208 - ENT Flashcards by Lucy Knox

NAme the cartilagenous structures that make up the pinna

Helix
Antihelix
Tragus (concha dip)

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What is atresia?

When there is no external auditory meatus

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What is the function of the external auditory meatus?

Funnels and amplifies sound

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What is otitis externa?

Skin infection in the canal

In the outer ear

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What is another name for surfer’s ear? What is it?

Exostoses
Benign bony growths in the ear canal
- Can be removed surgically but usually left

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What makes up the middle ear?

Ear drum
Ossicles (malleus, incus, stapes)
Eustacion tube
Mastoid

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What is the function of the middle ear?

Transmits air vibration to the ossicles to liquid in the inner ear, and amplifies sound

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What are 6 examples of middle ear diseases/problems

Perforation
retraction
otitis media with effusion
Cholesteatoma
Ossicular disease
Osteosclerosis

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What can cause a drum perforation?

Infection
trauma
surgery

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What is the effect of a perforation?

Can cause hearing loss as the drum loses ability to vibrate properly
Pain may go if it was an infection as pressure relieved

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What is a retraction?

The drum gets drawn inwards due to a pressure difference (low in middle ear)

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Where do retractions usually occur on the drum/

In the pars flacida or posterior + superior quadrants

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What is a common name for otitis media with effusion?

Glue ear

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What part of anatomy makes children more likely to get glue ear?

Their Eustachian tube isn’t fully developed - it is at a less steep angle - so infection can travel up it, or milk (eg breast feeding baby on back). Children more prone to nasopharyngeal infections, adenoids swell + have exudates - irritates the tube and it closes up

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What are the symptoms of glue ear?

Hearing loss

Developmental delay - may be missed, child may not complain of hearing loss, fall behind in school/

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What are the management options of otitis media with effusion/glue ear?

Watch and wait
Grommets
+/- adinoidectomy
Hearing aid (great, but stigma from parents)

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What is a cholesteatoma? What symptoms? What complications arise from it?

Abnormal growth of skin in the middle ear - ve pressure sucks in pars flaccida, some migrating epithelium gets trapped and proliferates

conductive hearing loss, painless, foul smelling greenish discharge
Can be destructive - can get facial nerve palsy, meningitis, mastoid abscess

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What is osterosclerosis?

Calcification around the stapes footplate, becomes still/can’t move, so can’t transmit the vibrations - 60dbh conductive hearing loss

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How common is osterosclerosis

10% have it, only 10% know
2:1 female to male
85% bilaterally
Autosomal dominant

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What is the management of osteosclerosis

Hearing aids

Stapedectomy and piston

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What makes up the inner ear?

Membranous labyrinth, coclear, semicircular canals, saccule, utricle

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What turns sound waves into neural info in the middle ear?

Neuroepithelium - bathed in fluid that vibrates

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What disorders are there of the inner ear?

Presbyacusis
Acoustic neuroma
Noise damage
Iatrogenic - ototoxic drugs

What is presbyacusis?

Age associated hearing loss

High frequency lost first - can’t hear consonants

Why does presbyacusis occur?

The neuroepithelial cells and spiral ganglion cells degenerate and don't repair - so less function

What is an acoustic neuroma? What does it cause?

A schwannoma - usually of superior vestibular nerve, as it passes through internal acoustic meatus - Compresses nerve and surrounding nerves and can expand to brainstem - Hearing loss , tinitus (unilateral), mild vertigo, facial weakness (later sign as harder to compress motor muscle)

What passes through the internal acoustic meatus + can be affected by an acoustic neuroma?

Superior vestibular nerve (CNVIII) Inferior vestibular nerve (CNIII) Cochlear (CNVIII) CNVII - Facial

What sort of hearing loss is seen after prolonged noise damage?

Permanent sensorineural loss

Name 3 classes of drugs that have ototoxic effects

Aminoglycosides (gentamicin, neomicin) Loop diuretcs (flurosomide) Chemo (cisplatin, carbopentin)

What is vertigo?

A Hallucination of movement

Name 4 diseases/causes of vertigo

BPPV Menieres Vestibular neuritis Labyrinthitis

What is BPPV?

Benign paroxsysmal positional vertigo Isolted vertigo, lasts seconds, often after getting out of bed, no deafness or tinitus rotational nstagmus seen

What is the pathophysiology of BPPV?

Otoconia get displaced, lidge in semicircular canals, stuck behind bupula - so when you move then it detects more movement than in reality - get vertigo

What test proves BPPV, what action cures it?

Dix - Hallpike test = diagnostic | Epley manouver = treatment

What symptoms are seen in menieres disease?

Hearing loss Tinnitus Vertigo (lasting hours) + nausea, aural pressure

How do you treat menieres?

Resolves itself Can try - salt restriction, anti-emetics, betahistamines (eg. serc) Grommets sometimes help (don't know why!) Gentamicin to destroy labyrinth?

What is the pathophysiology of menieres?

Function of endolymph regulating sac gets impaired, so there is a build up of endolymph -> Endolymph hydrops - This excess causes it to rupture, so it mixes with perilymph - there is a ionic disequilibrium - damages the neuroeptihelium - get symptoms - Once balance is restored symptoms get better

What is vestibular neuritis?

Painless, viral or vascular occulsion - causes reduced neuronal activity in vestibular nerves on one side - vertigo and nstagmus

What are the symptoms on vestibular neuritis?

Severe vertigo Nausea Vomiting For a few days, takes 6 weeks to fully resolve

What is labyrinthitis?

Painless, viral or bacterial infection, occasionally vascular, effecting the whole labyrinth - get vestibular + cochlear issues

What symptoms are seen in labyrinthitis?

Severe vertigo, nausea, vomiting | Permanent changes in hearing and tinnitus

How much more efficient does the middle ear make sound transmission?

18X more (14 x conc going from tympanic membrane to oval window) 1.3X more having the stapes rock rather than lift up

What are the 3 parts of the cochlear called? What type of fluid does each contain?

``` Scale vestibuli (perilymph) Scala Media (endolymph) Scale tympani (perilymph) ```

Hair cells are found on the organ of ..... in the cochle

Organ of corti

In the vestibular system, what is the name of the longest hair on the hair cell?

Kinocilium

When the cilia move towards the kilocilium what happens to the tonic firing?

Firing increases as cilia move towards kinocilia

What type of movement does the utricle and saccule detect?

Linear movements - flat - side to side, front to back

What type of movement do the semicircular canals detect?

Angular movements - hear turns, up and down

How do we detect overall movement of the head?

The vestibular apparatus acts in functional pairs - so you can work out which way you turn combining the info

What is the vestibular-occular reflex?

Each vestibular canal is connected to a pair of extraoccular muscles, so as you turn your head, the firing increases in the respective nerve - causes you to move your eyes the other way - ie. so even if you move your head your eye can fix on the same object

What is the clinical sign you can see if the vestibular-occular reflex is disrupted?

Nstagmus

When does the frontal sinus develop?

From age 2, size increases from 6 to teens

When do the ethmoid sinuses develop?

Fluid filled at birth, pneumotise until 12

When do the maxillary sinuses develop?

1st | 0-3 months, and ones grow 6-12 years

When does the sphenoid sinus reach full size?

Late teens