4th Year Ear Additions Flashcards
what is an important differential in SNHL in the elderly?
dementia
does hearing loss increase your risk of dementia?
yes, but treating can reduce the risk
medications that cause SNHL
loop diuretics (furosemide)
aminoglycosides (gentamicin)
chemotherapy (cisplatin)
what movement do the semi-circular canals detect?
rotational
what movement do the otolith organs detect?
linear
what is the role of the vestibular nerve?
balance
what is the role of the cochlear nerve?
hearing
what are not features of vestibular neuronitis?
tinnitus and hearing loss as this is inflammation of only the vestibular nerve
if these are present consider labyrinthitis
short-term acute management options for peripheral vertigo
prochlorperazine
antihistamines
what does prolonged use of prochlorperazine and antihistamines cause?
can slow recovery
what condition is bilateral acoustic neuromas associated with?
NF 2
what can acoustic neuromas damage if they grow large enough?
vestibulocochlear and facial nerve
where does the facial nerve exit the brainstem?
cerebellopontine angle
what does the facial nerve pass through?
temporal bone
parotid gland
branches of the facial nerve
5 branches:
- temporal
- zygomatic
- buccal
- marginal mandibular
- cervical
what does UMN facial palsy suggest?
stroke
forehead spared
does LMN have forehead sparing?
no
management of Bell’s palsy
prednisolone lubricating eyedrops (exposure keratopathy)
where is the bony labyrinth located?
petrous part of the temporal bone with perilymph
what does the bony labyrinth consist of?
cochlea
vestibule
three semi-circular canals
where is the membranous labyrinth?
within the bony labyrinth
what does the membranous labyrinth consist of?
cochlear duct
semi-circular ducts
utricle
saccule
filled with endolymph
congenital causes of SNHL
Connexin 26 GJB2 Waardenburg's (AD) Jervell and Lange-Nielsen Stickler (AD) Usher's (AR) Pendred's (AR)
RF for congenital SNHL
FH maternal infection craniofacial abnormalities LBW hyperbilirubinaemia ototoxic medication meningitis low APGAR
pathway for testing SNHL in children
new-born screening
objective audiometry
auditory brainstem response audiogram
non-genetic causes of SNHL
maternal infections (rubella, chickenpox, CMV, HIV, strep) alcohol/ drug misuse inflammatory (meningitis, labyrinthitis) AI (sarcoidosis, RA, GPA)
noise-induced hearing loss prolonged exposure length?
10+ years 8 hours a day
what conditions is pulsatile tinnitus associated with?
GCA
IIH
grading for facial palsy
House-Brackmann (normal is 1 and paralysis is 6)
causes of facial palsy
stroke vestibular schwannoma Bell's palsy herpes zoster parotid tumour surgery Lyme disease sarcoidosis
most common procedure that risks facial nerve injury?
parotidectomy
when nerve is traumatised but thought to be intact then systemic steroids are used
what is a myringotomy?
cut to relieve pressure of the eardrum
what does sudden SNHL require for diagnosis?
at least 30dB lost in three consecutive frequencies
what does acute release of pain in acute otitis media indicate?
tympanic membrane perforation
what to consider in unilateral glue ear in adults?
nasopharyngeal cancer and eustachian tube obstruction
especially in smokers and people of Chinese or South East Asia origin
OTC device for eustachian tube dysfunction?
otovent (patient blows into balloon using a single nostril)
what is betahistine?
labyrinthine vasodilator
risk in pinna haematoma?
cauliflower ear
how can the teeth refer pain to the ear?
auriculo-temporal brach of the trigeminal nerve
how can the larynx cause ear pain?
auricular branch of the vagus
how can the throat cause ear pain?
tympanic branch of glossopharyngeal
