dizzy and ear disease revision Flashcards
what are 5 ear related symptoms you should ask patients about?
- discharge
- otalgia
- vertigo/dizziness
- hearing loss
- tinnitus
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
bone conduction and air conduction hearing loss no gap so it is sensorineural hearing loss
acute otitis media
-usually leave but if recurrent oral antibiotics
(bulging ear drum)
mastoiditis
(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
cholesteatoma
what should be suspected in older patients with glue ear?
nasopharyngeal cancer
BPPV
what test diagnoses BPPV?
Dix-Hallpike
what are the manoeuvres to treat BPPV?
- semont
- Epley
- Brandt daroff
vestibular neuritis
what parts does the temporal bone comprise of?
5 parts
- squamous
- zygomatic arch
- styloid process
- tympanic
- petromastoid
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
what is Battle sign a classic presentation of?
temporal fracture
what should be checked if there is a suspected temporal fracture?
- Check condition of TM and ear canal
- Assess facial nerve
- Hearing test
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
