Disorders of the Ear Flashcards
In which parts of the ear would you experience a conductive vs Sensorineural hearing loss?
Give examples of specific structures
Conductive hearing loss: external and middle ear
- problems with ossicle, tympanic membrane or eustachian tube
Sensorineural hearing loss: inner ear
- problems with the cochlea, semicircular canal (balance mechanism) or acoustic nerve
Give 4 examples of conditions affecting the middle ear
- acute otitis media (AOM)
- glue ear (OME)
- tympanic membrane retractions
- cholesteatoma
- otosclerosis
Give 4 other congenital disorders of the external ear (pinna)
(Not anotia or microti)
1) Canal atresia
2) Ossicular chain anomalies
3) Facial nerve atypia
4) Pre auricular sinus
5) Collaural sinuses/ fistula
Complete absence of the external ear is known as what?
Anotia (congenital deformity)
A small ear is known as what?
What developmental failure causes this?
Microtia: congenital deformity caused by improper formation of the 6 hillocks of His
Ear appears small and deformed
Give 4 acquired pinna deformities
1) Trauma
2) Basal cell carcinoma
3) Squamous cell carcinoma
4) Keratin horn
5) Pinna Haematoma
What is the name for a ‘califlower ear’ and explain how it occurs
Pinna Haematoma- Haematoma between cartilage and perichondrium
Damage to blood vessels between perichondrium and cartilage, may result in a haematoma if the blood vessels rupture
As the blood vessels run inside the perichondrium, it will result in NO blood supply preventing oxygenation to the cartilage
This will result in necrosis of the cartilage and PERMANENT damage because tissue becomes fibrotic
State how the following conditions affecting EAC can cause probelms:
1) Wax:
2) Hairy ears:
4) Foreign body
1) Wax: will only cause a problem if it is touching the ear drum or completely blocking the ear canal
2) Hairy ears: can be a problem as it makes it difficult for the wax to move out
4) Foreign body: infection or general problems associated with foreign bodies
What are ‘swimmers ears’ and how may this cause probelms?
Bumps in the ear canal (exostosis- bony lumps)
Usually harmless, but can cause problems if wax gets stuck behind them
What is Otitis Externa?
Give 3 signs and 3 symptoms
How you would treat?
Eczema of EAC skin +/- infection (can affect the ear canal and/or the pinna)
Symptoms: Itchy, pain, discharge
Signs: Tragal/pinna tenderness, Narrow EAM, Debris/discharge in EAM
Treatment: Aural toilet, ear drops and avoid water
What is Malignant otitis externa?
What bacteria most commonly causes this and who does it most commonly affect
List 2 things it can progress too
Osteomyelitis of ear canal- infection of the external ear which progresses into the petrous temporal bone (NOT cancerous!)
Most commonly caused by pseudomonas and most commonly affects elderly diabetics
It is very painful and can lead to cranial nerve palsies and if severe… death
What is Acute Otitis Media?
Who does it commonly affect?
Give 3 signs and 2 symptoms
How would you treat?
An acute bacterial infection of the middle ear cavity (eustachian tube)
Commonly occurs in children due to poor immunity
Signs: bulging ear drum, red ear drum, pus in the middle ear
Symptoms: pain and fever
Treatment: analgesia and antibiotics
Give the main complication of Acute Otitis Media and explain
PERFORATION!
Central perforation OR Subtotal perforation
This is a hole in ear drum which usually causes painless discharge and often heals spontaneously. BUT if it doesn’t heal it can result in long term discharge.
Can be treated with ear drops or surgically
Give another cause for a ‘hole in the ear drum’ and a serious consequnce of this
Trauma which can result in a fractured skull leading to CSF leaking
What is Mastoiditis?
Complication of Acute otitis media
Pus and infection in the mastoid bone lead to acute suppuration with back pressure into the mastoid cavity → ‘Mastoiditis’
Give 3 signs and 3 symptoms of mastoiditis
How would you treat?
Give 2 consequences
Symptoms: earache, fever, unwell
Signs: tender, swollen, red mastoid and a prominent pinna
Treatment: antibiotics and surgical drainage
Complications Intracranial infection/abscess and if untreated.. death
What is ‘glue ear’ and give 3 causes
Otitis Media with Effusion (OME) → Thick effusions accumulate behind ear drum
Causes:
- prolonged negative pressure
- eustachian tube dysfunction
- genetic predisposition
Who does Glue Ear most commonly affect and why?
What type of hearing loss is this?
OME most commonly affect children because they have short eustachian tubes at a flat angle. This means they can’t equalise pressure properly causing fluid/transudate to be sucked in from the walls of the middle ear.
Results in fluid in the middle ear (OME) which is therefore a conductive hearing loss
Give 5 symptoms and 2 signs of OME
Symptoms
- Conductive hearing loss
- Painless
- Speech and language delay
- Educational problems
- May be associated with AOM (painful)
Signs
- Tympanic membrane dull and retracted
- Effusion/bubbles
Give 4 principles of management of glue ear
1) watch and wait 3 months
2) otovent
3) grommets
4) hearing aids
Remember: Glue ear cannot be treated, the only cure is to grow out of it
Below is a treatment option for OME, what is this and explain how it works
Otovent: Forces air up the eustachian tube in order to try and equalise pressure between the back of the nose and the ear
What is a grommet?
Grommets = Ventilation tubes: These aim to equalise the middle ear pressure through making a hole in the ear drum and putting a gromet tube inside the hole
Compare Acute Otitis Media (AOM) and Otitis Media with Effusions (OME)
They are NOT the same thing!!
AOM: infection of the middle ear, very painful
OME: NOT an infection and therefore not painful… (can become infected but this is not the cause)
What 2 serious consequences may prolonged negative middle ear pressure lead to?
Explain how this occurs
1) Tympanic Retraction
2) Cholesteatoma
Negative middle ear pressure
⬇
Retraction pockets
⬇
Dead skin cells accumulate in pockets
⬇
Necrotic mass of dead skin (Cholesteatoma)
⬇
Erosion of middle ear structures and bone via lytic enzymes (what leads to a conductive hearing loss)
What is a Cholesteatoma?
Dead skin cells and keratin building up in the retraction pockets formed due to negative ear pressure. Particularly in the ‘Par flaccida’ (the top) of the tympanic membrane
Give 3 symptoms and 3 signs of Cholesteatoma
How would you treat and give one serious consequence if left untreated
Symptoms: hearing loss, smelly discharge, recurrent infections
Signs: conductive hearing loss, discharge/keratin debris, attic crust/polyp
Treatment: surgery
Complications: Brain infection/ abscess
What region of the ear should you examine if you suspect Cholesteatoma?
What may hide the presence of this?
Always examine the pars flacida (also known as the attic)
Crusts in this region can hide a cholesteatoma
What nerve may be affected in middle ear disease and why?
Give 3 indicative features of this
Facial Nerve dysfunction: because the facial nerve runs through the middle ear and is vulnerable to damage from middle ear disease
1) Soothing out of forehead
2) Eyebrow drop
3) Dropping of corner of mouth
What is Otosclerosis and explain what it causes
Vascular, spongy bone replaces normal bone around stapes footplate (where is joins the oval foot plate). This means the bone doesn’t vibrate as well
The ossicle vibrate to carry the sound into the inner ear but the stapes doesn’t and therefore the vibrations are less resulting in a hearing loss
Give one symptom and 2 signs of Otosclerosis
How would you treat?
Symptoms: Hearing loss
Signs
- Normal ear drum (Schwarzes sign in 10%)
- Conductive hearing loss
Treatment: Stapedectomy/ hearing aids
List 4 locations of reffered pain that pain present as an earache
- Tongue
- Teeth
- Tonsil
- Throat and neck
- TMJ
- Ramsay Hunt syndrome (shingles)
- Cervical spine
Remember: Nerve supply to the ear includes V, VII, IX, X and cervical nerves
What 2 things does ability to hear depend on?
What is the human hearing range and at what value does it become painful?
1) Pitch (frequency) (Hz)
2) Loudness (dB)
Human hearing range: 20-20,000Hz….. at >90 dB painful
What are aquired sensorineural hearing loss most commonly due to?
Give 4 aquired causes of this that are bilateral
Most commonly due to loss of hair cells
1) Infections: measles, meningitis
2) Presbyacusis: with age
3) Noise induced hearing loss
4) Ototoxic drugs (gentamicin)
Give 2 aquired unilateral causes of sensorineural hearing loss (inner ear)
1) Acoustic neuroma (vestibular schwannoma)
2) Menieres
What investigations are involved as part of a sensorineural hearing loss?
What are we trying to exclude?
MRI Internal auditory meati if unilateral, to exclude acoustic neuroma
Give 2 treatments for a sensorineural hearing loss?
1) Hearing aids
2) Cochlear implant
Using the Weber tuning fork method, what findings would indicate a conductive vs sensorineural loss?
Conductive loss: lateralises to affected side
Sensorineural loss: lateralises to unaffected side
Using the Rinnies tuning fork method, what findings would indicate a conductive vs sensorineural loss?
Conductive loss: bone conduction is better than air conduction
Sensorineural loss: air conduction is better than bone conduction
Sensorineural = same as people with normal hearing, but patients with sensorineural hearing loss will indicate the sound has stopped much earlier
What type of hearing loss do each of the following Audiograms show? Explain why
1) Presbyacusis (high frequency SNHL): there is a decrease of hearing at higher frequencies
2) Conductive loss: the bone conduction is better than air (shown by the air-bone gap)
3) Sensorineural loss: lines are the same, cant distinguish difference
What is Tinnitus?
Perception of hearing a sound in the absence of any external sound
This is a symptom NOT a diagnosis
Usually (but not always) associated with hearing loss
May be persistent or come and go
What is vertigo and how is it diagnosed?
This is a vestibular disease that presents with a spinning sensation/ feeling of movement
Diagnosed on the history of the vertiginous attacks and Timing
What are the 4 main symptom complexes present with true rotational vertigo and how are they differentiated?
Secs to Mins - Benign Positional
Mins to Hours - Vertigo Meniere’s Disease
More than 24hrs - Labyrinthine Failure
Random and with other symptoms - Vertiginous Migraine
What is Benign Positional Vertigo (BPV)?
Due to otolith displacement. Precipitated by head movement and typically lasts seconds
Treatment: repositioning manoeuvres
What is Meniere’s Disease (+ cause) and the typical is the ‘trio’ of symptoms?
Give 2 associated symptoms
Random attacks of vertigo typically lasting minutes/hours due to endolymphatic hydrops (excess fluid/pressure in endolymph)
Trilogy of vertigo, tinnitus, hearing loss
Associated with vomiting and aural fullness
What is the onset and recovery time of Labyrinthine failure?
What is it associated with?
Sudden onset and takes up to 6 weeks to recover
Associated with upper respiratory tract infections
What is the timing of a Vestibular migraine?
Give 3 associated symptoms?
Random timimg
Often associated with headache, vomiting, visual symptoms
Using the mnemonic VERTIGO, give 7 other causes of Vertigo
V: Vascular
E: Epilepsy
R: Receiving Treatment
T: Tumours, Trauma, Thyroid
I: Infection
G: Glial (MS)
O: Ocular
