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E N T 1 Flashcards

1
Q

describe anatomy of the ear

A
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2
Q

describe the anatomy of the tympanic membrane

A
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3
Q

what are the two functions of the ear

A

hearing - auditory

balance - vestibular

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4
Q

describe the pathophysiology of hearing

A

sound signal from environment
collected by pinna and passed to external auditory meatus
sound strikes the tympanic membrane
transmitted to stapes footplate through chain of ossicles

movement of stapes footplate causes pressure changes in labryinthine fluids = movement of basilar membrane

stimulates hair cells of organ of Corti
act as transducers and convert mechanical energy into electrical impulses

electrical impulse travels along cochlear nerve to auditory cortex

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5
Q

what sx can pt get from problems in the ear

A 
hearing loss
oltalgia 
otorrhea 
tinnitus  
vertigo
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6
Q

what examination techniques are used to examine the ear

A

inspection for asymmetry, cauliflower ear, top, sebaceous cysts, scars, discharge

palpation of pinna - tenderness
post auricular region, mastoid, tragus (ask pt to open and close mouth)

otoscope - external and middle ear = external auditory canal and tympanic membrane

Rinne and Weber’s test in hearing loss

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7
Q

what are the two types of hearing loss

A

conductive

and sensorineural

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8
Q

what is the difference between sensorineural and conductive hearing loss

A

conductive hearing loss - problem with conduction of sound in external or middle ear or both = outer and middle ear pathology

sensorineural hearing loss = problem with cochlear or transmission of signals to auditory cortex = inner ear pathology

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9
Q

how do you perform Weber’s Test

A

strike tuning fork on your elbow
and place in midline of forehead of pt

ask pt if they hear sound louder in one ear or another

or ask if they hear it everywhere

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10
Q

describe interpretation of weber’s test

A

normal = sound heard at midline, same in both ears

conductive hearing loss = sound heard louder in affected ear

sensorineural hearing loss = sound hear louder in normal or unaffected ear

in bilateral symmetrical hearing loss = Weber’s test is normal

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11
Q

how to perform Rinne’s test

A

Rinne’s test compares air conduction with bone conduction

strike running fork against elbow or knee

place on mastoid of pt 2-3s

lift fork off mastoid and place vibrating ti[s 1cm from external auditory meatus leave for a few s before taking tuning fork away

ask to which positions they’re able to hear sound loudest

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12
Q

what is a positive vs negative Rinne’s test

A

positive = loudest when fork 1cm from external auditory meatus

if loudest when hear against mastoid = negative Rinne’s test

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13
Q

how is Rinne’s test interpreted

A

no significant conductive hearing loss = if air conduction better than bone (positive RInne’s)

in sensorineural hearing loss on the right, for example, Rinne’s test should be positive on the right

conductive hearing loss = bone conduction better than air conduction (negative Rinne’s)

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14
Q

what is the eustachian tube

A

tube that connects the middle ear to the post nasal space

lining of middle ear = mucosal = mucus producing

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15
Q

when does the Eustachian tube open and what does this allow for

A

Eustachian tube normally closed
opens regularly - in swallowing or chewing

allows mucus in middle ear space to drain

allow air to move between the post nasal space (atmospheric pressure) and pressure in middle ear = allows for equilibration of air pressure

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16
Q

why is the eustachian tube blocked or locks completely in children

A

common in children - smaller diameter tube, different orientation, more coughs and colds so nasal lining gets more inflamed
large adenoids in post nasal space which can block tube

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17
Q

why does blockage of eustachian tube cause sx

A

air in middle ear can not equilibrate with atmospheric pressure in post nasal space

mucus in middle ear accumulates and cannot drain

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18
Q

glue ear on otoscope due to

A

no equilibrating between atm pressure and middle ear

air reabsorbed leading to negative air pressure in middle air leaving fluid produced by middle ear mucosa

leads to pulling in of tympanic membrane, becomes more concave

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19
Q

why is acute otitis media do pt get a bulging tympanic membrane

A

bulging tympanic membrane
due to inflammatory exudate by middle ear mucosa

increasing middle ear pressure, pushing tympanic membrane outwards

20
Q

describe the management of eustachian tube blockage

A

use of grommets = provide an alternative opening to middle ear

allow air to equilibrate despite closed eustachian tube

21
Q

otoscopic views

A

impacted wax - normal and healthy - only needs treatment if causing conductive hearing loss

foreign body

otitis externa = trying to look into ear canal, notice walls of ear canal are oedematous and inflammed + redness of canal wall with discharge (obstruct tympanic view)

can get fungal otitis externa - fungi hyphi not common

22
Q

what are the infections of the middle ear

A
  1. infective otitis media

2. mastoiditis

23
Q

what are the types of infective otitis media

A

acute otitis media without perforation

acute otitis media with perforation

chronic suppurative otitis media

24
Q

mastoiditis, presentation and management

A

affects children

spread of infection in middle ear into mastoid air cells

paeds emergency which required admission for IV abx

examine outside of ear in children = inflammation behind the ear + mastoid tenderness

25
Q

what are tympanic membrane pathologies

A
  1. perforations = wet (discharge) , dry (no discharge from ear), central/peripheral/attic

wet perforation = chronic supporative otitis media

  1. cholesteatoma
  2. tympanosclerosis
26
Q

which perforation is safer attic vs peripheral

A

attic = pars flaccid = more dangerous as less tension - associated with more complications

peripheral = pars tense

central

27
Q

what is a cholesteotoma

A

retraction pocket in pars flaccid

which fills with keratin, which leads to build up = enlarging cholesteotoma

which can erode middle ear contents

foul smelling, blood stained persistent discharge = consider cholesteotoma

pearly white apperance

refer to specialist assessment

28
Q

chalky white deposits on tympanic membrane is..

A

tympanicsclerosis
not serious

sign of previous ear infections, calcification from healing

no sx from it

29
Q

what are other disease of the middle ear

A
  1. otitis media with effusion (glue ear)
  2. eustachian tube dysfunction + grometts
  3. otosclerosis
30
Q

what is the typical apperance of glue ear on otoscope

A

dark apperance of tympanic membrane = fluid/ mucus

honey comb appearance of fluid

air pockets within the tympanic membrane

otitis media with effusion

31
Q

what is the treatment for acute otitis media with effusion

A

grommet insertion in tympanic membrane

allows for air to equilibrate with atmospheric pressure

provides outlet in blocked eustachian tube

32
Q

how is dx of cholesteatoma made

A

recurrent purulent, foul smelling discharge

hearing loss

deep retraction pocket in tympanic membrane + granulation tissue and skin debris

tympanic membrane may be perforated

33
Q

management of cholesteatoma

A

arrange semi urgent referral ENT specialist or urgent if signs of complication - facial nerve palsy or vertigo

34
Q

how is earwax managed

A

if pt symptomatic treat

3-5 days of ear drops to soften wax

ear irrigation

35
Q

what are the rx to acute otitis externa

A

foreign body, trauma to ear canal, contact dermatitis, acute otitis media, skin conditions like eczema, water exposure

36
Q

how does acute otitis externa present, what is seen OE

A

itch of ear canal - rapid onset

ear pain tenderness of tragic our pinna

discharge

hearing loss (less common)

O/E = oedema and erythema or ear canal, tenderness of tragic or pinn, cellulitis

37
Q

what questions should be asked to patient with suspected otitis externa

A

onset, nature, and severity of symptoms, such as:
Pain or tenderness on moving the ear (tragus or pinna) or jaw.
Ear discharge.
Itch in the ear canal.
Fever.

Hearing loss (conductive).
Impact on daily functioning and quality of life.

Any possible causes or risk factors, including recent ear trauma, use of hearing aids or ear plugs, history of head or neck radiotherapy

ear surgery or perforation

Any history of allergic or irritant contact dermatitis.

38
Q

O/E of ear look for

A

red, erythematous ear canal
ear discharge

signs of fungal infection = candida white strands

regional lymphadenopathy

cellulitis being ear

39
Q

management of acute otitis externa

A
  1. advice on routes of information and support - NHS patient leaflet
  2. selfcare measures = keep ears clean and dry, avoid swimming and water sports for 7-10days
  3. analgesia = paracetamol or ibuprofen
40
Q

what is the presentation of AOM

A

earache.

In younger children —

holding, tugging, or rubbing of the ear, or non-specific symptoms such as fever, crying, poor feeding, restlessness, behavioural changes, cough, or rhinorrhoea.

41
Q

management of AOM

A

analgesia = regular paracetamol or ibuprofen

prescribe 5-7 amoxicillin or erythromycin if pen allergy

refer for admission/ specialist if severe systemic infection, meningitis, mastoiditis, children younger than 3 months with temp 38 or more

42
Q

management of OME

A

watchful waiting bro 3 months - spontaneous resolution

grommets insertion

43
Q

otitis media chronic suppurative infection management

A

refer for ENT assessment

44
Q

management of perforated tympanic membrane

A

self limiting within 3 months

abx if discharge or systemic features

does not heal by itself a myringoplasty may be performed

45
Q

most common cause of bacterial otitis media

A

Haemophilus influenzae is a common cause of bacterial otitis media

G P (5 decks)

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