Unit 7 - 3 Pathology And Microbiology

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normal flora of the ear

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AKA furnuculosis

sx: severe pain, focal erythematous swelling, possible drainage

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Acute localized otitis externa

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w itching and pain, FOUL SMELLING DISCHARGE, hearing loss if lumen is swollen, red swollen with moist purulent debris

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acute diffuse external otitis

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Repeated middle ear infections w erythematous scaling deramatitis, pruiritis

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Chronic otitis externa

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Pseumonas aeruginosa

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swimmers ear

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cerumen

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ear wax; secreted in the ear canal

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A. niger

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may grow in cerumen and desquamate keratinaceous debris in the external auditory canal

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mcc of fugal ear infections

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aspergillus niger and candida

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teleomorph

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fungus producing sexual spores

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anamorph

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form of the fungus producing asexual sportes

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Sporangiospores are asexual spores produced in a structure called sporangia and are characteristic of the Zygomycetes genera like Mucor or Rhizopus

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Conidia are asexual spores that are borne “naked” on specialized structures as seen in Aspergillus spp, Penicillium and dermatophytes.

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Gout: Urate precipitates as needle shaped monosodium urate crystals deposited in avascular or relatively avascular tissues ( tendons, cartilage, walls of bursae etc.) as well as skin around cooler distal joints and tissues such as the ears
Tophi are crystal aggregates that usually develop in joint and cutaneous tissue

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Keloids; seen after piercing or other trauma; mc in black/asians; thick and hyalinized bundles of collagen in the dermis

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in wrestlers/boxers

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Deformities that result from recurrent mechanical trauma to the external ear
These injuries result in subperichondrial hematomas that organize and lead to deformation

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mcc of otitis media

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s. p neumoniae (35%)

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Acute otitis media

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usually secondary to viral infection; often complicated by secondary bacterial infections; can cause a transudate in the middle ear and mastoid cavities; Acute otitis media occurs if pathogens from the nasopharynx are introduced into this fluid that has collected into the middle ear.


Follows a viral URI; most commonly affects those between 3 months and 3 years

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+ URI

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Acute otitis media; infant has difficulty sleeping or is cranky; children may have fever, nausea, vomiting and diarrhea; note bulging tympanic membrane w indistinct landmarks

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Moraxella catahharis review

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Gram negative diplococcus; aerobic, oxiase positive, gamma hemolytic

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Haemophilus influenzae review

Gram negative short rods

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The inability of a Haemophilus species to grow on sheep blood agar indicates dependence on “V” Factor (nicotinamide adenine dinucleotide, also known as NAD or Coenzyme I). The V factor dependance is also reflected in the satellite phenomenon when co-cultured with S. aureus.

FAILS to grow on MacConkey agar and BAP

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Myringotomy

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surgical procedure in which a tiny incision is created in the eardrum to relieve pressure cased by the excessie build-up of fluid.

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Serous otitis media with effusion; commonly follows acute otitis media in children and may last weeks to months

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Mastoiditis

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bacterial infection of the mastoid air cells; occurs after acute otitis media; caused by s. pneumoniae or h. influenzae

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A cholesteatoma is a growth of epithelial cells that forms in the middle ear, mastoid, or epitympanum in association with chronic otitis media

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White debris in middle ear
Draining polypoid mass protruding through the TM perforation
Mucopurulent granulation tissue in the ear canal

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acute tympanic membrane rupture; note the sharp edges of the ruptured membrane; often due to foreign body insertion; coincussions; head trauma; barotrauma

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Paraganglia

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Clusters of neuroendocrine cells that are associated with the sympathetic and parasympathetic nervous systems

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Neoplasm originating from paraganglia; The most common site of occurrence involving the great vessels of the head and neck is the carotid body can also involve the jugulotympanic ganglia;


Nests of round-oval cells (Zellballen) surrounded by delicate vascular septae
The cells have abundant clear or granular eosinophilic cytoplasm
The nuclei are uniform round-ovoid, and sometimes vesicular

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What other dz is associated with acoutstic neuroma (vestibular schwannoma)

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NF2

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Aoustic neuroma symptoms

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Slow progressive sensorineural hearing loss

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Meniere’s Disease

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Sudden attacks of vertigo; constant or intermittent tinitus unrelated to position;

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Osteosclerosis

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Accumulation of new bone within the oval window; restricts stapes movements = CONDUCTIVE hearing loss; 50% cases are inherited

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Labryinthitis

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Vertigo, nausea, and vomiting with onset occurring over several hours
The symptoms generally peak within 24 hours and then resolve gradually over several weeks
Otoscopic exam is usually normal
Possible hearing loss in the affected ear
There is usually complete recovery within 1-3 months. Older patients may have dizziness for many months

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Causes of acute bacterial sinusitis

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What are the three different patterns of clinical manifestations of sinusitis?

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Persistent URI symptoms for more than 10 days. May include periorbital edema, malodorous breath, low-grade fever.
Onset of severe symptoms
Worsening symptoms: initial regression which worsen again with in the first 10 days of illness.

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Fungal causes of acute or chronic sinusitis

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Mucor in biopsy. Note broad irregular, non-septate hyphae with right angle branching

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three elements of sinusitis pathogenesis

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Narrow sinus ostia
Dysfunction of ciliary apparatus
viscous sinus secretions