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MD2 Surgery and Anaesthesia > Common Conditions of the Ear > Flashcards

Common Conditions of the Ear Flashcards

1
Q

For what do the symbols on an audiogram stand?

A 
O = right ear, air conduction
X = left ear, air conduction
[ = right ear, bone conduction
] = left ear, bone conduction
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2
Q

What is the hearing threshold for normal hearing?

A

20 dB or better

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3
Q

What is mild hearing loss?

A

20-40 dB
May not realise you have it
Can get with age
Manage in quiet situations with clear voices
Difficult to hear soft speech and conversation
Difficult to hear in background noise

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4
Q

What is moderate hearing loss?

A 
41-60 dB
Miss most of conversation
Pronunciation not clear
Difficulty in background noise
Limited vocabulary
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5
Q

What is severe hearing loss?

A 
61-90 dB
Won't hear most conversational speech
Speech and language don't develop spontaneously
Very limited vocabulary
Pronunciation not clear
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6
Q

What can be done to facilitate language learning in children with severe hearing loss?

A

Hearing aids

Visual cues

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7
Q

What is profound hearing loss?

A

91 dB or worse
Can’t hear speech sounds
Speech won’t develop without hearing aid/cochlear implant
Will need manual communication for language if no implant

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8
Q

What is sensorineural hearing loss?

A

Air and bone conduction similar
Hearing threshold worse than 20 dB
- Can’t hear high pitched and soft noises

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9
Q

What is conductive hearing loss?

A

Hearing threshold 20 dB or better for bone conduction

Hearing threshold worse than 20 dB for air conduction

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10
Q

What is mixed hearing loss?

A

Hearing threshold worse than 20 dB for bone and air conduction
Air and bone conduction different

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11
Q

What is the most common cause of otitis externa?

A

Fungal infection

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12
Q

What is the epidemiology of otitis externa due to Aspergillus?

A

More common if swimming in river

More common in Indigenous Australians

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13
Q

What is the management for otitis externa?

A 
Analgesia
Ear toilet/cleaning
Topical antifungal therapy; eg:
- Clioquinol
- Flumethasone
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14
Q

What are the common organisms that cause otitis media?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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15
Q

What is the management for otitis media?

A

Analgesia
Ear toilet/cleaning
Antibiotics
Follow-up in 2-3 months to check for fluid and healing of eardrum

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16
Q

Is treatment with oral antibiotics necessary in otitis media?

A

No, usually resolves spontaneously
Associated perforation of eardrum also resolves spontaneously, but worried about secondary bacterial infections in meantime

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17
Q

Who, with otitis media, should be treated with oral antibiotics?

A 
2 years old or less
Tympanic membrane perforation
Indigenous Australian
Known immune deficiency
Cochlear implant
Only hearing ear infected
Possible complications; eg:
- Mastoiditis
- Facial paralysis
- Intracranial complications
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18
Q

Which antibiotics are used to treat otitis media?

A 
Amoxicillin
Cefuroxime
- If allergic to penicillins
Amoxicillin + clavulanic acid
- If recurrent acute otitis media
- If no improvement in acute symptoms after 48 hours of amoxicillin
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19
Q

What is the route of administration of antibiotics in the treatment of otitis media with perforation?

A

Topical if tympanic membrane perforation
- Use non-ototoxic medication like ciprofloxacin
Generally use oral antibiotics, too

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20
Q

What is glue ear?

A

Chronic otitis media with effusion

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21
Q

What is the management for chronic otitis with effusion?

A

Audiogram to confirm hearing loss
- Determine if sensorineural component
Consider insertion of middle ear ventilation tubes = grommets

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22
Q

What are the indications for middle ear ventilation tubes?

A

Otitis media with effusion for at least 4 months, with hearing loss/other symptoms and signs
Recurrent/persistent otitis media with effusion in at risk child, regardless of hearing
Otitis media with effusion and structural damage to tympanic membrane

23
Q

What defines a child as being at risk, when it comes to deciding whether or not grommets are needed?

A

Has increased risk of developmental difficulties due to factors not related to otitis media with effusion

  • Physical; eg: cleft palate
  • Sensory; eg: visual impairment
  • Cognitive; eg: developmental delay
  • Behavioural; eg: autism spectrum
24
Q

How are grommets removed?

A

Drop out by themselves once their job is done > eardrum takes over

25
Q

What is cholesteatoma?

A

Keratinisation of ulcer

Like end-stage chronic otitis media

26
Q

What are the complications of chronic suppurative otitis media with cholesteatoma?

A

Hearing loss
- Conductive from erosion of ossicles
- Sensorineural from erosion into labyrinth
- Mixed
Imbalance/vertigo from erosion into labyrinth

27
Q

What is meant by the “safe” and “unsafe” zones when it comes to perforation of the eardrum?

A 
Safe = tubutympanic disease
- Central perforation
Unsafe = attico-antral disease
- Infection can spread to bone, nerves, etc
- Cholesteatoma damages underlying bone
28
Q

What investigations are needed in chronic suppurative otitis media with cholesteatoma?

A

MRI/CT to determine extent of damage

29
Q

What are the symptoms of chronic suppurative otitis media?

A

Deafness
Discharge
Itchiness
No pain

30
Q

What is chronic suppurative otitis media?

A

Recurrent/persistent bacterial infection of ear
Destruction of tympanic membrane and sometimes ossicles
Irreversible problems

31
Q

What are the complications of cholesteatoma?

A 
Ossicle erosion > conductive hearing loss
Erosion into labyrinth > sensorineural hearing loss
Labyrinthine fistula > vertigo
Facial paralysis
- Acute if superimposed infection
- Gradual and subtle
Intracranial
- Can be life-threatening
32
Q

What do the results of Weber’s test mean?

A

If conductive hearing loss - sound lateralises to worse hearing ear
If sensorineural hearing loss - sound lateralises to better hearing ear

33
Q

What do the results of Rinne’s test mean?

A

Air conduction better than bone conduction > Rinne positive

Bone conduction better than air conduction > Rinne negative > conductive hearing loss

34
Q

What are some causes of otorrhoea?

A 
Wax
Otitis externa
Foreign body in ear canal
Acute otitis media with perforation
Chronic suppurative otitis media +/- cholesteatoma
35
Q

What are the causes of otalgia?

A 
Outer ear
- Trauma
- Otitis externa
- Foreign body
- Tumour
Middle ear
- Acute otitis media
- Chronic suppurative otitis media
- Middle ear tumour
Referred otalgia
36
Q

From where can pain be referred to the ear?

A 
Paranasal sinuses - CN V
Oropharynx - CN IX
- Post-tonsillectomy
- Carcinoma of tongue base
Laryngopharynx - CN X
- Pyriform fossa
Upper molar teeth, temporomandibular joint, parotid gland - CN V3
Cervical spine - C2, C3
37
Q

What is Ramsay Hunt syndrome?

A

Herpes zoster oticus = reactivation of virus in geniculate ganglion

38
Q

What are the clinical features of Ramsay Hunt syndrome?

A 
Vesicular rash on external ear
LMN paralysis of facial nerve
Loss of taste over anterior 2/3 of tongue
If CN VIII also involved
- Hearing loss
- Vertigo/imbalance
39
Q

What is the management of herpes zoster oticus?

A

Oral steroids
If seen within 3 days of onset of symptoms, acyclovir
Audiology
Protect eye from exposure keratopathy with artificial tears and pad

40
Q

Why can facial paralysis occur with ear pathologies?

A

Facial nerve has course through middle ear and mastoid bone

Can be damaged in diseases of ear and surgery of ear

41
Q

What is the benign paroxysmal positional vertigo (BPPV)?

A

Otoliths from utricle become loose

Lodge in posterior semicircular canal

42
Q

How do you test for BPPV?

A

Hallpike manoeuvre

43
Q

What is the Hallpike manoeuvre?

A

Patient lies down with head down and turned to one side
Turning head to right tests for right BPPV
After latency of few seconds > vertigo and rotational nystagmus towards floor
Lasts <1 min

44
Q

What is the management for BPPV?

A

Epley manoeuvre

45
Q

What is the Epley manoeuvre?

A

Head turned 90 degrees to move otoliths
Patient rolls onto opposite shoulder and faces bed
Moves particles away from posterior semicircular canal

46
Q

What is vestibular neuritis?

A

Abrupt onset of vertigo, possibly due to viral inflammation of vestibular ganglion
No hearing loss/tinnitus
Balance improves over few weeks

47
Q

What are the features of Meniere’s disease?

A

At least 3 of
- Vertigo - lasts for at least half an hour, but less than a day
Fullness in ear
Roaring tinnitus
Initially low-frequency sensorineural hearing loss > fluctuates > becomes worse and permanent

48
Q

What is the management for Meniere’s disease?

A 
Acute episodes
- Vestibular suppressants like 
   - Prochlorperazine
   - Diazepam
Maintenance therapy
- Determine if any reversible stresses in her life
- Low salt diet
- Medications if persistent problems
   - Thiuzide diuretic
   - Betahistine
In 20%, vertigo continues to be disabling
- Surgery to improve vertigo
Hearing aids for hearing loss
49
Q

What is the step-wise surgical treatment for Meniere’s disease?

A

Endolymphatic sac surgery
Gentamicin injections
Vestibular nerve section
Complete destruction of inner ear

50
Q

What are the most common differential diagnoses for vertigo?

A

BPPV
Meniere’s disease
Vestibular neuritis

51
Q

If a baby has hearing loss, what is the management?

A 
Aim to have hearing aid use established by 6 months
Early intervention program
Ophthalmology referral
Paediatrician
Referral for genetic counselling
Application for Centrelink benefits
52
Q

What is the definition of sudden sensorineural hearing loss?

A

Occurs within 3 days
In at least 3 frequencies
At least 30 dB

53
Q

What is the management for sudden sensorineural hearing loss?

A

Oral prednisolone

MD2 Surgery and Anaesthesia (31 decks)

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