy (for large tumors).

✅ Malignant Tumors:

• Adenocarcinoma / Squamous Cell Carcinoma:
  • Rare but aggressive.
  • Symptoms: Persistent ear pain, Bloody discharge, Hearing loss.
  • Treatment: Surgical excision + Chemotherapy/Radiation.

3. Inner Ear Tumors

✅ Vestibular Schwannoma (Acoustic Neuroma)

• Benign tumor of the vestibulocochlear nerve (CN VIII).
• Most common tumor of the auditory nerve.
• Associated with Neurofibromatosis Type 2 (NF-2).
• Symptoms:
  • Unilateral Sensorineural Hearing Loss (Early Sign).
  • Tinnitus (Ringing in the ear).
  • Vertigo, Imbalance, Facial numbness (CN VII compression).
• Diagnosis:
  • Audiometry (Sensorineural hearing loss).
  • MRI (Gold Standard).
• Treatment:
  • Observation (Small tumors).
  • Stereotactic Radiosurgery (Gamma Knife) – For moderate tumors.
  • Microsurgical Excision – For large tumors causing brainstem compression.

II. Insufflation of the Eustachian Tube

✅ Definition:
Eustachian Tube Insufflation is a procedure to clear blockages and restore normal function of the Eustachian tube (which connects the middle ear to the nasopharynx).

✅ Indications:

• Eustachian Tube Dysfunction (ETD).
• Chronic Otitis Media with Effusion (Glue Ear).
• Barotrauma (Altitude/Flight-related ear pressure).

✅ Methods of Eustachian Tube Insufflation:

1. Valsalva Maneuver:
   • Patient closes mouth, pinches nostrils, and exhales gently.
   • Helps open Eustachian tube.
2. Toynbee Maneuver:
   • Patient swallows with nostrils pinched.
   • Equalizes ear pressure.
3. Politzerization (Politzer Method):
   • Balloon device used to blow air into the nose while swallowing.
   • Used in children with glue ear.
4. Catheter Insufflation:
   • Small catheter inserted into the Eustachian tube via the nose to force air into the middle ear.
   • Used in severe cases of Eustachian tube dysfunction.

✅ Contraindications:

• Acute upper respiratory infection (May push infection into the middle ear).
• Perforated Eardrum (Risk of damage).

🔥 High-Yield Key Points for Competitive Exams

✅ Most common malignant tumor of the external ear: Squamous Cell Carcinoma.
✅ Most common benign tumor of the middle ear: Glomus Tumor (Paraganglioma).
✅ Most common tumor of the auditory nerve: Vestibular Schwannoma (Acoustic Neuroma).
✅ Gold Standard test for Acoustic Neuroma: MRI.
✅ First sign of Acoustic Neuroma: Unilateral Sensorineural Hearing Loss.
✅ Common maneuver to equalize middle ear pressure: Valsalva Maneuver.
✅ Best treatment for small Vestibular Schwannoma: Observation or Gamma Knife Radiosurgery.
✅ Procedure for forced air insufflation into the Eustachian tube: Politzerization.

📝 Competitive Exam Practice MCQs

1. What is the most common tumor of the auditory nerve?

a) Vestibular Schwannoma
b) Glomus Tumor
c) Basal Cell Carcinoma
d) Squamous Cell Carcinoma
✅ Answer: a) Vestibular Schwannoma

2. Which of the following is NOT a method of Eustachian tube insufflation?

a) Valsalva Maneuver
b) Politzerization
c) Stapedectomy
d) Toynbee Maneuver
✅ Answer: c) Stapedectomy

3. The best diagnostic test for detecting an Acoustic Neuroma is:

a) Audiometry
b) CT Scan
c) MRI
d) Tympanometry
✅ Answer: c) MRI

🔥 Diagnostic Tests & Diseases of the Nose – 🔥

I. Diagnostic Tests for Nose Disorders

✅ 1. Nasal Examination:

• Anterior Rhinoscopy: Uses a nasal speculum to inspect nasal mucosa, turbinates, polyps, septum.
• Posterior Rhinoscopy: Uses a mirror to examine nasopharynx and posterior nasal structures.
• Endoscopic Nasal Examination (Nasal Endoscopy):
  • Best for sinus infections, nasal polyps, tumors.

✅ 2. Imaging Tests:

• X-ray (Water’s View): Best for maxillary sinus infections, fractures.
• CT Scan (Paranasal Sinuses):
  • Gold Standard for Chronic Sinusitis, Nasal Polyps, Tumors.
• MRI (For Soft Tissue Assessment):
  • Used for nasal tumors, fungal sinusitis.

✅ 3. Laboratory Tests:

• Nasal Swab Culture & Sensitivity: Identifies bacterial infections (Sinusitis, Rhinitis).
• Allergy Testing (Skin Prick Test, IgE Levels): Diagnoses Allergic Rhinitis.

✅ 4. Specialized Tests:

• Olfactory Function Test (Smell Test): Evaluates anosmia (loss of smell).
• Nasal Airflow Test (Peak Nasal Inspiratory Flow – PNIF): Assesses nasal obstruction.

II. Diseases & Disorders of the Nose

A. Infections of the Nose

✅ 1. Rhinitis (Inflammation of the Nasal Mucosa)

• Types:
  • Allergic Rhinitis: Triggered by pollen, dust, pet dander.
  • Viral Rhinitis (Common Cold): Caused by Rhinovirus, Coronavirus.
  • Bacterial Rhinitis: Secondary to Sinusitis, Pharyngitis.
  • Atrophic Rhinitis: Chronic nasal mucosal thinning (seen in elderly).
• Symptoms:
  • Nasal congestion, Sneezing, Runny nose (Rhinorrhea), Postnasal drip.
• Diagnosis:
  • Clinical examination, Allergy tests (for allergic rhinitis).
• Treatment:
  • Antihistamines (Loratadine, Cetirizine) – For Allergic Rhinitis.
  • Nasal decongestants (Oxymetazoline) – Short-term use only.
  • Intranasal corticosteroids (Fluticasone, Budesonide).

✅ 2. Sinusitis (Inflammation of the Sinuses)

• Causes:
  • Viral (Most common), Bacterial (Strep pneumoniae, H. influenzae), Fungal (Aspergillus – in immunocompromised).
• Types:
  • Acute Sinusitis (<4 weeks) – Sudden onset, common after cold.
  • Chronic Sinusitis (>12 weeks) – Persistent symptoms.
• Symptoms:
  • Facial pain/pressure (worse when bending forward), Nasal congestion, Fever, Postnasal drip.
• Diagnosis:
  • Clinical, X-ray (Water’s View), CT PNS (Gold Standard).
• Treatment:
  • Antibiotics (Amoxicillin-Clavulanic Acid) – If bacterial.
  • Saline Nasal Irrigation, Steam Inhalation.
  • Surgical Drainage (If severe).

B. Nasal Obstruction

✅ 1. Nasal Polyps (Benign Growths in the Nasal Cavity)

• Causes:
  • Chronic Inflammation (Allergic Rhinitis, Asthma, Cystic Fibrosis).
• Symptoms:
  • Nasal blockage, Loss of smell (Anosmia), Recurrent infections.
• Diagnosis:
  • Nasal Endoscopy, CT Scan (PNS).
• Treatment:
  • Intranasal Corticosteroids (Fluticasone, Budesonide).
  • Surgical Removal (Polypectomy) – If severe.

✅ 2. Foreign Body in Nose

• Common in: Children (beads, peanuts, toys).
• Symptoms:
  • Unilateral nasal obstruction, Foul-smelling nasal discharge, Nosebleeds.
• Diagnosis: Anterior Rhinoscopy, Nasal Endoscopy.
• Management:
  • Removal with forceps, suction, or balloon catheter.
  • Avoid blind probing (Risk of pushing object deeper).

✅ 3. Deviated Nasal Septum (DNS)

• Definition: Displacement of the nasal septum, causing obstruction.
• Causes:
  • Congenital, Trauma.
• Symptoms:
  • Nasal congestion (one-sided), Recurrent Sinusitis, Snoring.
• Diagnosis: Clinical, CT Scan (for severe cases).
• Treatment:
  • Mild Cases: Nasal decongestants, Saline sprays.
  • Severe Cases: Septoplasty (Surgical Correction).

C. Nasal Trauma & Epistaxis (Nosebleeds)

✅ 1. Fracture of Nasal Bone

• Causes:
  • Sports injury, Falls, Assaults.
• Symptoms:
  • Swelling, Nasal deformity, Bruising, Nasal obstruction, Epistaxis.
• Diagnosis: X-ray, CT Scan (for severe cases).
• Treatment:
  • Closed Reduction (if within 1-2 weeks).
  • Rhinoplasty (For cosmetic correction).

✅ 2. Epistaxis (Nosebleeds)

• Causes:
  • Local: Trauma, Dry air, Infections, Tumors.
  • Systemic: Hypertension, Blood disorders (Hemophilia, Leukemia), NSAIDs.
• Types:
  • Anterior Epistaxis (90%) – Bleeding from Kiesselbach’s Plexus.
  • Posterior Epistaxis – More severe, from Sphenopalatine Artery.
• Management:
  • First Aid:
    • Sit forward, Pinch nose for 10-15 minutes.
    • Apply ice packs to nose and forehead.
  • Medical:
    • Nasal packing (if persistent bleeding).
    • Cauterization (Silver Nitrate, Electrocautery).
  • Surgical (for severe cases): Ligation of Sphenopalatine Artery.

🔥 High-Yield Key Points for Competitive Exams

✅ Gold standard imaging for Sinusitis: CT PNS.
✅ Most common site of nasal polyps: Middle meatus.
✅ Best treatment for Allergic Rhinitis: Intranasal Corticosteroids (Fluticasone).
✅ Most common cause of Epistaxis: Trauma (Nose-picking in children).
✅ Most common site of Anterior Epistaxis: Kiesselbach’s Plexus.
✅ Treatment for Posterior Epistaxis: Sphenopalatine Artery Ligation.
✅ Best surgery for Deviated Nasal Septum: Septoplasty.

📝 Competitive Exam Practice MCQs

1. Which imaging test is considered the gold standard for diagnosing sinusitis?

a) X-ray Water’s View
b) CT Scan PNS
c) MRI Brain
d) Nasal Endoscopy
✅ Answer: b) CT Scan PNS

2. The most common cause of anterior epistaxis is:

a) Hypertension
b) Trauma (Nose-picking)
c) Nasal Tumor
d) Allergic Rhinitis
✅ Answer: b) Trauma (Nose-picking)

3. Nasal polyps are most commonly associated with:

a) Bacterial Rhinitis
b) Chronic Sinusitis
c) Epistaxis
d) Nasal Fracture
✅ Answer: b) Chronic Sinusitis