Clinical Otology (pathophysiology and management) Flashcards
Describe the basic pathophysiology (factors involved) and management of presbyacusis?
Age related sensorineural hearing loss caused by multiple factors
Intrinsic Factors:
Neuronal loss
Loss of cochlea hair cells
Atrophy of the highly vascular stria in the lateral cochlea wall
Inflammation
Systemic illness (hypertension and diabetes)
Extrinsic factors:
Noise
Ototoxic meds
It is managed with hearing aids.
Describe the basic pathophysiology and management of a 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.
Including erosion of ossicles (conductive hearing loss)
Erosion of cochlea (sensorineural hearing loss)
Facial nn palsy
Meningitis and brain abcesses
It is managed surgically.
Tympanomastoidectomy. Open technique but left with a larger auditory meatus.
Tympanoplasty. Closed technique and left with a normal sized meatus but there is a greater risk of relapsing therefore there may be a need for a repeat op 6-12months down the line. Specialist MRI’s however are helping make this a better option.
Note altered taste is a common side effect of the surgery due to damage to the chorda tympani.
Describe the basic pathophysiology and management of glue ear?
Otitis media with effusion. Aka middle ear inflammation with a build up of fluid in the middle ear aka behind the tympanic membrane.
Currently NICE recommend active observation as it can often spontaneously heal.
Previously surgery was used much more commonly, surgery involves insertion of grommits (a tube inserted in the tymapanic membrane to aid drainage). Only indicated if there is persistent hearing loss of 25-30 dB for 3 months or more.
Addenoidectomy’s are indicated if recurrent upper respiratory tract symptoms are a feature.
Describe the basic pathophysiology and management of otosclerosis?
This is a genetically mediated metabolic dysplasia, affecting the bony tissue of the otic capsule (the skeletal elements enclosing the inner ear mechanism), and the auditory ossicles.
There is a pathological incraese in bone turnover and density resulting in ankylosis (stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint) of the stapes.
Autosomal dominant genetic condition however it has variable penetrance and environmental factors such as (fluoride and measles infection) are thought to be critical in the phenotypic activation of the genetic susceptability.
It is managed by using bilateral hearing aids or via surgery.
Stapedectomy, removal of stapes footplate.
Stapedotomy, a small hole is inserted into the stapes improving the circulation of fluid within the cochlea canal.
Surgeries are very successful but come with usual risks + 1-2% risk total unlateral sensorineural hearing loss.
Describe the basic pathophysiology and management of noise related hearing loss?
Sensorineural hearing loss due to repeated loud noise exposure damaging the hair cells in the inner ear.
Management: No treatment or cure for noise induced hearing loss, management is on preventing further deterioration using hearing protection devices aka ear plugs, muffs etc.
Describe the basic pathophysiology and management of menieres?
A disorder of the inner caused by a change of fluid volume in the labyrinth.
There is a progressive distension of the membranous labyrinth, which is called ‘endolymphatic hydrops’.
This may injure the vestibular system, causing vertigo; or the cochlea, causing hearing loss. Aetiology is unknown but thought to be multifactorial.
Management:
Involves symptomatic control, treating nausea. Steroids have also been found to help acute attacks.
Prophylaxis for attacks: Certain foods are thought to be triggers, chocolate, caffeine, alcohol. As well as excessive fatigue.
DVLA need informing.
Describe the pathophysiology and management of tinnitus?
Can be idiopathic or noise induced can also occur with presbyacusis or as a symptom of another disease.
Management: If underlying cause treat it.
If no underlying cause:
Reassure patient that there it is nothing sinister. Relaxation techniques may help as it is linked with stress.
Tinnitus retraining therapy teaching the patient to habituate the tinnitus.
Describe the pathophysiology and management of Acoustic Neuroma?
It is a benign slow growing tumour of the schwann cell of the vestibularcochlea nerve, therefore it is also known as vestibular schwannoma (most arise from the vestibular portion). Although it is benign it can cause symptoms due to a pressure effect and can eventually be life threatening.
Management:
If the tumour is small and not causing significant hearing or balance issues, then a wait and watch approach is taken with annual follow ups.
Surgery is also an option and complete removal is often possible but there are many potential complications: Mortality (risk about 1%) CSF leak and meningitis Cerebellar injury Stroke Epilepsy Facial paralysis (either partial or complete) Hearing loss Balance impairment Persistent headache
Lastly patients can have a targeted radiotherapy known as sterotactic radiosurgery.
Describe the pathophysiology and management of otitis externa and furuncle?
Otitis externa is any inflammation of the outer ear and therefore can be caused by any skin infection. Therefore management involves treating the inflammation with anti-inflammatory meds or antimicrobials if infected.
If there is a furuncle it requires drainage this will often also relieve pain.
Describe the pathophysiology and management of haematoma?
The perichondrium shearing from the tightly adhered cartilage tearing the highly vascular layer forming a haematoma between the perichondrium and cartilage.
Management involves draining to prevent avascualr necrosis of the underlying cartilage.
Describe the pathophysiology and management of chondrodermatitis nodularis helicis?
Benign inflammatory condition in which a scaly tender nodule appears on the helix or antihelix.
Aetiology is linked to pressure and the anatomy of the pinnear and its blood supply. It is usually precipitated by pressure on the ear, sleeping on your ear every night, tight head gear etc.
Management:
May need an initial biopsy to rule out skin malignancy.
Treated conservatively aka avoid pressure, or with steroids or cryotherapy. Lastly it can be surgically excised.
Describe the pathophysiology and management of obscure auditory dysfunction (King Kopetzky Syndrome)?
This is a condition where there is no dyfunction with the conduction or sensory component of the ear but an issue in processing the sensory information.
Management:
Hearing therapies as in sessions to teach patients how to improve there listening.
Treatment of anxiety and or depression if present as shown to significantly worsen the symptoms of KKS, a focus of talking therapies should be used.
