Common Conditions of the Ear Flashcards
For what do the symbols on an audiogram stand?
O = right ear, air conduction X = left ear, air conduction [ = right ear, bone conduction ] = left ear, bone conduction
What is the hearing threshold for normal hearing?
20 dB or better
What is mild hearing loss?
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
What is moderate hearing loss?
41-60 dB Miss most of conversation Pronunciation not clear Difficulty in background noise Limited vocabulary
What is severe hearing loss?
61-90 dB Won't hear most conversational speech Speech and language don't develop spontaneously Very limited vocabulary Pronunciation not clear
What can be done to facilitate language learning in children with severe hearing loss?
Hearing aids
Visual cues
What is profound hearing loss?
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
What is sensorineural hearing loss?
Air and bone conduction similar
Hearing threshold worse than 20 dB
- Can’t hear high pitched and soft noises
What is conductive hearing loss?
Hearing threshold 20 dB or better for bone conduction
Hearing threshold worse than 20 dB for air conduction
What is mixed hearing loss?
Hearing threshold worse than 20 dB for bone and air conduction
Air and bone conduction different
What is the most common cause of otitis externa?
Fungal infection
What is the epidemiology of otitis externa due to Aspergillus?
More common if swimming in river
More common in Indigenous Australians
What is the management for otitis externa?
Analgesia Ear toilet/cleaning Topical antifungal therapy; eg: - Clioquinol - Flumethasone
What are the common organisms that cause otitis media?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What is the management for otitis media?
Analgesia
Ear toilet/cleaning
Antibiotics
Follow-up in 2-3 months to check for fluid and healing of eardrum
Is treatment with oral antibiotics necessary in otitis media?
No, usually resolves spontaneously
Associated perforation of eardrum also resolves spontaneously, but worried about secondary bacterial infections in meantime
Who, with otitis media, should be treated with oral antibiotics?
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
Which antibiotics are used to treat otitis media?
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
What is the route of administration of antibiotics in the treatment of otitis media with perforation?
Topical if tympanic membrane perforation
- Use non-ototoxic medication like ciprofloxacin
Generally use oral antibiotics, too
What is glue ear?
Chronic otitis media with effusion
What is the management for chronic otitis with effusion?
Audiogram to confirm hearing loss
- Determine if sensorineural component
Consider insertion of middle ear ventilation tubes = grommets
What are the indications for middle ear ventilation tubes?
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
What defines a child as being at risk, when it comes to deciding whether or not grommets are needed?
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
How are grommets removed?
Drop out by themselves once their job is done > eardrum takes over
What is cholesteatoma?
Keratinisation of ulcer
Like end-stage chronic otitis media
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
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
What investigations are needed in chronic suppurative otitis media with cholesteatoma?
MRI/CT to determine extent of damage
What are the symptoms of chronic suppurative otitis media?
Deafness
Discharge
Itchiness
No pain
What is chronic suppurative otitis media?
Recurrent/persistent bacterial infection of ear
Destruction of tympanic membrane and sometimes ossicles
Irreversible problems
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
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
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
What are some causes of otorrhoea?
Wax Otitis externa Foreign body in ear canal Acute otitis media with perforation Chronic suppurative otitis media +/- cholesteatoma
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
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
What is Ramsay Hunt syndrome?
Herpes zoster oticus = reactivation of virus in geniculate ganglion
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
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
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
What is the benign paroxysmal positional vertigo (BPPV)?
Otoliths from utricle become loose
Lodge in posterior semicircular canal
How do you test for BPPV?
Hallpike manoeuvre
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
What is the management for BPPV?
Epley manoeuvre
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
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
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
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
What is the step-wise surgical treatment for Meniere’s disease?
Endolymphatic sac surgery
Gentamicin injections
Vestibular nerve section
Complete destruction of inner ear
What are the most common differential diagnoses for vertigo?
BPPV
Meniere’s disease
Vestibular neuritis
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
What is the definition of sudden sensorineural hearing loss?
Occurs within 3 days
In at least 3 frequencies
At least 30 dB
What is the management for sudden sensorineural hearing loss?
Oral prednisolone
