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E Flashcards

1
Q

What is vertigo

A

An illusion of movement, usually rotatory

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2
Q

What happens if balance goes wrong?

A

Can’t stand up or walk straight
Nystagmus
Vomiting

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3
Q

What is nystagmus? 2 different types

A

Periodic rhythmic ocular oscillations - everyone gets at the extremes of gaze
Pendular - both directions at same speed
Jerk - fast and slow phase

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4
Q

Inputs of balance system

A

Eyes
Proprioception
Vestibular system

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5
Q

Central connections

A

Brainstem

Cerebellum

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6
Q

Output

A

Musculoskeletal

Eye movements

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7
Q

Things that can go wrong with central connections of balance

A

Migraine associated vertigo
Brain stem infarct
Cerebellum infarct
Tumours

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8
Q

Problems with output of vestibular system

A

PD

Arthritis

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9
Q

Problems with inputs of vestibular system

A

Eyes - blind
Neuropathy - proprioception
Vestibular - BPPV, labrynthitis, Ménière’s disease

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10
Q

What is BPPV?

A

Benign paroxysmal positional vertigo

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11
Q

Occurance of BPPV

A

Common, easily treatable

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12
Q

Presentation of BBPV

A

Short episodes of vertigo lasting seconds to minutes

Commonly precipitated by rolling over in bed - couple seconds later the room starts to spin

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13
Q

Pathology of BPPV

A

Debris in the posterior semicircular canal
Canalolithiasis
Loose in canal and cause excessive stimulation of hair cells

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14
Q

Dx of BPPV

A

History

Hallpikes test

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15
Q

Treatment of BPPV

A

Epleys manoeuvre

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16
Q

What is labyrinthitis

A

Single episode of vertigo lasting for several days

Often precipitated by URTI

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17
Q

Symptoms of labrynthitis

A

Vertigo, nausea and vomiting
So bad can’t get out of bed
No hearing loss

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18
Q

Nystagmus with labyrinthitis

A

Eyes will flick towards the affected ear - paralytic nystagmus
Or eyes will flick away from affected side - irritating nystagmus

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19
Q

Management of labyrinthitis

A 
Hydration
Benzodiazepines - vestibular sedatives
Prochlorperazine - antiemetic 
Steroids if severe
Antibiotics if bacteria cause suspected
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20
Q

What is menieres disease?

A

Attacks of vertigo, tinnitus, hearing loss and feeling of aural fullness/pressure
Multiple episodes often occur in clusters

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21
Q

Additional feature of Ménière’s disease

A

Drop attacks - tumarkin crisis
Suddenly fall to the ground with no loss of consciousness
Feel as though being pushed
Activations of hair cells - don’t know why
Not everyone gets them

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22
Q

Pathology of Ménière’s disease?

A

endolymphatic Hydrops - build up of endolymphatic fluid in the inner ear
Aetiology unknown

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23
Q

Dx of Ménière’s disease

A

History

Electrocochleography

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24
Q

Prevention of Ménière’s disease attacks

A

Low salt diet
Reduce caffeine and chocolate
Diuretics
Betahistamine

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25
Q

To abort Ménière’s disease attacks

A

Antiemetics - prochlorperazine or ondansetron

Antihistamines - Meclozine or drimethobenzamide

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26
Q

Treatment of Ménière’s disease

A

Intratympanic gentamicin (ototoxic therefore chemical labyrinthectomy- have severe vertigo for 2 weeks until body compensates for lack of vestibular input from that ear)

Intratympanic steroids
Endolymphatic surgery
Vestibular neurectomy
Labyrinthectomy

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27
Q

Features of migraine associated vertigo

A

Hearing normal
Not always a headache
Duration variable
Prophylactic agents work - acute migraine treatments don’t

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28
Q

What is dizziness?

A

The feeling that you are about to fall, instability and tendency to lose ones balance

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29
Q

What is otorrhoea

A

Discharging ear

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30
Q

Which hand do you use to hold the auroscope to examine the right ear

A

Your right hand

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31
Q

Where is ear wax produced and where should it normally be found?

A

Outer 1/3 of EAC and that is where it should be found

Shouldn’t see ear wax on the TM

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32
Q

Type of skin in EAC

A

Migratory epithelium - forms in centre of TM and then moves outwards
Cannot be normal skin because if you shed dead skin then the ear canal would get bunged up

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33
Q

Functions of ear wax

A

Natural protective layer
Keeps ear waterproof
Conditions the skin
Mild antibacterial

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34
Q

When does ear wax become pathological

A

When it gets completely compacted and occludes the ear canal

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35
Q

Treatment of pathological ear wax

A

Syringing it out - flood it with water - aim behind the wax - don’t aim at eardrum

Microsuction

36
Q

What is otitis externa?

A

Acute inflammation of the skin of the EAC

37
Q

Symptoms of otitis externa

A 
Otalgia
Itchy
Otorrhoea 
Oedema
Erythema 
Severe swelling can cause hear loss
38
Q

Predisposing factors of otitis externa

A 
Anatomical
Occlusion (FB, hearing aid)
Moisture (humidity or swimming)
Skin condition such as eczema - lose the protective layer 
DM 
COM
39
Q

Common bacteria in otitis externa and other common ones

A

Pseudomonas aeruginosa (pungent otorrhoea) + other gram negatives

40
Q

When do you suspect fungal otitis externa?

A

When discharge is resistant to Ab ear drops

41
Q

What is appearance of fungal otitits externa?

A

Fluffy “cotton wool” type debris or black spots (aspergillus niger)

42
Q

How do you treat fungal otitis externa?

A

Can take several weeks of therapy to clear

Don’t stop anti-fungal therapy when you can’t see any more - need to do it for weeks or it will reoccur

43
Q

What is furunculosis

A

Reccurent infected boil in the ear
Acute and really painful
Causes conductive hearing loss
Treated with systemic ab’s

44
Q

Treatment of otitis externa

A

Keep it dry and do not put things down it

Topical antibiotic/steroid combination (steroids because it is inflammatory not just infectious)

45
Q

If no improvement initially with medical treatment of otitis externa?

A

Microsuction or aural toilet

46
Q

What is necrotising otitis externa? What organism causes it and symptoms?

A

Life threatening invasive pseudomonal infection of the bone

Severe constant pain

47
Q

Who gets necrotising otitis externa?

A

Diabetics, elderly and immunocompromised

48
Q

Treatment of necrotising otitis externa?

A

Antipseudomonal ab long term and ciprofloxacin ear drops

49
Q

What can cause perforated ear drum?

A

Acute OM
Traumatic - blast injury
Iatrogenic

50
Q

What does ear drum perforation cause

A

Hearing loss with recurrent discharge (OM )

51
Q

Management of perforated ear drum

A

Keep it dry
Small and acute - wait and encourage healing and prevent infection
If larger - myringoplasty or tympanoplasty - surgical repair

52
Q

What is cholesteatoma?

A

Keratinizing squamous epithelium in the middle ear - ball of skin trapped there
Can’t go anywhere therefore gets infected

53
Q

Presentation of cholesteatoma

A

Foul-smelling otorrhoea

Hearing loss

54
Q

What does examination of cholesteatoma show?

A

Tympanic membrane full of white cheesy material

55
Q

Compliction of cholesteatoma

A

It grows and destorys structures - produces enzymes which break down bone eg. ossicles and inner ear

Can erode into facial nerve - cause palsy
Can also cause vertigo

56
Q

Management of cholesteatoma

A

Mastoidectomy

57
Q

Discharge in neoplastic lesions in the ear

A

Chronic pink (blood-stained) discharge

58
Q

Usually presentation of neoplastic lesions

A

Very rare. Previous hx of skin cancer and they are painful

59
Q

5 questions to ask if any ear symptoms

A

Tinnitus, hearing loss, pain, discharge and vertigo

60
Q

When is fhx relavant in hearing loss

A

Significant HL before age of 60

61
Q

What drugs are ototoxic?

A 
Aminoglycosides
Cisplatin 
Diuretics - furosemide
Aspirin
Quinine
62
Q

Rhine’s normal test

A

AC > BC, also present if mild SN HR

63
Q

Rhine’s negative test

A

Conductive hearing loss

BC > AC

64
Q

Weber’s normal test

A

Can hear a faint buzzing everywhere

65
Q

Weber’s if SN hearing loss

A

Bone conduction preferentially to side which is not affected

66
Q

Weber’s if CH R

A

Bone conduction to the side with conductive HR

67
Q

What is tympanometry

A

Measures the pressure across the tympanic membrane

Will be altered if perforation of compacted middle ear infection

68
Q

Causes of congenital conductive hearing loss

A

Anotia - no outer ear
Atresia of ear canal - canal hasn’t opened up yet
Ossicular malformation

69
Q

Management of congenital conductive hearing loss

A

Cochlear is frequently normal
Therefore rehab with hearing aid
Reconstruction surgery has poor results

70
Q

Causes of acquired hearing loss

A

1) Wax/FB
2) Otitis Externa
3) TM perforation
4) Otitis media (because compacted and ossicles can’t move)
5) Glue ear
6) Otosclerosis
7) Ossicular discontinuity

71
Q

Signs of OM

A

Severe pain and conductive hearing loss
Tinnitus
Children may get systemic symptoms
Otorrhoea if ear drum perforates

72
Q

Commonest cause of OM

A

Viral eg. following cold

73
Q

Bacterial causes of OM

A

Strep.pneumoniea
H/influenzae
Moraxella

74
Q

Treatment of OM

A

Most settle within 72hours without treatment

If systemic features after 72 hours then give amoxicillin

75
Q

What treatment is of no value in OM

A

Topical therapy

76
Q

Complications of OM

A

Perforation (no more pain and otorrhoea)

Infection of mastoid bone - tenderness and swelling over mastoid bone

77
Q

What is glue ear?

A

Otitis media with secondary effusion causing mucous plug in eustachian tube
Serous otitis media
Common in children because of Eustachian tube dysfunction

78
Q

Normal development of glue ear

A

Usually resolves naturally but can persist giving HL

Also predisposes to reccurent attacks of OM

79
Q

Treatment of glue ear

A

Grommet - tympanostomy tube - inserted into TM and ventilates the middle ear cavity - taking over eustachian tube function
Usually extruded from TM as it heals (over 6months to 2 years)

80
Q

After what age to eustachian tube dysfunctions become rare

A

7-14 when middle 1/3 of face grows

81
Q

What is otosclerosis?

A

Usually a hereditary disorder associated with new bony deposits within the stapes footplate and cochlea

82
Q

When does otosclerosis present?

A

Normally 20-30s
F>M
Worse in pregnancy

83
Q

Treatment of otosclerosis

A

Hearing aid
OR
Stapedectomy

84
Q

Causes of congenital SN HR

A

Cochlear dysplasia

Auditory nerve aplasia

85
Q

Most common acquired cause of SN HR

A

Presbyacusis
degenerative disorder of cochlea of old age
Can be due to loss of any part of SN pathway

86
Q

Which sound frequencies most commonly affected in presbyacusis?

A

High frequency - consonants - therefore speech intelligible

Treat with high frequency hearing aid

87
Q

Other causes of acquired SN HL

A 
Noise exposure 
Ototoxic drugs (overdose or normal dose in susceptible individuals - eg. renal failure, pre-existing SN HR or old age)

Menieres disease
Vestibular schawannoma

ENT (5 decks)

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