Common Conditions of the Ear

Question 1

What do you treat otitis media with?

Answer 1

Oral Amoxycillin, 15mg/kg, 8 hourly

Cefuroxime if allergic

Question 2

When are antibiotics given in otitis media?

Answer 2

<2 years

Perforation

Cochlear implant

Indigenous

It is the only hearing ear

Immunodeficient

Complications - mastoiditis, facial paralysis

Question 3

Explain Weber’s test and how it is interrupted?

Answer 3

A vibrating tuning fork is placed on a boney prominence, equidistant from both ears

Patient reports where they hear the buzzing

If there is a conductive hearing loss then the sound will be louder in the effected ear as bone conduction will compensate

If there is sensorineural loss then it will be heard in the unaffected ear

Question 4

What pitch is worse heard with sensorineural hearing loss?

Answer 4

High pitch

Question 5

How is chronic suppurative otitis media characterised?

Answer 5

Tubotympanic disease - “safe”

Atticoantral disease - “unsafe”

Question 6

What are some complications from cholesteatomas?

Answer 6

Conductive or sensorineural hearing loss

Vertigo

Facial paralysis

Intracranial pathology

Question 7

How is Ramsay-Hunt mananged?

Answer 7

Steroids

Acyclovir if within 3 days

Eye patch and artificial tears if facial nerve involvement

Question 8

What is a cholesteatoma?

Answer 8

A squamous epithelium trapped in the temporal bone that can be congenital or secondary to tympanic membrane pathology

Question 9

What structures can refer pain to the ear?

Answer 9

Teeth

Sinuses

Throat

Cervical neck

Larynx

Temporomandibular

Question 10

What is Rinne’s test? How is it interrupted?

Answer 10

Place the vibrating fork on the mastoid process

If bone conduction is better than air then there is conductive hearing loss

Question 11

What symptoms do you get with vestibular neuritis?

Answer 11

Persistent vertigo following an acute infection

No hearing loss or tinnitus

Question 12

What manoeuvres are used in BPPV? What is the function of each one?

Answer 12

The Dix-Hallpike - Diagnosis

Epley - Treatment

Question 13

How is Meniere’s treated?

Answer 13

Diazepam or prochlorperazine for acute attacks

Lifestyle modification

Low salt diet

Thiazide diuretic or betahistine

Surgery

Question 14

What is the pathophysiology of BPPV?

Answer 14

Otoliths from the utricle become loose and lodge in the posterior semicircular canal

Question 15

Which symptoms do you get with meniere’s disease?

Answer 15

Intermittent vertigo - >30 minutes but <1 day

Tinnitus

Hearing loss

Fullness in the ear

Question 16

What is a potential complications of acute otitis media?

Answer 16

Chronic otitis media

Question 17

What are some common causative agents of otitis media?

Answer 17

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Question 18

What is chronic suppurative otitis media? What symptoms do patients get?

Answer 18

Recurrent or persistent bacterial infection that causes irreversible damage to the tympanic membrane and some the ossicles resulting in conductive hearing loss

Hearing loss

Itch

Discharge

Question 19

What is Ramsay-Hunt syndrome? What are the symptoms?

Answer 19

Reactivation of herpes-zoster in the facial nerve ganglion

Ear pain

Ataxia

Facial paralysis

Hearing loss

Question 20

Who should get middle ear ventilatory tubes?

Answer 20

OME for 4 months with other symptoms

Recurrent OME in an at risk group

OME and structure damage to the tympanic membrane

Question 21

Which part of the brain controls hearing?

Answer 21

Temporal lobe of the cerebral cortex