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ENT > Diseases of the Ear > Flashcards

Diseases of the Ear Flashcards

1
Q

what is dizziness

A

non-specific term which may cover vertigo, pre-syncope etc

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2
Q

what is vertigo

A

a sensation of movement, usually spinning

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3
Q

what is one of the most common causes of vertigo

A

benign positional paroxysmal vertigo

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4
Q

what causes benign positional paroxysmal vertigo

A

otolith material from the utricle displaced into semicircular canals

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5
Q

what conditions cause benign positional paroxysmal vertigo

A

head trauma
ear surgery
idiopathic

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6
Q

what are the symptoms of benign positional paroxysmal vertigo

A

vertigo lasting seconds

no other symptoms

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7
Q

what causes the vertigo in benign positional paroxysmal vertigo

A

rolling over in bed
looking up
bending
moving head quickly

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8
Q

what is the investigation for benign positional paroxysmal vertigo

A

Hallpike test

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9
Q

what is the hall pike test

A

turn head to one side then lie down, symptoms should appear

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10
Q

what is the treatment of benign positional paroxysmal vertigo

A

1st line = Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercises

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11
Q

what is vestibular neuritis

A

prolonged vertigo that lasts days

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12
Q

what are the symptoms of vestibular neuritis

A

long-lasting vertigo

nausea/vomiting

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13
Q

what is the treatment of vestibular neuritis

A

supportive with vestibular sedatives

rehab exercises if prolonged

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14
Q

what is Ménière’s disease

A

recurrent, spontaneous, rotational vertigo with at least 2 episodes lasting >20mins (usually hours)

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15
Q

what are the symptoms of Ménière’s disease

A

tinnitus on affected side
aural fullness on affected side
documented hearing loss

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16
Q

what causes Ménière’s disease

A

unknown

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17
Q

what is the management of Ménière’s disease

A

supportive during episodes
tinnitus therapies
hearing aids

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18
Q

what is advised in the preventing of Ménière’s disease

A

restrict salt, caffeine, and alcohol

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19
Q

what is the treatment of Ménière’s disease

A

grommet insertion/meniette
intra-tympanic steroids
gentamicin
surgery = vestibular nerve section

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20
Q

what is labyrinthitis

A

prolonged vertigo lasting days

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21
Q

what are the symptoms of labyrinthitis

A

prolonged vertigo

tinnitus or hearing loss

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22
Q

what is the treatment of labyrinthitis

A

supportive with vestibular sedatives

rehab exercises if prolonged

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23
Q

what is the difference between labyrinthitis and vestibular neuritis

A

labyrinthitis has tinnitus or hearing loss

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24
Q

what is acute otitis media, what is it due to

A

URTI involving inflammation of the middle ear due to the infection travelling up the eustachian tube

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25
Q

who is commonly affected by acute otitis media

A

infants and children

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26
Q

what is the cause of acute otitis media

A

usually viral but occasionally can be bacterial

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27
Q

what is the cause of chronic acute otitis media

A

pseudomonas aeruginosa
staph aureus
fungal

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28
Q

what are the symptoms of acute otitis media

A

earache
associated with URTI and glue ear
no hearing loss

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29
Q

what is the investigations of acute otitis media

A

audiometry
tympanometry
swab of eardrum if it perforates

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30
Q

what is the treatment of acute otitis media

A

usually resolves within 4 days

review at 3 weeks if persisting

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31
Q

what is the treatment of acute otitis media lasting >3 weeks

A

1st line = amoxicillin

2nd line = erythromycin

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32
Q

when should you refer a patient with acute otitis media to a specialist

A

bilateral and lasting >3 weeks

speech/language/ behavioural problems

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33
Q

what surgery is used in the treatment of acute otitis media

A

<3 years = grommets
>3 years:
1st line = grommets
2nd line = grommets and adenoidectomy

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34
Q

what 3 conditions are involved in chronic otitis media

A

otitis media with effusion
cholesteatoma
perforation

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35
Q

what is otitis media with effusion

A

inflammation of the middle ear accompanied by accumulation of fluid without signs of acute inflammation

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36
Q

what is otitis media with effusion also know as

A

glue ear

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37
Q

what causes otitis media with effusion

A

eustachian tube dysfunction/obstruction
rhino-sinusitis (adult)
nasopharyngeal carcinoma or lymphoma (adult)

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38
Q

what are the symptoms of otitis media with effusion

A

CONDUCTIVE hearing loss
speech delay
poor school performance
behavioural issues

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39
Q

what are the investigations of otitis media with effusion

A

otoscopy
audiometry
flat tympanogram

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40
Q

what is seen on otoscope of a patient with otitis media with effusion

A

TM retraction
reduced TM mobility
altered TM colour
visible fluid/bubbles

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41
Q

what would be shown on audiometry of a patient with otitis media with effusion

A

CONDUCTIVE hearing loss

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42
Q

what is otitis externa

A

inflammation of the outer ear canal

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43
Q

what is otitis externa also known as

A

swimmer’s ear

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44
Q

what are the common bacterial causes of otitis externa

A

staph aureus
proteus spp
pseudomonas aeruginosa

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45
Q

what are the common fungal causes of otitis externa

A

aspergillus niger

candida albicans

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46
Q

what are the symptoms of otitis externa

A 
red, swollen ear canal
itchy = early stages
painful
discharge/increased ear wax
hearing may be affected
47
Q

what is the investigations of otitis externa

A

swab only in unresponsive or severe cases

48
Q

what is the treatment of bacterial otitis externa

A

topical aural toilet

gentamicin

49
Q

what is the treatment of otitis externa caused by aspergillus niger

A

topical clotrimazole

50
Q

what is malignant otitis externa

A

extension of otitis externa into the bone surrounding the ear canal

51
Q

what causes malignant otitis externa

A

pseudomonas aeruginosa

52
Q

what are the risk factors to develop malignant otitis externa

A

diabetes

radiotherapy to head and neck

53
Q

what are the symptoms of malignant otitis externa

A 
severe pain
headache
facial nerve palsy
exposed bone in ear canal 
granulation of tissue at bone-cartilage unction
54
Q

what are the investigations of malignant otitis externa

A

CRP
X-ray
culture

55
Q

what are the common causes of perforation

A

acute otitis media
cholesteatoma
trauma

56
Q

what is the treatment of perforation

A

usually heals spontaneously

57
Q

what is cholesteatoma

A

abnormal collection of skin cells (keratin) located in the ear that erode the surrounding bone

58
Q

where does cholesteatoma most commonly happen

A

pars tensa

pars flaccida = 2nd most common

59
Q

whats the histology of cholesteatoma

A

abnormally situation squamous epithelial
abundant keratin production
high cell turnover

60
Q

what are the symptoms of cholesteatoma

A

chronic oitis media
perforated TM
hearing loss
discharge

61
Q

what is the treatment of cholesteatoma

A

surgical excision and reconstruction

62
Q

what are the complication of a medial cholesteatoma

A

sensorineural hearing loss
tinnitus
vertigo
facial palsy

63
Q

what are the complication of a superior cholesteatoma

A

brain abscess

meningitis

64
Q

what are the complication of an inferior cholesteatoma

A

venous sinus thrombosis

65
Q

what causes a nasal fracture

A

trauma

66
Q

what are the symptoms of nasal fracture

A

pain
deviation/comesis
breathing issues

67
Q

what is the treatment of nasal fracture

A

review in ENT clinic 5-7 days post-injury

consider digital manipulation <3 weeks

68
Q

what are the complications of nasal fracture

A

epistaxis = nosebleed
CFS leak
meningitis
anosmia = cribriform plate fracture

69
Q

what makes epistaxis more common in a nasal fracture

A

if it is near the ant ethmoid artery

70
Q

what epistaxis

A

nosebleed

71
Q

where does the blood commonly come from in nosebleeds

A

“little’s area” on the anterior septum where the blood vessel anastomose

72
Q

what is the causes of epistaxis

A

idiopathic
trauma/foreign bodies
inflammation
tumour

73
Q

what re the investigations of epistaxis

A

anterior rhinoscopt
30 degree rigid nasendoscopy
FBC

74
Q

what is the treatment of epistaxis

A 
first aid
nasal packing
cautery = silver nitrate or diathermy 
topical vasoconstrictor
ligation
remove clot 
platelet tranfusion
75
Q

what topical vasoconstrictors are used in treatment of epistaxis

A

ligocaine + adrenaline

co-phenylcaine

76
Q

what causes a CSF leak

A

fracture usually at the cribriform plate

77
Q

whats the treatment of CSF leak

A

often settle spontaneously

surgical repair if not resolved within 10 days

78
Q

what are the two types of temporal bone fracture

A

longitudinal (80%)

transverse

79
Q

what causes longitudinal temporal bone fractures

A

lateral blow

80
Q

what are the symptoms of longitudinal temporal bone fractures

A

bleeding from external ear canal
haemotympanum causing conductive deafness
ossicular chain disruption causing conductive deafness
facial palsy (20%)

81
Q

what causes transverse temporal bone fractures

A

frontal blow

82
Q

what are the symptoms of transverse temporal bone fractures

A

damage to 8th CN causing sensorineural hearing loss
facial nerve palsy
vertigo

83
Q

where is a longitudinal temporal bone fracture located

A

Fracture line parallels the long axis of the petrous pyramid

84
Q

where is a transverse temporal bone fracture located, what can this result in

A

Fracture is at a right angles to the long axis of the petrous pyramid = can cross internal acoustic meatus causing damage to auditory and facial nerves

85
Q

what are the investigations of temporal bone fractures

A

X-ray
hearing test = weber’s test
EMG studies

86
Q

what is the treatment of temporal bone fracture

A

may need facial nerve decompression failing to improve

hearing restoration = hearing aid, ossiculoplasty

87
Q

what is vestibular schwannoma

A

BENIGN tumour of 7th CN nerve sheath within the internal acoustic meatus

88
Q

what is the cause of vestibular schwannoma

A

95% are sporadic

89
Q

what are the symptoms of vestibular schwannoma

A 
unilateral symptoms (95%)
if bilateral and young consider NF type 2 
circumscribed tan/yellow/white mass
progressive hearing loss/imbalance
tinnitus
90
Q

what is the investigation of vestibular schwannoma

A

MRI

91
Q

what are the 3 types of hearing loss

A

mixed
conductive
sensorineural

92
Q

what is mixed hearing loss

A

combination of conductive and sensorineural hearing loss due to damage in both he outer/middle ear AND the inner ear

93
Q

what causes mixed hearing loss

A

birth defect
tumours
head injury
specific diseases

94
Q

what is the investigation of mixed hearing loss

A

audiogram

95
Q

what would you expect on an audiogram of mixed hearing loss

A

significant gap between air and bone conduction

bone conduction is abnormal

96
Q

what is the cause of conductive hearing loss

A

sound is unable to pass freely to the inner ear

97
Q

what diseases cause conductive hearing loss

A

ear infections
middle ear fluid = glue ear
perforated ear drum
otosclerosis

98
Q

what is the investigation of conductive hearing loss

A

audiogram

99
Q

what would you expect to see on an audiogram of conductive hearing loss

A

significant gap between air and bone conduction

bone conduction is within normal limits

100
Q

what is otosclerosis

A

gradual onset of conductive hearing loss

101
Q

who is commonly affected by otosclerosis

A

women

progresses more rapidly during pregnancy

102
Q

what causes otosclerosis

A

fixation of stapes footplate

103
Q

what would you expect to see on audiogram of otosclerosis

A

conductive hearing loss

carhart’s notch at 2KHz

104
Q

what is the treatment of otosclerosis

A

correction via stapedectomy

105
Q

what is the cause of sensorineural hearing loss

A

damage to the hair cells within the cochlea or hearing nerve or both

106
Q

what is the treatment of sensorineural hearing loss

A

none, it is irreversible and has no cure

107
Q

what diseases cause sensorineural hearing loss

A 
noise-induced
drug-induced 
certain infections e.g. rubella
benign tumours on the auditory nerve
presbycusis
108
Q

what is the investigation of sensorineural hearing loss

A

audiogram

109
Q

what would you expect to see on an audiogram of sensorineural hearing loss

A

no gap between air and bone conduction

110
Q

what is presbycusis

A

hearing loss due to old age

111
Q

what is the symptoms of presbycusis

A

hearing loss = high pitches are lost first

112
Q

what drugs can cause hearing loss

A

gentamicin
chemo
aspirin/NSAID overdose

113
Q

what would you expect to see on an audiogram of noise-induced hearing loss

A

dip at 4kHz

114
Q

what is the treatment of noise-induced hearing loss

A

preventable with the correct ear protection

ENT (6 decks)

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