5: ENT A

Question 1

how do you perform an otoscopic exam

Answer 1

start by examining the outside of the ear
hold the otoscope sideways
assess the TM for colour, bulging/retraction, cone of light the attic and perforation

Question 2

describe the anatomy of the ear canal

Answer 2

external third is cartilaginous
within the cartilaginous tissue there is ceruminous glands
the internal third is osseous (from temporal bone)
its innervated by the auriculotemporal nerve, and branches of the fascial and vagus nerve

Question 3

what is the eustachian tube

Answer 3

drains excess fluids and secretions
ventilates middle ear and equalises pressure
protection from pathogens
connects the middle ear to the airway

Question 4

what is the annulus

Answer 4

fibrocartilage ring which secures the TM

Question 5

what is the umbo

Answer 5

where the malleus attaches to the pars tensa

Question 6

how can you tell on otoscopic exam which ear is which

Answer 6

malleus and the cone of light, shaped like <
the < points to the nose

Question 7

describe conductive hearing loss and its results of webbers and rinnes test

Answer 7

affects the external and middle ear
webbers = louder in affected ear
rinnes = BC>AC

Question 8

what are some causes of conductive hearing loss

Answer 8

wax
otosclerosis
otitis externa
foreign bodies
severe eustachian tube dysfunction
choleastoma

Question 9

what can cause sensorineural hearing loss

Answer 9

presbycusis
loud sound damage to stereo cillia
conegnital
menieres disease

Question 10

what would tuning fork tests show for sensorineural hearing loss

Answer 10

webbers = louder in normal ear
rinne = AC>BC

caution if billateral as this will appear as a normal result

Question 11

what is pure tone threshold

Answer 11

softest sound audible to an individual at least 50% of the time

Question 12

what is audiometry

Answer 12

objective testing of different tones and volumes
AC is done through headphones
BC is done through an oscillator

Question 13

how does hearing loss present on audiometry

Answer 13

sensorineural: one of or both bone conduction and air conduction would be below 20 dBs

conductive: BC normal. AC below 20

Question 14

describe otitis externa

Answer 14

inflammation of external ear
presents with ear ache, itching, erythema, otorrhea, hearing loss, fever, lymphedema
ear drops are generally first line treatment - ABX or anti fungal
in severe cases (suspected cellulitis), can give oral steriods
advise to keep ear dry and avoid foreign objects in ear

Question 15

describe noise related hearing loss

Answer 15

loud noise damages stereocilia, leading to damage / death
gradual onset bilateral sensorineural hearing loss
higher pitch hearing tends to be affected first
may also experience tinnitus
management can be hearing amplification, assisted listening devices, lip reading training, counselling and advice to avoid further loud exposure

Question 16

describe Meniere’s disease

Answer 16

excessive endolymph in the inner ear
longer lasting episodes of vertigo, tinnitus, ear fullness, sensorineural hearing loss, nausea and vomiting
management: vestibular therapy, anti-emetics (prochlorperazine), counselling
last line is labyrinthectomy

Question 17

what are risk factors for Meniere’s disease

Answer 17

FHx
allergies
menigitis
chemical imbalance in cochlear fluid

Question 18

describe BPPV

Answer 18

crystals form within the vestibular apparatus and dislodge on movement
can be associated with head trauma or surgery
most common in over 50s
episodes of vertigo (asc. with movement), tinnitus, N&V
Dix-hall pike manoeuvre can show nystagmus

management: MRI to exclude other causes, Epley manoeuvre, vestibular rehab, anti-emetics
last line is vestibular neuroectomy

Question 19

describe acute otitis media

Answer 19

most commonly pseudomonas
most common in children with eustachian tube dysfunction
ear fullness, pain, discharge, and fever
conductive hearing loss
conservative - ear drops
if persistent / impacting child’s speech development then referral for grommets

Question 20

describe mastoiditis

Answer 20

infection which has spread from the middle ear into the mastoid air cells.
medical emergency
presents acutely unwell, fever, red swollen mastoid process
requires urgent admission for IV ABX due to risk of intracranial infection

Question 21

describe chronic suppurative otitis media

Answer 21

chronic inflammation of the middle ear with perforated TM
often bacterial infection with eustachian tube dysfunction
tends to present in 2 year olds, with persistent otorrhea, impaired hearing, aural fullness, and tinnitus.
TM tends to heal within a few weeks, avoid getting ear wet or putting things in the ear while healing
tympanoplasty if failure to heal

Question 22

describe cholesteatoma

Answer 22

malignant change within the middle/inner ear
often linked to eustachian tube dysfunction
keratin cells rapidly proliferate with uncontrolled growth, cells produce enzymes which are able to degrade the inner ear.
has foul smelling discharge, gradual hearing loss,
management: urgent referral to ENT, often treated with mastoidectomy
requires follow up in 9-12 months

Question 23

how is otitis media with effusion managed

Answer 23

generally resolves in 2-3 weeks, can observe for up to 3 months in children
can use auto inflation to help ventilate the middle ear to help equalize pressure and drain it.
Valsalva manoeuvre
if affected speech development consider referral for grommets

Question 24

how is otitis media with effusion managed

Answer 24

generally resolves in 2-3 weeks, can observe for up to 3 months in children
can use auto inflation to help ventilate the middle ear to help equalize pressure and drain it.
Valsalva manoeuvre
if affected speech development consider referral for grommets