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ENT > Diseases Of Inner Ear > Flashcards

Diseases Of Inner Ear Flashcards

Sensorineural hearing loss

1
Q

Sensorineural hearing loss

A

Lesions to the cochlea, 8th nerve or central auditory pathway prevent transmission of acoustic vibrations and frequency specific action potentials

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2
Q

Aetiology of SNHL

A

Congenital or Acquired Unilateral or bilateral

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3
Q

Common causes of unilateral SNHL

A

Sudden onset SNHL Menieres Vestibular schwannoma Trauma to temporal bone (fractures and head injury) Infections (bacteria. Viral, meningitis, labrynthitis) Iattogenic post OP deafness Acoustic trauma

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4
Q

Common causes of bilateral SNHL

A

Presbycusis Ototoxicity Familial progressive hearing loss Systemic disease (DM, SLE, hypothyroidism) All unilateral causes affecting both ears Autoimmune inner ear disease Noise induced occupational hearing loss

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5
Q

SNHL clinical fetaures

A

Hearing loss from birth or gradual. Onset may also be sudden. Difficulty hearing in noisy surroundings and where people are talking from different directions Speech and word discrimination difficult

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6
Q

SNHL rehab

A

Hearing aid

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7
Q

Presbycusis

A

Hearing loss condition associated with aging process

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8
Q

The type of hearing loss in SNHL

A

Bilaterally symmetrical

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9
Q

How to diagnose SNHL

A

Pure tone audiometry. Showing bilateral hearing loss. Reduction of both air and bone reduction. No air- bone gap

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10
Q

What do you need to rule out in a unilateral hearing loss

A

Vestibular schwannomas Cerebello Pontine angle tumours

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11
Q

Ototoxicity

A

The tendency of certain therapeutic agents to damage tissues of inner ear

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12
Q

Clinical features of ototoxicity

A

Tinnitus Hearing loss Disequilibrium

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13
Q

Tinnitus in SNHL

A

Initially high pitched, continuous then low pitched when damage continues. Early warning sign of inner ear damage

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14
Q

Hearing loss in SNHL

A

Often gradual but immediate with loop diuretics

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15
Q

Vertigo in SNHL

A

True vertigo is rare, as both ears are affected symmetrically

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16
Q

Where does disequilibrium predominantly occur

A

With vestibulotoxic drugs

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17
Q

Common ototoxic drugs

A

Aminoglycoside antibiotics Loop diuretics (furosemide) Salicylates (aspirin) Quinine Cisplatin and carboplatin Erythromycin Chloramphenicol Indomethacin Ibuprofen Propranolol Propylthiouracil

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18
Q

Noise induced hearing loss

A

Decline in hearing acuity due to noise exposure

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19
Q

Acoustic trauma

A

Single exposure to intense, loud sound from firecrackers, fire arms, blasts

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20
Q

Vertigo

A

False sense of motion, either of environment or of 8individual when there is nonen

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21
Q

Benign paroxysmal positional vertigo

A

Spinning sensation when head is placed in certain position

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22
Q

To confirm BPPV

A

Dix-Hallpike

23
Q

BPPV aetiology

A

Free floating otoconial debris from the utricle or saccule settled in semicircular canal. Moves with endolymph pt itself moves causing vertigo

24
Q

BPPV treatment

A

Epleys manouevre

25
Q

Vestibular neuronitis

A

Sudden onset of severe vertigo which lasts for several days to weeks

26
Q

Clinical features if vestibular neuronitis

A

Acutely unwell Pt lies still on bed Nausea and vomiting Vestibular Weakness

27
Q

Vestibular neuronitis treatment

A

Vestibular sedatives Anxiolytics Vestibular rehabilitation therapy

28
Q

Tinnitus

A

Perfection of sound in absence of any external source¹

29
Q

Subjective tinnitus

A

Only heard by patient Ringing Buzzing Hissing Roaring

30
Q

Otologic causes of tinnitus

A

Impacted cerumem, Otitis externa OME Otosclerosis Meniers disease Noise trauma Ototoxic drugs tumours of CN 8 Presbycusis

31
Q

Non otologic causes of tinnitus

A

CNS: stroke, tumors, MS, epilepsy, migraine Anaemia Hypertension Hypoglycemia Metabolic disturbance

32
Q

Objective tinnitus vascular causes

A

Aberrant internal carotid artery High and dehiscent jugular bulb Glomus tumours Arteriosclerosis AV malformations

33
Q

Aetiology of tinnitus

A

Anything that reduces hearing By everyone when exposed to loud noise

34
Q

Tinnitus investigations

A

Pure tone audiometry MRI CT NEURO evaluation

35
Q

Most common cause of facial nerve paralysis

A

Bells palsy

36
Q

Bells palsy

A

Most common CN neuro disorder. Cause of 60-65% of all facial nerve paralysis. Acute onset peripheral lower motor neuron facial nerve paralysis

37
Q

Aetiology of Bell’s palsy

A

HSV that enters the lips and moves to geniculate region Reactivated in stress causing loss of myelin and temporary facial nerve paralysis Herpes Zoster (Ramsay Hunt syndrome)

38
Q

Pathophysiology of Bells palsy

A

Vascular ischemia Inflammation and oedema of nerve Increased pressure in bony Fallopian canal and further ischemia Borrelia infection, autoimmune reaction, microvascular disease and inflammation

39
Q

Bell’s palsy clinical features

A

Wekaness of sudden onset affecting upper and lower face unilaterally Flat forehead and nasolabial fold Inability to raise eyebrow Face deviates to normal side when smiling Poor eyelid closure Post auricular pain or ear may precede the weakness Epiphora Loud sound intolerance Nostalgia ocular pain Blurry vision Taste disturbance

40
Q

How to grade facial wekaness of Bells palsy

A

House Brackmann grading system

41
Q

Bell’s palsy treatment

A

Eye care Oral steroids Antivirals like acyclovir

42
Q

Ramsay Hunt syndrome

A

Herpes Zoster infection resulting in facial nerve paralysis. 10-12% of facial paralysis

43
Q

Herpes Zoster oticus clinical features

A

Burning pain in ear Vesicular rash Dizziness Tinnitus Hearing loss

44
Q

Labrynthitis

A

Ingectice trauma or COM complicationaffects entire lanynth. Cayses6inflammaton sippration is irreversible

45
Q

The triad of Menieres disease

A

episodic vertigo, fluctuating hearing loss and tinnitus,

46
Q

What is often associated with the triad of Menieres

A

Aural fullness

47
Q

Evaluation in Menieres disease

A

Clinical examination of the ear reveals no abnormalities.

Tuning fork tests will show the presence of sensori-neural hearing loss of a varying degree (positive Rinne’s test, Weber lateralising to the better ear).

Nystagmus can be appreciated during an acute attack

48
Q

Diagnosis in Menieres

A

Pure tone audiometry reveals sensorineural hearing loss.

49
Q

The characteristics of sensorineural hearing loss in Menieres

A

Early in the disease the hearing loss is more at lower frequencies with an up-sloping audiometric curve; however, as the disease progresses, hearing decreases further, whereby affecting all frequencies with the curve flattening out

50
Q

Tumours of the inner ear

A

Acoustic neuroma

51
Q

What is acoustic neuroma?

A

It is a benign tumour, arising from the Schwann cells of the vestibular nerve. Thus, it is also called the vestibular schwannoma. It affects individuals in the 4 th to 6th decades

52
Q

Aetiology of acoutic neuroma

A

The only predisposing factor, which increases its incidence, is exposure to radiation. Bilateral acoustic neuromas are seen in patients with neurofibromatosis II.

53
Q

Clinical features of acoustic neuroma

A

Unilateral hearing loss and tinnitus are very common presenting features

There is compress the VIIIth cranial nerve, producing hearing loss

Vertigo is not common as the tumour grows quite slowly,

As tumours grow larger, the trigeminal nerve can be affected, causing facial numbness

Paraesthesia and hypoaesthesia of the posterior meatal wall

Cerebellar signs

ENT (11 decks)

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