Diseases of the Ear Flashcards
what is dizziness
non-specific term which may cover vertigo, pre-syncope etc
what is vertigo
a sensation of movement, usually spinning
what is one of the most common causes of vertigo
benign positional paroxysmal vertigo
what causes benign positional paroxysmal vertigo
otolith material from the utricle displaced into semicircular canals
what conditions cause benign positional paroxysmal vertigo
head trauma
ear surgery
idiopathic
what are the symptoms of benign positional paroxysmal vertigo
vertigo lasting seconds
no other symptoms
what causes the vertigo in benign positional paroxysmal vertigo
rolling over in bed
looking up
bending
moving head quickly
what is the investigation for benign positional paroxysmal vertigo
Hallpike test
what is the hall pike test
turn head to one side then lie down, symptoms should appear
what is the treatment of benign positional paroxysmal vertigo
1st line = Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercises
what is vestibular neuritis
prolonged vertigo that lasts days
what are the symptoms of vestibular neuritis
long-lasting vertigo
nausea/vomiting
what is the treatment of vestibular neuritis
supportive with vestibular sedatives
rehab exercises if prolonged
what is Ménière’s disease
recurrent, spontaneous, rotational vertigo with at least 2 episodes lasting >20mins (usually hours)
what are the symptoms of Ménière’s disease
tinnitus on affected side
aural fullness on affected side
documented hearing loss
what causes Ménière’s disease
unknown
what is the management of Ménière’s disease
supportive during episodes
tinnitus therapies
hearing aids
what is advised in the preventing of Ménière’s disease
restrict salt, caffeine, and alcohol
what is the treatment of Ménière’s disease
grommet insertion/meniette
intra-tympanic steroids
gentamicin
surgery = vestibular nerve section
what is labyrinthitis
prolonged vertigo lasting days
what are the symptoms of labyrinthitis
prolonged vertigo
tinnitus or hearing loss
what is the treatment of labyrinthitis
supportive with vestibular sedatives
rehab exercises if prolonged
what is the difference between labyrinthitis and vestibular neuritis
labyrinthitis has tinnitus or hearing loss
what is acute otitis media, what is it due to
URTI involving inflammation of the middle ear due to the infection travelling up the eustachian tube
who is commonly affected by acute otitis media
infants and children
what is the cause of acute otitis media
usually viral but occasionally can be bacterial
what is the cause of chronic acute otitis media
pseudomonas aeruginosa
staph aureus
fungal
what are the symptoms of acute otitis media
earache
associated with URTI and glue ear
no hearing loss
what is the investigations of acute otitis media
audiometry
tympanometry
swab of eardrum if it perforates
what is the treatment of acute otitis media
usually resolves within 4 days
review at 3 weeks if persisting
what is the treatment of acute otitis media lasting >3 weeks
1st line = amoxicillin
2nd line = erythromycin
when should you refer a patient with acute otitis media to a specialist
bilateral and lasting >3 weeks
speech/language/ behavioural problems
what surgery is used in the treatment of acute otitis media
<3 years = grommets
>3 years:
1st line = grommets
2nd line = grommets and adenoidectomy
what 3 conditions are involved in chronic otitis media
otitis media with effusion
cholesteatoma
perforation
what is otitis media with effusion
inflammation of the middle ear accompanied by accumulation of fluid without signs of acute inflammation
what is otitis media with effusion also know as
glue ear
what causes otitis media with effusion
eustachian tube dysfunction/obstruction
rhino-sinusitis (adult)
nasopharyngeal carcinoma or lymphoma (adult)
what are the symptoms of otitis media with effusion
CONDUCTIVE hearing loss
speech delay
poor school performance
behavioural issues
what are the investigations of otitis media with effusion
otoscopy
audiometry
flat tympanogram
what is seen on otoscope of a patient with otitis media with effusion
TM retraction
reduced TM mobility
altered TM colour
visible fluid/bubbles
what would be shown on audiometry of a patient with otitis media with effusion
CONDUCTIVE hearing loss
what is otitis externa
inflammation of the outer ear canal
what is otitis externa also known as
swimmer’s ear
what are the common bacterial causes of otitis externa
staph aureus
proteus spp
pseudomonas aeruginosa
what are the common fungal causes of otitis externa
aspergillus niger
candida albicans
what are the symptoms of otitis externa
red, swollen ear canal itchy = early stages painful discharge/increased ear wax hearing may be affected
what is the investigations of otitis externa
swab only in unresponsive or severe cases
what is the treatment of bacterial otitis externa
topical aural toilet
gentamicin
what is the treatment of otitis externa caused by aspergillus niger
topical clotrimazole
what is malignant otitis externa
extension of otitis externa into the bone surrounding the ear canal
what causes malignant otitis externa
pseudomonas aeruginosa
what are the risk factors to develop malignant otitis externa
diabetes
radiotherapy to head and neck
what are the symptoms of malignant otitis externa
severe pain headache facial nerve palsy exposed bone in ear canal granulation of tissue at bone-cartilage unction
what are the investigations of malignant otitis externa
CRP
X-ray
culture
what are the common causes of perforation
acute otitis media
cholesteatoma
trauma
what is the treatment of perforation
usually heals spontaneously
what is cholesteatoma
abnormal collection of skin cells (keratin) located in the ear that erode the surrounding bone
where does cholesteatoma most commonly happen
pars tensa
pars flaccida = 2nd most common
whats the histology of cholesteatoma
abnormally situation squamous epithelial
abundant keratin production
high cell turnover
what are the symptoms of cholesteatoma
chronic oitis media
perforated TM
hearing loss
discharge
what is the treatment of cholesteatoma
surgical excision and reconstruction
what are the complication of a medial cholesteatoma
sensorineural hearing loss
tinnitus
vertigo
facial palsy
what are the complication of a superior cholesteatoma
brain abscess
meningitis
what are the complication of an inferior cholesteatoma
venous sinus thrombosis
what causes a nasal fracture
trauma
what are the symptoms of nasal fracture
pain
deviation/comesis
breathing issues
what is the treatment of nasal fracture
review in ENT clinic 5-7 days post-injury
consider digital manipulation <3 weeks
what are the complications of nasal fracture
epistaxis = nosebleed
CFS leak
meningitis
anosmia = cribriform plate fracture
what makes epistaxis more common in a nasal fracture
if it is near the ant ethmoid artery
what epistaxis
nosebleed
where does the blood commonly come from in nosebleeds
“little’s area” on the anterior septum where the blood vessel anastomose
what is the causes of epistaxis
idiopathic
trauma/foreign bodies
inflammation
tumour
what re the investigations of epistaxis
anterior rhinoscopt
30 degree rigid nasendoscopy
FBC
what is the treatment of epistaxis
first aid nasal packing cautery = silver nitrate or diathermy topical vasoconstrictor ligation remove clot platelet tranfusion
what topical vasoconstrictors are used in treatment of epistaxis
ligocaine + adrenaline
co-phenylcaine
what causes a CSF leak
fracture usually at the cribriform plate
whats the treatment of CSF leak
often settle spontaneously
surgical repair if not resolved within 10 days
what are the two types of temporal bone fracture
longitudinal (80%)
transverse
what causes longitudinal temporal bone fractures
lateral blow
what are the symptoms of longitudinal temporal bone fractures
bleeding from external ear canal
haemotympanum causing conductive deafness
ossicular chain disruption causing conductive deafness
facial palsy (20%)
what causes transverse temporal bone fractures
frontal blow
what are the symptoms of transverse temporal bone fractures
damage to 8th CN causing sensorineural hearing loss
facial nerve palsy
vertigo
where is a longitudinal temporal bone fracture located
Fracture line parallels the long axis of the petrous pyramid
where is a transverse temporal bone fracture located, what can this result in
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
what are the investigations of temporal bone fractures
X-ray
hearing test = weber’s test
EMG studies
what is the treatment of temporal bone fracture
may need facial nerve decompression failing to improve
hearing restoration = hearing aid, ossiculoplasty
what is vestibular schwannoma
BENIGN tumour of 7th CN nerve sheath within the internal acoustic meatus
what is the cause of vestibular schwannoma
95% are sporadic
what are the symptoms of vestibular schwannoma
unilateral symptoms (95%) if bilateral and young consider NF type 2 circumscribed tan/yellow/white mass progressive hearing loss/imbalance tinnitus
what is the investigation of vestibular schwannoma
MRI
what are the 3 types of hearing loss
mixed
conductive
sensorineural
what is mixed hearing loss
combination of conductive and sensorineural hearing loss due to damage in both he outer/middle ear AND the inner ear
what causes mixed hearing loss
birth defect
tumours
head injury
specific diseases
what is the investigation of mixed hearing loss
audiogram
what would you expect on an audiogram of mixed hearing loss
significant gap between air and bone conduction
bone conduction is abnormal
what is the cause of conductive hearing loss
sound is unable to pass freely to the inner ear
what diseases cause conductive hearing loss
ear infections
middle ear fluid = glue ear
perforated ear drum
otosclerosis
what is the investigation of conductive hearing loss
audiogram
what would you expect to see on an audiogram of conductive hearing loss
significant gap between air and bone conduction
bone conduction is within normal limits
what is otosclerosis
gradual onset of conductive hearing loss
who is commonly affected by otosclerosis
women
progresses more rapidly during pregnancy
what causes otosclerosis
fixation of stapes footplate
what would you expect to see on audiogram of otosclerosis
conductive hearing loss
carhart’s notch at 2KHz
what is the treatment of otosclerosis
correction via stapedectomy
what is the cause of sensorineural hearing loss
damage to the hair cells within the cochlea or hearing nerve or both
what is the treatment of sensorineural hearing loss
none, it is irreversible and has no cure
what diseases cause sensorineural hearing loss
noise-induced drug-induced certain infections e.g. rubella benign tumours on the auditory nerve presbycusis
what is the investigation of sensorineural hearing loss
audiogram
what would you expect to see on an audiogram of sensorineural hearing loss
no gap between air and bone conduction
what is presbycusis
hearing loss due to old age
what is the symptoms of presbycusis
hearing loss = high pitches are lost first
what drugs can cause hearing loss
gentamicin
chemo
aspirin/NSAID overdose
what would you expect to see on an audiogram of noise-induced hearing loss
dip at 4kHz
what is the treatment of noise-induced hearing loss
preventable with the correct ear protection
