dizzy and ear disease revision Flashcards by Amy Hollis

what are 5 ear related symptoms you should ask patients about?

discharge
otalgia
vertigo/dizziness
hearing loss
tinnitus

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Allens test

Otscopy- looking in ear
Cranial nerve exam- exam balance and hearing nerve
Rhomborgs test- test of palance
Allens test- pulsation to the wrists

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bone conduction and air conduction hearing loss no gap so it is sensorineural hearing loss

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acute otitis media

-usually leave but if recurrent oral antibiotics

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(bulging ear drum)

mastoiditis

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(boy with mastoiditis)

if you think he is going to theatre and not improving them give oral antibiotics
if they have neural problems do a CT scan

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cholesteatoma

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what should be suspected in older patients with glue ear?

nasopharyngeal cancer

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BPPV

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what test diagnoses BPPV?

Dix-Hallpike

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what are the manoeuvres to treat BPPV?

semont
Epley
Brandt daroff

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vestibular neuritis

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what parts does the temporal bone comprise of?

5 parts

squamous
zygomatic arch
styloid process
tympanic
petromastoid

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what should be asked in the history if there is a suspected temporal fracture?

injury mechanism
hearing loss
facial palsy
vertigo
CSF leak
associated injuries

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what is Battle sign a classic presentation of?

temporal fracture

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what should be checked if there is a suspected temporal fracture?

Check condition of TM and ear canal
Assess facial nerve
Hearing test

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How may you classify temporal fractures?

Longitudinal
transverse (transverse is worse)

Otic capsule involved (displacement of cochlear or vestibular apparatus so more chance of hearing loss, dizzyness and facial palsy)

Otic capsule spared (mild symptoms)

which type of temporal fracture tends to have otic capsule involvement?

Transverse

how may a patient present if a temporal fracture involves the otic capsule?

this would displace the cochlear or vestibular apparatus

- can present with hearing loss, dizziness and facial nerve palsy

are transverse or longitudinal temporal skull fractures more common?

Longitudinal (80%) are more common than transverse (20%)

what type of fracture does a lateral blow to the temporal bone usually cause?

longitudinal fracture

How can a longitudinal temporal fracture present?

lateral blows
fracture line parallels the long axis of the petrous pyramid
bleeding from external canal due to laceration of skin and ear drum
Haemotympanum (blood in middle ear canal) (conductive deafness)
Vesicular chain disruption (conductive deafness)
facial palsy (20%)
CSF otorrhea

what type of fracture does a frontal blow to the temporal bone usually cause?

transverse fracture

how may a transverse temporal fracture present?

frontal blows
fracture at right angles to the long axis of the petrous pyramid
can cross internal acoustic meatus causing damage to the auditory and facial nerve
sensorineural hearing loss due to damage to 8th cranial nerve
facial nerve palsy (50%) and verigo

what are some causes of conductive hearing loss?

- fluid - TM perforation - ossicular problem

what is the treatment for a temporal fracture?

Often lead by different teams - may need facial nerve decompression, if no recovery EMG studies - may need to manage CSF leak, most settle but may need repair - may need hearing restoration, either hearing aid or ossiculoplasty

what should be done if there is a sudden sensorineural hearing loss?

EMERGENCY Weber test- if it goes to the opposite ear (e.g. hearing loss on right hand side but Weber test goes to left hand side suggests sensorineural loss in right ear) steroids 1mg/kg and consider intratympanic treatment

how are foreign bodies stuck treated?

Can usually wait until urgent clinic for removal - Remove batteries immediately - Remove things that can swim immediately - if a live animal drown in oil and remove the next day

what should be asked in a history of someone with neck trauma?

- MOA - pain (location, nature, intensity, onset, radiation) - aerodigestive tract (dyspnoea, hoarseness, dysphonia, dysphasia, haemoptysis) - CNS problems (paraesthesias, weakness)

how can neck trauma be categorised?

Zone I- from the Cricoid down Zone II-Middle of the neck (least morbidity) Zone III

what does zone I in neck trauma include?

``` From cricoid down -trachea -oesophagus -thoracic duct -thyroid -spinal cord vessels= brachiocephalic, subclavian, common carotid, thyrocervical trunk ```

what does Zone II in neck trauma include?

Middle neck - larynx - hypopharynx - CNX, XI, XII - spinal cord vessels= carotids, internal jugular

what does Zone III in neck trauma include?

Pharynx Cranial Nerves Spinal cord Vessels= carotid, IJV, vessels

How do you manage neck trauma?

ABCDE - FBC, G&S/XM - AP/Lateral neck - CXR - CT angiogram - laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy

what is one of the most common causes of a deep neck space infection?

-extension of infection from tonsil or oropharynx into deeper tissues

how may someone with a deep neck space infection present?

- sore throat - unwell - limited neck movement - febrile - trismus - red/tender neck

what is the management of deep space neck infection?

- admit - IV access, bloods, fluid rehydration - IV antibiotics such as co amoxiclav or clindamycin - may need theatre for incision and drainage

how does a maxillary fracture present?

- Pain, Decreased visual acuity, Diplopia - Hypoaesthesia in infraorbital region - Periorbital ecchymosis - Oedema - Enopthalmos - Restriction of ocular movement - Bony step of orbital rim

how does a maxillary fracture present on a CT of the sinuses?

teardrop sign

what is the treatment for a maxillary fracture?

Conservative | Surgical repair of bony walls if: Entrapment / Large defect / Significant enophthlamos