Dysfunction Of The Ear

Question 1

What is tinnitus?

Answer 1

Perception of abnormal ear or head noises not produced by an external stimulus often described as a ringing of the ears

Question 2

What are some of the causes of tinnitus?

Answer 2

Noise induced hearing loss
Presbycussis
Hypertension
Atherosclerosis
Head injury
Cochleae and labyrinthine inflammation or infection

Question 3

Tinnitus May be due to abnormal firing of auditory receptors, dysfunction of cochleae neurotransmitter function or ionic balance. T/F?

Answer 3

True

Question 4

What is vertigo?

Answer 4

A disorder of vestibular function in which there is an illusion of movement

Question 5

Vertigo due to peripheral vestibular disorders tend to be severe but brief. How is central vestibular vertigo described?

Answer 5

Mild and constant, chronic in duration

Question 6

What is menieres disease?

Answer 6

Auditory disease where there is sudden onset vertigo, low frequenting hearing loss and tinnitus, sensation of fullness in the inner ear

Question 7

Ménière’s disease is idiopathic. T/F?

Answer 7

True

Question 8

In Ménière’s disease there is overproduction of endolymph. T/F?

Answer 8

True

Question 9

How does overproduction of endolymph cause Ménière’s disease symptoms?

Answer 9

The excess fluid provides pressure which causes distension and rupture of Reissners membrane and the release of potassium rich endolymph into the perilmphatic space causes further injury to the sensory and neural elements of the inner ear

Question 10

What age if patient is most likely to present with Ménière’s disease?

Answer 10

Middle aged

Question 11

In Ménière’s disease there are several acute attacks.T/F?

Answer 11

True

Question 12

The Romberg year is often positive in patients with Ménière’s disease. What is this test?

Answer 12

Tests ability to stand with feet together and eyes closed

Question 13

A positive Fakudq or unterberger test is often found in Ménière’s disease. What is this test?

Answer 13

Patient marches on the sport with eyes closed. They may be unable to stay in one spot and will move to the affected side

Question 14

Nystagmus May be present in patients with Ménière’s disease. What is this?

Answer 14

Rapid involuntary eye movements

Question 15

What type of hearing loss typically occurs in Ménière’s disease?

Answer 15

Sensinourinal

Question 16

What are the differential diagnoses for Ménière’s disease?

Answer 16

Acoustic neuroma
Vestibular migraine
Vestibular neurons ‘tis
Viral labyrinthitis 
Benign paroxysmal positional vertigo
Vertebrobasilar insufficiency

Question 17

There is a cure for Ménière’s disease. T/F?

Answer 17

False

Question 18

How is Ménière’s disease treated?

Answer 18

Low salt diet
Diuretics
Limit caffeine and alcohol consumption 
Cease smoking 
Vestibular suppressants
Anti emetics
Tinnitus maskers 
Corticosteroids

Question 19

What are tinnitus maskers?

Answer 19

Devices similar to hearing aids which produce an external sound to distract the patient from the internal tinnitus

Question 20

What drugs are used as vestibular suppressants and about emetics in the treatment of Ménière’s disease?

Answer 20

Antihistamines
Phenothiazine
Anticholenergics
Benzodiazepine

Question 21

What is an acoustic neuroma?

Answer 21

Benign rumour which grows from the vestibular component of CNVIII

Question 22

Pathologically, what type of tumour is an acoustic neuroma?

Answer 22

Shwannoma

Question 23

Acoustic neuromas can cause life threatening obstructive hydrocephalus. T/F?

Answer 23

True

Question 24

The amount of hearing loss is related to the size of the acoustic neuroma. T/F?

Answer 24

False

Question 25

What are the symptoms of an acoustic neuroma?

Answer 25

``` Unilateral sensinourinal hearing loss Unilateral facial weakness Tinnitus Metallic or reduced taste in affected side Increased or decreased tears on affected side Headache Diplopoda Swallowing difficulties Poor sound localisation ```

Question 26

Nystagmus can be present with acoustic neuroma. T/F?

Answer 26

True

Question 27

What imaging tests are used to diagnose an acoustic neuroma?

Answer 27

Gadolinium enhanced MRI or CT

Question 28

What are the differential diagnoses of acoustic neuroma?

Answer 28

Meningioma Epidermoid Facial nerve schwannoma Trigeminal schwannoma

Question 29

How are acoustic neuromas treated?

Answer 29

Radiology and/or surgery

Question 30

Why can acoustic neuromas cause symptoms related to the facial nerve?

Answer 30

Because as the rumour grows it can impact on the facial nerve which exists in close proximity to CN VIII in the internal acoustic Meatus

Question 31

Chemotherapy is effective against acoustic neuromas. T/F?

Answer 31

False

Question 32

Describe he retro sigmoid approach to surgery to treat an acoustic neuroma?

Answer 32

Part of the occipital bone behind the ear is removed to gain access to the tumours. The surgeon must go underneath the sigmoid sinus to reach the internal acoustic meatus. This approach can preserve hearing

Question 33

What is a facial palsy?

Answer 33

Loss of muscle control on one side of the face which may be temporary or permanent

Question 34

Facial weakness or paralysis is common following neurosurgery. How long might this persist?

Answer 34

6-12 months

Question 35

What is otitis media with effusion?

Answer 35

Inflammation of the middle ear with the presence of fluid without signs of acute infection

Question 36

What are the risk factors for otitis media?

Answer 36

``` Age between 3 months and 3 years premature birth male native american low socioeconomic status ```

Question 37

What upper respiratory tract infections most commonly cause otitis media?

Answer 37

S.pneumonium H.influenzae Moraxella catarrhalis

Question 38

Explain the pathophysiology behind the effusion seen in otitis media

Answer 38

Dysfunction of the Eustachian tube (perhaps caused by upper respiratory tract infection causing swelling of the pharyngeal tonsil around the opening of the Eustachian tube into the nasopharynx), traps the gas volume in the middle ear and some of this is absorbed by surrounding tissue leading to negative pressure in the middle ear. This negative pressure can cause fluid from the surrounding tissue to be sucked into the tympanic cavity resulting in effusion. This fluid can act as a good medium for the growth of bacteria

Question 39

Otitis media with effusion is often asymptomatic. T/F?

Answer 39

True

Question 40

What are the signs and symptoms of otitis media with effusion?

Answer 40

``` Mild, intermittent ear pain Ear fullness Ear popping hearing loss causing lack of attentiveness, behavioural changes and failure to response to conversation ear rubbing excessive irritability sleep disturbances balance problems / unexplained clumsiness delayed speech/language development ```

Question 41

Describe the appearance of the tympanic membrane in otitis media?

Answer 41

Discolouration, opacification | decreased or absent motility of the membrane

Question 42

Most cases of otitis media with effusion resolve spontaneously within what time period?

Answer 42

3 week to 3 month period

Question 43

What are the medical treatments for otitis media with effusion?

Answer 43

Antibiotics | Corticosteroids

Question 44

Describe the use of grommets in otitis media with effusion?

Answer 44

May be indicated if effusion is present for more than 4 months grommet is inserted into the tympanic membrane to relieve the pressure in the middle ear and this essentially takes on the role of the Eustachian tube

Question 45

Give examples of conditions which can cause conductive hearing loss?

Answer 45

``` Impacted earwax or foreign body otitis externa trauma otitis media otosclerosis tumours ```

Question 46

Give examples of conditions which can cause sensorineural hearing loss?

Answer 46

``` head injury noise trauma CNS infections presbycussis atherslcerosis sudden deafness ototoxic drugs acoustic neuroma meningioma metastatic tumour menieres disease ```

Question 47

Describe the mechanism of conductive hearing loss?

Answer 47

Auditory stimuli are not adequately transmitted through the auditory canal, tympanic membrane, middle ear or ossicle chain to the inner ear can be temporary or permanent hearing loss

Question 48

Describe the mechanism of sensorineural hearing loss?

Answer 48

occurs with disorders that affect the inner ear, auditory nerve or auditory pathways in the brain sound waves are conducted to the inner ear but abnormalities of the cochlear apparatus or auditory nerve decrease or distort the transfer of information to the brain

Question 49

Describe Rhinne's hearing test?

Answer 49

512Hz vibrating tuning fork placed on the mastoid process to test bone conduction then placed near to the ear to test air conductance. Normally air conductance should be louder buy bone conductance will be louder in conductive deafness

Question 50

Describe weber's hearing test?

Answer 50

Vibrating tuning fork placed at the vertex in the midline between the two ears and the patient is asked whether the sound is perceived equally in both ears. sound is heard louder in the affected ear in conductive deafness and in the unaffected ear in perceptive deafness

Question 51

Why is it important to identify hearing problems as early as possible?

Answer 51

Hearing problems will impact on a child's speech and language development, social skills and education

Question 52

There is newborn screening for hearing. T/F?

Answer 52

True

Question 53

Most children will have hearing tests when they start school. T/F?

Answer 53

True

Question 54

The otoacoustic emissions (OAE) test is used as a hearing screening test. What does this involve?

Answer 54

Measures sound waves generated in the cochlea in response to clicks or tone bursts emitted and recorded by a minute microphage place in the external ear canals of the infant

Question 55

The auditory brain stem evoked responses (ABR) is a test used in hearing screening. What does this involve?

Answer 55

Uses 3 electrodes pasted to the infants scalp to measure the EEG waves generated by clicks