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Head and Neck > Anatomy And Disorders Of The Ear > Flashcards

Anatomy And Disorders Of The Ear Flashcards

1
Q

What parts makeup the external ear?

A

Pinna and external auditory meatus

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2
Q

What is the middle ear?

A

Air filled cavity containing the ossicles, connecting the tympanic membrane to the cochlea and vestibular apparatus. Lined with respiratory epithelium.

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3
Q

What is the inner ear?

A

Fluid filled space made up of the cochlea and vestibular apparatus, directly responsible for generating action potentials for hearing and balance at the vestibulocochlear nerve

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4
Q

What does the Eustachian tube connect?

A

Middle ear and nasopharynx. Also known as the Pharyngotympanic tube

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5
Q

Which nerves carry general sensation from the ear? Why is this important clinically?

A

Vagus, trigeminal (auriculotempral branch), Glossopharyngeal (tympanic nerve branch).
Referred pain from any of these nerves may occur to the ear.

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6
Q

What are common alternative sites of pathology that may present with otalgia?

A

TMJ dysfunction,
Diseases of the oropharynx such as pharyngitis,
Cancers of pharynx and larynx.

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7
Q

What is the purpose of the external ear?

A

Collect, transmit and focus sound waves onto the tympanic membrane

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8
Q

What syndrome is characterised by facial palsy and a painful vesicular rash of the pinna?

A

Ramsay Hunt Syndrome (herpes zoster infection of the facial nerve)

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9
Q

What is perichondritis?

How is it treated?

A

Inflammation of perichondrium of the pinna secondary to infection. Presents with pain and swelling. Treated with antibiotics.

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10
Q

What is a pinna haematoma?

How is it managed?

A

Accumulation of blood between cartilage and overlying perichondrium from blunt injury. Deprives cartilage of blood supply and leads to pressure necrosis. Treated by draining and reapposing the layers of perichondrium and cartilage with cotton roll

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11
Q

What deformity occurs if a Pinna haematoma remains untreated?

A

Cauliflower deformity due to fibrosis and asymmetrical cartilage development.

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12
Q

What lines the external auditory meatus?

A

Keratinising, stratified squamous epithelium. Contains hair, sebaceous and ceruminous glands along its cartilaginous portion

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13
Q

What shape is the external acoustic meatus?

How long is it?

A

Sigmoidally shaped, 2.5cm in length.

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14
Q

How is the external acoustic meatus self cleaning?

A

Desquamation and epithelial migration occurs laterally off of the tympanic membrane and out of the canal.

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15
Q

What is otitis externa?

A

Inflammation of the external ear, causing pain, itching, hearing loss and potentially discharge.

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16
Q

What is malignant otitis externa?

Who is most at risk?

A

Otitis externa caused by necrotising bacteria that erode the bones of the ear. Potentially life threatening. Common in immunocompromised and diabetic.

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17
Q

What shape is the tympanic membrane normally?

How does this change in otitis media and otitis media with effusion?

A

Normally slightly concave. Bulging and convex in otitis media. Retracted in otitis media with effusion and evidence of fluid.

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18
Q

What causes a Cholesteatoma?

A

Retraction of pars flaccida forms a pocket that traps the migrating stratified squamous keratinising epithelium. This builds up and proliferates, forming the cholesteatoma. (Often secondary to Eustachian tube dysfunction, as negative pressure pulls the pocket into the middle ear.

19
Q

What may occur if a cholesteatoma is not resolved?

A

Enzymatic bony destruction of ossicles, mastoid, petrous bone and cochlea.

20
Q

What three bones, laterally to medially, make up the ossicles?
What connects them?

A

Malleus, Incus, Stapes. Connected by synovial joints

21
Q

Which two muscles tamper the movement of the ossicles in response to a loud noise?

A

Tensor tympani and stapedius. Occurs via tympanic reflex.

22
Q

What is Otosclerosis?

A

Fusion of the ossicles at articulations due to abnormal bone growth. Occurs mostly at the base plate of the stapes and oval window. Most common cause of acquires hearing loss in young adults.

23
Q

What is the purpose of the Pharyngotympanic tube?

A

Allows equilibration of pressure within middle ear with that of atmosphere, alongside ventilation and drainage of mucus.

24
Q

What causes otitis media with effusion?

A

Fluid and negative pressure in the ear due to Eustachian tube dysfunction. Decreases mobility of the tympanic membrane and ossicles, affecting hearing.

25
Q

How is otitis media with effusion managed?

A

Often spontaneously resolves within 3 months. Analgesics in the meantime. If it does not resolve, tympanostomy tubes (grommets) can be inserted to equilibrate pressure.

26
Q

What is otitis media?

A

Acute middle ear infection. Presents with otalgia and systemic symptoms eg fever. Red bulging tympanic membrane seen on otoscopy.

27
Q

What are the common causative organisms for otitis media?

A

Likely viral. If not, often caused by streptococcus pneumoniae and haemophilus influenzae.

28
Q

Why is ear infection more common in infants?

A

Eustachian tube is shorter and more horizontal in infants. More likely to ram stuff up their ears too. Dickheads.

29
Q

What are the complications of otitis media?

A

Tympanic membrane perforation (felt as intense pain that often resolves).
Mastoiditis.
Meningitis.
Sigmoid sinus thrombosis.

30
Q

What anatomical feature allows mastoiditis to occur?

A

Middle ear cavity communicates with mastoid air cells via the mastoid antrum. Infection may spread between these.

31
Q

What is the purpose of the cochlea?

A

Convert movement of fluid within the cochlear duct into action potentials at the vestibulocochlear nerve

32
Q

What is the purpose of the vestibular apparatus?

A

Convert fluid movement generated by the rotation of the head into action potentials in the vestibulocochlear nerve, perceived as sense of balance.

33
Q

Describe the process that allows us to hear.

A
  1. Auricle and external auditory meatus funnel sound waves to the tympanic membrane which vibrates.
  2. Ossicles in turn vibrate, penultimately the stapes at the oval window which establishes movement in cochlear fluid.
  3. Movement is sensed by stereocilia in organ of corti.
  4. Action potential triggered in cochlear part of CN VIII.
  5. Potential travels to the primary auditory comp,ex in the temporal lobes of the brain and is perceived as sound.
34
Q

What is Presbycusis?

A

Sensorineural hearing loss associated with old age. Corrected with hearing aids.

35
Q

What is Benign Paroxysmal Positional Vertigo?

A

Short lived episodes of vertigo triggered by movement of the head. Thought to be crystals that influence movement of stereocilia in vestibular apparatus.

36
Q

What treatment is used for BPPV?

A

Dix-Hallpike and Epley manoeuvres - aim to move crystals to points where they no longer have an effect on stereocilia and balance.

37
Q

What is Ménière’s disease?

A

Unilateral vertigo, hearing loss and tinnitus, associated with aural fullness and nausea or vomiting. Symptoms are long lasting (30 mins to 24 hours).

38
Q

What is Acute Labrynthitis?

A

Inflammation of all inner ear structures with hearing loss, tinnitus, vomiting and vertigo. Often linked to history of upper respiratory tract infection.

39
Q

What is Acute Vestibular Neuronitis?

A

Sudden onset of vomiting and severe vertigo lasting days. Often associated with upper respiratory tract infection.

40
Q

What are the Weber’s and Rinne’s tuning fork tests used for?

A

Unilateral hearing loss, establishing which structures of the ear are involved. Use a 512Hz tuning fork.

41
Q

How is the Rinne’s test performed?

A

Tuning fork perpendicular to external acoustic meatus and then on bony prominence surrounding ear. If conductive hearing loss, bone conduction is louder than air conduction.

42
Q

How is Weber’s test performed

A

Tuning fork on midline of skull. Heard in midline if normal, bad ear if conductive hearing loss, good ear if sensorineural hearing loss.

43
Q

What is the difference between conductive and sensorineural hearing loss?

A

Conductive - involves structures of external or middle ear. Sensorineural - involves inner ear structures or vestibulocochlear nerve.

Head and Neck (12 decks)

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