Disorders of the Ear Flashcards by SN K

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

How well did you know this?

Not at all

Perfectly

Give 4 examples of conditions affecting the middle ear

acute otitis media (AOM)
glue ear (OME)
tympanic membrane retractions
cholesteatoma
otosclerosis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Complete absence of the external ear is known as what?

Anotia (congenital deformity)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Give 4 acquired pinna deformities

1) Trauma
2) Basal cell carcinoma
3) Squamous cell carcinoma
4) Keratin horn
5) Pinna Haematoma

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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’

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

1. Tongue 2. Teeth 3. Tonsil 4. Throat and neck 5. TMJ 6. Ramsay Hunt syndrome (shingles) 7. 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