12 - Head & Neck - The Ear 2

Question 1

What part of the labyrinth contains receptors detecting rotational acceleration?

Answer 1

• Utricle
• Saccule
• Semicircular ducts

Question 2

How should a normal, healthy tympanic membrane appear during otoscopy?

Answer 2

Intact
Pearly
Translucent
Blood vessels around perimeter

Question 3

What are the main causative organisms of otitis externa?

Answer 3

• S.aureus
• Aspergillus
• Pseudomonas aeruginosa

Question 4

What is a auricular haematoma? What is the complication of this if it isn’t treated rapidly?

Answer 4

Blood between perichondrium + auricular cartilage
Fibrosis and new asymmetric cartilage formation
‘Cauliflower ear’

Must be drained promptly

Question 5

Why is otitis media more common in children?

Answer 5

• Eustachian tube is shorter + more horizontal

- Allows infection to spread from nasopharynx more easily

Question 6

Describe the appearance of a tympanic membrane during otitis media (no effusion):

Answer 6

• Red
• Bulging
• Loss of normal landmarks

Question 7

How can otitis media lead to inflammation of the facial nerve?

Answer 7

The facial nerve runs in a bony canal on the posterior wall of the middle ear, and gives out Chorda Tympani branch here, which can become inflamed/infected
= loss of taste first

Question 8

List some complications of otitis media:

Answer 8

• Tympanic membrane perforation
• Facial nerve inflammation
• Mastoiditis
• Hearing loss
• Meningitis
• Brain abscess

Question 9

What are the symptoms of mastoiditis?

Answer 9

• Ear pushed forward

- Redness behind pinna

Question 10

What is a cholesteatoma?

Answer 10

Slowly growing collection of abnormal keratinised skin cells within the middle ear

Question 11

How does a cholesteatoma usually form?

Answer 11

• Chronic/recurring otitis media + ET blockage
  = Decreased pressure within middle ear, draws eardrum inwards, creates small pocket at top of tympanic membrane
• Epithelia are trapped, collect and proliferate

Question 12

What is an acoustic neuroma?

Answer 12

Benign tumour of sheath covering CN VIII

Question 13

What are the symptoms associated with an acoustic neuroma?

Answer 13

• Gradual hearing loss
• Tinnitus
• Dizzyness
• Facial weakness (damaged CN VII)
• Facial parasthesia (damaged CN V)

Question 14

What is Meniere’s disease?

Answer 14

Disorder of inner ear due to excess endolymph, causin progressive destruction of ducts and membranes

Question 15

What are the symptoms associated with Meniere’s disease?

Answer 15

• Vertigo
• Hearing loss
• Low-pitched tinnitus
• Feeling of pressure/fullness in ear

Question 16

Describe the appearance of a tympanic membrane affected by otitis media with effusion:

Answer 16

• Retracted

- Straw coloured

Question 17

If the eustachian tube becomes blocked, why does the pressure within the middle ear drop?

Answer 17

Cells within the middle ear absorb air = reduced pressure in middle ear cavity

Question 18

What is otitis media with effusion?

Answer 18

Build up of fluid and negative pressure in middle ear, due to eustachian tube dysfunction (not infection)

Question 19

How does otitis media with effusion cause a loss of hearing? How it this condition managed?

Answer 19

Build up of fluid reduces ossicle movement, so sound is not amplified.

• Usually resolves spontaneously < 3 months
• If chronic = grommets to allow drainage and pressure equalisation

Question 20

Define conductive hearing loss:

Answer 20

Hearing loss due to pathology in the external or middle ear.

Question 21

Define sensori-neural hearing loss:

Answer 21

Hearing loss due to pathology in the inner ear or CN VIII

Question 22

How is Weber’s test conducted?

Answer 22

• Place vibrating tuning fork on center of head

- Ask whether the sound is equal in both ears, or louder in one

Question 23

If Weber’s test results in the sound being louder in the right ear, what could this suggest?

Answer 23

• Sensorineural loss in L ear

- Conductive loss in R ear

Question 24

How is Rinne’s test conducted?

Answer 24

• Hold vibrating tuning fork in front of ear
• Hold vibrating tuning fork on mastoid process
• Ask which sounded louder

Question 25

What is the outcome of Weber’s test if there is no disease present?

Answer 25

Sound will not equalise to one side, they are equal

Question 26

What is the outcome of Rinne’s test if there is no disease present?

Answer 26

Air > Bone

Question 27

If someone has a conductive hearing loss of their R ear, what will the results of Weber’s + Rinne’s tests be?

Answer 27

Weber's = Localise to R ear
Rinne's = In R ear: Bone > Air

Question 28

If someone has a sensorineural hearing loss of their L ear, what will the results of Weber’s + Rinne’s tests be?

Answer 28

Weber's = Localise to R ear
Rinne's = In L ear: Air > Bone

Question 29

What are the 3 branches of the facial nerve which arise on the petrous part of the temporal bone?

Answer 29

1) Greater petrosal
2) Nerve to Stapedius
3) Chorda Tympani

Question 30

Reactivation of varicella zoster virus in the facial nerve can cause which complication?
What is the main difference between shingles and this complication?

Answer 30

Ramsay Hunt syndrome = facial nerve palsy + rash around ear

Shingles= affects sensory nerves
RH syndrome = affects sensory + motor

Question 31

What is the nerve innervation to the auricle?

Answer 31

• Greater auricular nerve C2/3

- Auriculotemporal nerve CN V3

Question 32

What is the nerve innervation to the tympanic membrane?

Answer 32

Externally : Mainly CN V, some CN X

Internally : CN IX

Question 33

Why might a child with recurrent ear infections benefit from an adenoidectomy?

Answer 33

• Freq. infection can cause adenoids to enlarge, blocking eustachian tubes, increasing risk of further infections
• Adenoidectomy can mean quicker resolution time of otitis media with effusion