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HNN > Conditions Of The Ear > Flashcards

Conditions Of The Ear Flashcards

1
Q

What conditions can affect the pinna?

A
  • Perichondritis
  • Ramsay Hunt Syndrome
  • Cauliflower ear
  • Pinna Haematoma
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2
Q

Presentation of Ramsay Hunt Syndrome

A

Facial nerve palsy
Painful red ear with vesicles

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3
Q

What is a pinna haematoma?

A

Accumulation of blood between cartilage and overlying perichondrium

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4
Q

What is a pinna haematoma due to?

A

Blunt trauma
eg. Contact sport

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5
Q

What happens to an untreated pinna haematoma?

A
  • cartilage is deprived of blood + pressure necrosis
  • fibrosis of cartilage > new asymmetrical cartilage development (cauliflower ear)
  • hearing not impaired but cosmetic implications
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6
Q

Treatment of pinna haematoma

A
  • Drainage + aspirate
  • Prevent re-accumulation using a dressing between the two layers
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7
Q

What conditions affect the external auditory meatus?

A
  • acute otitis externa
  • necrotising otitis externa
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8
Q

What is acute otitis externa?

A

Inflammation of external acoustic meatus usually due to infection (staph aureus or pseudomonas aeruginosa)

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9
Q

What organism normally causes otitis externa?

A

staphylococcus aureus
pseudomonas aeruginosa

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10
Q

Presentation of acute otitis externa

A

Otalgia
Custard like discharge
+/- hearing loss

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11
Q

Risk factors of acute otitis externa

A
  • injury to EAM e.g. scratch from itching
  • swimming
  • warm weather
  • skin problems e.g. eczema
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12
Q

Treatment of acute otitis externa

A

Ear drops
(Topical antibiotics +/- steroids)

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13
Q

Presentation of necrotising otitis externa

A
  • severe otalgia (may keep them up at night)
  • purulent discharge
  • non resolving acute otitis externa
  • hearing loss
  • CN involvement
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14
Q

What is the main organism that causes necrotising otitis externa?

A

Pseudomonas aeruginosa

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15
Q

Risk factors of necrotising otitis externa

A
  • male
  • diabetic
  • immunocompromised
  • > 65 years old
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16
Q

What is necrotising otitis externa?

A
  • complication of otitis externa
  • infection spreads deeper > osteomyelitis of temporal bone + skull base
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17
Q

Treatment of necrotising otitis externa

A
  • IV antibiotics
  • Analgesia
  • Discharged with oral antibiotics (+ topical drops)
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18
Q

What is the best imagining if suspecting necrotising otitis externa?

A

CT of temporal bone

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19
Q

Why are middle ear infections more common in children?

A

Shorter, more horizontal pharyngotympanic tube

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20
Q

Conditions affecting the middle ear

A

Acute otitis media (+/- effusion)
Mastoiditis
Cholesteatoma

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21
Q

What is acute otitis media?

A

Middle ear infection

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22
Q

Presentation of acute otitis media

A
  • infants
  • otalgia (child pulling ear as can’t communicate)
  • fever
  • red +/- bulging tympanic membrane
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23
Q

Treatment of acute otitis media

A
  • most will resolve in 3-7 days
  • analgesia e.g. calpol, paracetamol
  • back up antibiotic prescription if doesn’t self resolve - amoxicillin
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24
Q

Complications of acute otitis media

A
  • tympanic membrane perforation
  • facial nerve involvement
  • mastoiditis
  • intracranial complications e.g. meningitis, sigmoid sinus thrombosis, brain abscess
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25
Q

Presentation of mastoiditis

A
  • sharp angle behind hear lost (boggy oedema)
  • pinna pushed down and forward
  • unwell + fever
  • signs + symptoms of acute otitis media
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26
Q

How can infection spread from the middle ear to the mastoid bone?

A

Middle ear > mastoid antrum > mastoid air cell (mastoid bone)

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27
Q

Presentation of otitis media with effusion

A

Well child
Hearing loss (like turning up the tv)

28
Q

What is otitis media with effusion due to?

A
  • due to pharyngotympanic dysfunction
  • negative pressure in middle ear + inflammatory fluid activation
  • decreased mobility of TM + ossicles > affecting hearing
29
Q

What is another name for otitis media with effusion?

A

Glue ear

30
Q

Treatment of otitis media with effusion

A
  • most resolve in 2-3 months
  • grommets to maintain equilibration of pressures
31
Q

Function of grommets

A

Act to maintain equilibration of pressures

32
Q

What is cholesteatoma?

A
  • congenital or acquired
  • retraction pocket in tympanic membrane > dead skin accumulates
  • grows into middle ear and beyond
33
Q

Presentation of cholesteatoma

A
  • foul smelling discharge from ear
  • +/- progressive hearing loss
34
Q

Treatment of cholesteatoma

A

Surgical treatment
(Mastoidectomy)

35
Q

Conditions that affect the inner ear

A
  • age related hearing loss (presbycusis)
  • Benign paroxysmal positional vertigo
  • Meniere’ disease
  • acute labyrinthitis + acute vestibular neuronitis
36
Q

What is presbycusis?

A

Age related hearing loss
Bilateral + gradual

37
Q

Presentation of Ménière’s disease

A
  • 40-60 years
  • Unilateral
  • Vertigo (potentially associated with aural fullness, N+V)
  • Tinnitus
  • Hearing loss
  • between 20 mins to several hours
38
Q

Typical history of a patient with BPPV

A
  • older
  • episodes of short lived vertigo in response to change in position
39
Q

Treatment of BPPV
How does it work?

A

Epley manoeuvre
Moves the otoliths back into the utricle + saccule

40
Q

How does BPPV happen?

A

Otoliths in semicircular canals move due to change in position which is perceived by the body as movement > vertigo

41
Q

Diagnosis of BPPV

A

Dix-Hallpike manoeuvre

42
Q

Where are otoliths normally located?

A

Utricle
Saccule

43
Q

Triad of Ménière’s disease

A

Vertigo
Tinnitus
Hearing loss

44
Q

Describe acute labyrinthitis

A
  • prior history of URTI
  • involvement of all inner ear structures
  • hearing loss
  • tinnitus
  • vomiting
  • vertigo
45
Q

Presentation of acute labyrinthitis

A

Hearing loss
Tinnitus
Vomiting
Vertigo
Prior history of URTI

46
Q

Presentation of acute vestibular neuronitis

A
  • Suddent onset vomiting
  • Severe vertigo lasting days
  • No hearing loss or tinnitus
47
Q

Compare the presentation of acute labyrinthitis + acute vascular neuronitis

A
  • both present with vomiting + vertigo (more severe in AVN)
  • only hearing loss + tinnitus in AL
48
Q

What is needed if a patient presents with sudden onset unilateral hearing loss with no explanation?

A
  • immediate referral to ENT
  • need to rule out sudden sensorineural hearing loss + acosutic neuroma
49
Q

Describe conductive hearing loss
Examples

A

Pathology involving the external or middle ear
e.g. wax, acute otitis media, otitis media with effusion, otosclerosis

50
Q

Presentation of otosclerosis

A

Gradual hearing loss
Unilateral > bilateral overtime
Otherwise well
Tinnitus
Young female

51
Q

What is otosclerosis?

A

Gradual hearing loss over years
Due to bony growth on stapes

52
Q

Treatment of otosclerosis

A

Hearing aids
Surgical (replacing stapes with prosthesis)

53
Q

Describe sensorineural hearing loss
Examples

A

Pathology involving inner ear structures or vestibulocochlear nerve
e.g. age related hearing loss, noise related hearing loss, Meinere’s disease, ototoxic meds, acoustic neuroma, suddent sensorineural hearing loss

54
Q

What is an acoustic neuroma?

A
  • Benign slow growing posterior cranial fossa tumour
  • Involves Schwann cells of vestibular component of CN VIII

(also called a vestibular schwannoma)

55
Q

Presentation of acoustic neuroma

A

Unilateral hearing loss
Tinnitus
Vertigo
Facial nerve palsy

56
Q

What is needed to diagnose acoustic neuroma?

A

MRI

57
Q

Treatment of acoustic neuroma

A

Observe if small
Surgery
Radiation

58
Q

Describe what you would see during an otoscope exam in a child with otitis media with effusion?

A
  • TM is retracted due to negative pressure
  • loss of cone of light
  • straw coloured fluid
59
Q

Parts of the surface anatomy of the external ear

A

Helix
Antihelix
Concha
Tragus
Antitragus
Lobule

60
Q

Is air or bone conduction better normally?

A

Air conduction is better

61
Q

In conductive hearing loss, is air or bone conduction better?

A

Bone conduction

62
Q

In sensorineural hearing loss is air or bone conduction better?

A

Air conduction

63
Q

Normal findings of a Weber’s test

A

Centre
(Equal in both ears)

64
Q

Findings of a Weber’s test in conductive hearing loss

A

Sound lateralises towards pathology

65
Q

Findings of Weber’s test in sensorineural hearing loss

A

Sound lateralises away from pathology

66
Q

A patient come to the GP complaining of a foul smelling discharge coming from their ear, what is the most likely diagnosis?

A

Cholesteatoma

67
Q

What organism causes Ramsay Hunt syndrome?

A

Varicella zoster

HNN (24 decks)

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