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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
What is cholesteatoma?
Keratinisation of ulcer | Like end-stage chronic otitis media
26
What are the complications of chronic suppurative otitis media with cholesteatoma?
Hearing loss - Conductive from erosion of ossicles - Sensorineural from erosion into labyrinth - Mixed Imbalance/vertigo from erosion into labyrinth
27
What is meant by the "safe" and "unsafe" zones when it comes to perforation of the eardrum?
``` Safe = tubutympanic disease - Central perforation Unsafe = attico-antral disease - Infection can spread to bone, nerves, etc - Cholesteatoma damages underlying bone ```
28
What investigations are needed in chronic suppurative otitis media with cholesteatoma?
MRI/CT to determine extent of damage
29
What are the symptoms of chronic suppurative otitis media?
Deafness Discharge Itchiness No pain
30
What is chronic suppurative otitis media?
Recurrent/persistent bacterial infection of ear Destruction of tympanic membrane and sometimes ossicles Irreversible problems
31
What are the complications of cholesteatoma?
``` 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
What do the results of Weber's test mean?
If conductive hearing loss - sound lateralises to worse hearing ear If sensorineural hearing loss - sound lateralises to better hearing ear
33
What do the results of Rinne's test mean?
Air conduction better than bone conduction > Rinne positive | Bone conduction better than air conduction > Rinne negative > conductive hearing loss
34
What are some causes of otorrhoea?
``` Wax Otitis externa Foreign body in ear canal Acute otitis media with perforation Chronic suppurative otitis media +/- cholesteatoma ```
35
What are the causes of otalgia?
``` Outer ear - Trauma - Otitis externa - Foreign body - Tumour Middle ear - Acute otitis media - Chronic suppurative otitis media - Middle ear tumour Referred otalgia ```
36
From where can pain be referred to the ear?
``` 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
What is Ramsay Hunt syndrome?
Herpes zoster oticus = reactivation of virus in geniculate ganglion
38
What are the clinical features of Ramsay Hunt syndrome?
``` 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
What is the management of herpes zoster oticus?
Oral steroids If seen within 3 days of onset of symptoms, acyclovir Audiology Protect eye from exposure keratopathy with artificial tears and pad
40
Why can facial paralysis occur with ear pathologies?
Facial nerve has course through middle ear and mastoid bone | Can be damaged in diseases of ear and surgery of ear
41
What is the benign paroxysmal positional vertigo (BPPV)?
Otoliths from utricle become loose | Lodge in posterior semicircular canal
42
How do you test for BPPV?
Hallpike manoeuvre
43
What is the Hallpike manoeuvre?
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
What is the management for BPPV?
Epley manoeuvre
45
What is the Epley manoeuvre?
Head turned 90 degrees to move otoliths Patient rolls onto opposite shoulder and faces bed Moves particles away from posterior semicircular canal
46
What is vestibular neuritis?
Abrupt onset of vertigo, possibly due to viral inflammation of vestibular ganglion No hearing loss/tinnitus Balance improves over few weeks
47
What are the features of Meniere's disease?
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
What is the management for Meniere's disease?
``` 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
What is the step-wise surgical treatment for Meniere's disease?
Endolymphatic sac surgery Gentamicin injections Vestibular nerve section Complete destruction of inner ear
50
What are the most common differential diagnoses for vertigo?
BPPV Meniere's disease Vestibular neuritis
51
If a baby has hearing loss, what is the management?
``` 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
What is the definition of sudden sensorineural hearing loss?
Occurs within 3 days In at least 3 frequencies At least 30 dB
53
What is the management for sudden sensorineural hearing loss?
Oral prednisolone

MD2 Surgery and Anaesthesia (31 decks)

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