Clinical Otology (diagnosis) Flashcards
What special questions is it important to ask about in a history of a patient with ear problems?
Hearing loss Pain Discharge Tinnitus Vertigo
Time span of symptoms
Preciptating factors
DH (ototoxic drugs?)
Environmental noise exposure
What is the likely diagnosis: a 7yo child presenting with ear pain, malaise, fever.
Otitis Media
Inflammation of the middle ear. Very common in children.
What is the likely diagnosis: a 30yo lady who has been complaining of progressive bilateral hearing loss, she has a particular problem hearing her husband speak. Rinne’s is -ve bilaterally.
Otosclerosis.
More difficulty with lower voices.
Bilateral progressive conductive hearing loss.
More common in females, and in ages 15-35.
Autosomal dominant genetic condition however it has variable penetrance and environmental factors are thought to be critical in the phenotypic activation of the genetic susceptability.
What is the likely diagnosis: a 82yo gentleman, his wife has complained that he cannot hear her very well anymore and listens to the TV excessively loudly.
Presbyacusis
Bilateral age related sensorineural hearing loss.
What is the likely diagnosis: a 45yo lady who had been complaining of attacks of hearing loss, a ringing in her ear and dizziness.
Menieres disease
A disorder of the inner caused by a change of fluid volume in the inner ear. Aetiology is unknown.
What is the likely diagnosis: a 35yo bar man that is complaining of a ringing in his right ear often when he is trying to go to sleep.
Tinnitus
Can be idiopathic or noise induced can also occur with presbyacusis or as a symptom of another disease.
What is the likely diagnosis: a 4yo boy who has been having behavioural problems at kindergarten and complaining of his ear hurting.
Otitis media with effusion aka glue ear.
Inflammation of the middle ear accompanied by fluid accumulation in the middle ear causing a conductive hearing loss.
What is the likely diagnosis: a 50yo officer in the army who has noticed he is having difficulty hearing people. Nothing remarkable on otoscopy.
Noise related hearing loss.
Sensorineural hearing loss due to repeated loud noise exposure damaging the hair cells in the inner ear.
What is the likely diagnosis: a 36yo lady who has noticed her hearing in her left ear has worsened and there is a foul smelling discharge coming out of it.
Cholesteatoma.
A build up of skin cells which get trapped in the middle ear and form a mass as more skin cells get trapped it grows and can erode the surrounding structures causing a variety of complications.
What is the likely diagnosis: a 56yo gentleman complaining of a ringing in one ear, and difficulty balancing.
Acoustic neuroma. (Vetibular schwanoma)
May also present with hearing loss instead of tinnitus and impaired facial sensation. Balance issues may be subtle at first.
What is the likely diagnosis: a 15yo boy complaining of severe ear pain, on examination he has a temperature of 38.2 you try and look in his ear but it is too painful.
Otitis externa with a furuncle, (an infection of a hair follicle with a collection of purulent fluid)
Otitis externa is any inflammation of the outer ear and therefore can be caused by any skin infection. May be pain when moving the jaw, may be an obvious lesion.
A 20 year old student gets punched in the ear whilst on a night out, their is significant brusing and swelling of his ear, what is the risk and pathophysiology?
The perichondrium may have been sheared from the tightly adhered cartilage forming a haematoma between them.
If the haematoma is not drained there may be avascular necrosis of the cartilage. This will lead to new cartilage growth and a deformed ear aka cauliflower ear.
What is the likely diagnosis: a 65yo gentleman with a tender scaly nodule on the helix of his right ear?
Chrondrodermatitis Nodularis Helicis
Benign inflammatory condition usually precipitated by pressure sleeping on your ear every night, tight head gear etc.
What is the likely diagnosis: a 21yo lady who has difficulty hearing people speaking particularly in noisy places. She came into the ENT clinic and had pure tone audiometry and tympanometry tests. On both tests the results were normal.
Obscure auditory dysfucntion also known as King Kopetzky Syndrome.
This is a condition where there is no dysfunction with the conduction or sensory component of the ear but an issue in processing the sensory information. It has a genetic component in its aetiology.
