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Year 4 Neuro and Special Senses > Ear > Flashcards

Ear Flashcards

1
Q

Describe the structure of the External Auditory Meatus

A

Sigmoid shaped tube
External 1/3 Cartilage
Internal 2/3 Temporal Bone

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2
Q

Describe the structure of the Tympanic Membrane

A

Skin on the external surface and mucous membrane on the inside
Connected to surrounding temporal bone by cartilagenous ring

Parts include: Pars Tensa, Pars Flaccida, Anterior and Posterior Malleolar fold

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3
Q

Describe the blood supply to the External Ear

A

Branches of ECA (Posterior Auricular, Superficial Temporal, Occipital, Maxillary)

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4
Q

Name the four nerves innervating the External Ear

A

Auriculotemporal
Greater Auricular Nerve
Lesser Occipital
Auricular branch of vagus

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5
Q

How would bites of the external ear be managed?

A

Wounds left open, irrigated, abx given

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6
Q

Why does a Pinna Haematoma require urgent ENT referral?

A

Disrupts overlying vessels in the Perichondrium which can lead to avascular necrosis (and cauliflower ear)

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7
Q

How is Tympanic Membrane perforation managed?

A

Traumatic - Watch and wait for 6 weeks, avoid water, after this if persisting then refer for myringoplasty

Non traumatic (eg post OM) - Antibiotics, water avoidance, and review in 6 months

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8
Q

What is a Haemotympanum?

A

Blood in the middle ear often associated with Temporal Bone Fracture

Conservatively managed but followed up to check for residual damage

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9
Q

Name the two parts of the middle ear

A

Tympanic Cavity (containing Malleus, Incus, Stapes)

Epitympanic Recess (superior to Tympanic Cavity near mastoid air cells)

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10
Q

Where does Stapes connect to?

A

Oval Window of middle ear

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11
Q

What is the purpose of Mastoid Air Cells?

A

Buffer system of air

Release air if pressure becomes too low

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12
Q

Two muscles are involved in the Acoustic Reflex. What is this and name the muscles involved.

A

Protective muscles contract in response to loud noises

Tensor Tympani and Stapedius

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13
Q

What is the role of the Eustacian Tube?

A

Connects middle ear to Nasopharynx, equalising pressure

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14
Q

Otitis Media can be Acute or Chronic. How can Chronic Otitis Media be subclassified?

A
  • Active Mucosal (discharge through perforation)
  • Inactive Mucosal (perforation but no discharge)
  • Active Squamous (cholesteotoma)
  • Inactive Squamous (retraction pocket)
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15
Q

What are the two main roles of the Inner Ear?

A

Converts mechanical signals into electrical

Maintains balance by detecting position and motion

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16
Q

There are two main components of the Inner Ear. Describe the Bony Labyrinth

A

Cochlea, Vestibule and three Semicircular Canals

Lined internally with Periosteum and contains Perilymph

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17
Q

There are two main components of the Inner Ear. Describe the Membranous Labyrinth

A

Lies within the Bony Labyrinth
Contains Endolymph

Cochlear duct, Semicircular Ducts, Utricle, Saccule

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18
Q

Describe the structure of the Vestibule

A

Central part of the bony labyrinth

Separated from middle ear by oval window

Contains Saccule and Utricle

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19
Q

Describe the structure of the Cochlea

A

Twists around a central portion of bone called the Midiolus

Spiral lamina bone attaches to cochlear duct

Two perilymph filled chambers (Scala Vestibuli, Scale Tympani)

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20
Q

Describe the structure of the Semicircular Canals

A

Anterior, Lateral and Posterior

Swelling at one end known as Ampulla

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21
Q

What is the Cochlear Duct?

A

Sits within the Cochlea and is the organ of hearing

Epithelial cells of hearing - Organ of Corti

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22
Q

What are the Saccule and Utricle?

A

Two membranous sacs which are organs of balance

Utricle connects to Semicircular Canals and senses position side to side
Saccule recieves cochlear duct and senses upwards and downwards movement

Endolymph drains from here

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23
Q

Describe the distribution of CNVIII

A

Forms Vestibular Ganglion which splits into superior and inferior parts to supply: Saccule, Utricle, Semicircular Canals

Cochlea portion: Enters at base of Mediolus to supply receptors of Organ of Corti

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24
Q

What is the time frame description for Otitis Externa?

A

Acute <3 weeks

Chronic >3 months

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25
Q

Describe the protective mechanisms of the External Ear

A
  • Elastic cartilage has protective hairs
  • Self cleansing via Epithelial Escalator
  • Ear wax
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26
Q

Ear wax is composed of Epithelial Cells, Lysozymes and Oily Secretions. Name four roles

A
  • Cleaning and lubrication
  • Protection from bacteria/dust/insects
  • Acidic coat inhibits microbial growth
  • Hydrophobic coat prevents water reaching canal skin
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27
Q

Name four risk factors for Otitis Externa

A

Hot and Humid Climates
Swimming
Immunocompromised
Insufficient or Excessive wax

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28
Q

What organisms are implicated in Otitis Externa?

A

90% Bacterial (S.Aureus, Pseudomonas)
10% Fungal (aspergillous - after prolonged abx)
Herpes Zoster

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29
Q

Name four non infective causes of Otitis Externa

A

Acne
Eczema
Psoriasis
Ear Plugs (irritants)

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30
Q

Name four symptoms of Otitis Externa

A

Pain
Itching
Hearing Loss
?Discharge

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31
Q

Name three signs OE of Otitis Externa

A

Inflamed External Canal
Scaly Skin
Pre-auricular LN

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32
Q

Necrotising Otitis Externa is a subtype of Otitis Externa. Define it

A

Extension into Mastoid or Temporal Bones (often in immunocompromised, elderly or diabetic)

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33
Q

How does Necrotising Otitis Externa present?

A

Discharge
Jaw Pain
Headache of great intensity
Facial nerve palsy - if osteomyelitis

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34
Q

How would you investigate Necrotising Otitis Externa?

A

Bone Scan

CT

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35
Q

How would you manage Necrotising Otitis Externa?

A

Prolonged Abx

Piperacillin- Tazobactam

Ciprofloxacin if pen allergic

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36
Q

You would only investigate Otitis Externa if it was atypical or non responding. How would you do this?

A

Ear Swab

Test integrity of membrane - can they taste something put in ear, can they blow out when nose is pinched

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37
Q

How is Otitis Externa managed?

A

Remove any debris

First line topical Abx (Cipro)+/- Steroids
Severe - Oral Flucloxacillin (if systemically unwell)and Topical Abx

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38
Q

What general advise should you give patients with Otitis Externa?

A

Use ear plugs when swimming
Keep ears clean and dry
Avoid swimming for 7-10d

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39
Q

What is Recurrent AOM?

A

> 3 distinct episodes of AOM in the past 6 months

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40
Q

Name the common organisms implicated in AOM

A

Haemophilus Influenza
Strep Pneumoniae
Rhinovirus
RSV

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41
Q

Name four risk factors for AOM

A

Smoking
URTI
Eustacian Tube Dysfunction
Craniofacial Abnormalities

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42
Q

Name three presenting features of AOM

A

Otalgia (tugging at ear)
Fever
Hearing Loss

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43
Q

Give three differentials for AOM

A

Trigeminal Neuralgia
TMJ dysfunction
GCA

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44
Q

What might you see on Otoscope of AOM

A

Red/Cloudy TM

Air fluid level

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45
Q

How would you immedately managed AOM?

A

Simple analgesia

Delayed Abx (5d Amoxicillin - not delayed if systemic sx or at risk)

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46
Q

When would you admit patients with AOM?

A

Severely systemically unwell
Suspected complications
<3m with temp >38

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47
Q

When would you refer a patient with AOM to ENT?

A

If recurrent in the present of persistant symptoms/persistent cervical lymphadenopathy/unilateral epistaxis

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48
Q

Name three complications of AOM

A

Tympanic perforation
Hearing loss
Labyrinthitis

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49
Q

What is Otitis Media with Effusion?

A

Results from either incomplete resolution of AOM or non infective obstruction of Eustacian Tube

Relative negative pressure in the ear canal drops leading to fluid accumulation

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50
Q

Name four risk factors for Otitis Media with Effusion

A

Chronic allergy
Sinusitis
Deviated septum
Enlarged tonsils

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51
Q

Name four presenting features of Otitis Media with Effusion

A

Rarely Otalgia
Fullness
Pressure popping
Poor speech development

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52
Q

What would you see on Otoscopy of Otitis Media with Effusion

A

Retracted Straw Coloured Tympanic Membrane

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53
Q

Adults with Otitis Media with Effusion should be fully investigated as it is rare. Name two investigations

A

FNE

Tympanogram

54
Q

Tympanograms measure compliance of TM by inserting a probe. Describe the three possible results

A

Type A - Peaks at 0 (normal)
Type B - Flat (Middle ear effusion - eg OME or perforation)
Type C - Tracing peaks at negative pressure (Eustacian Tube Dysfunction)

55
Q

Name the management options for Otitis Media with Effusion

A

Valsalva for temporary relief
Grommets
Adenoidectomy
Laser Myringotomy

Normally resolves in 6-12 weeks

56
Q

Cholesteotomas normally form due to dysfunctional eustacian tube. Describe the formation

A

Negative pressure pulls Pars Flaccida backwards, allowing epithelial cells to become trapped and proliferate
Osteolytic enzyme release can cause bony destruction

57
Q

The majority of cases of Cholesteotoma are Primary Acquired. Describe the aetiologies of Congenital and Secondary Acquired.

A

Congenital - Squamous epithelium becomes trapped in temporal bone during embryogenesis

Secondary - Insult to TM (as a result of trauma, surgery or Otitis Media)

58
Q

Name four presenting features of Cholesteotoma

A

Progressive hearing loss
Foul smelling painless otorrhoea
Vertigo
Headache

59
Q

How is a Cholesteotoma investigated?

A

Otoscope - pearly white mass behind TM, pus filled canal with granulation tissue

Audiological tests

CT - assesses bone invasion and how successful surgery would be

60
Q

What are the two surgical options for Cholesteotoma?

A

Open (Tympanomastoidectomy)

Closed (Tympanoplasty)

61
Q

What is the difference between Vestibular Neuritis and Labyrinthitis?

A

Vestibular Neuritis only affect vestibular nerve
Labyrinthitis affects vestibular nerve and labyrinth

Vestibular Neuritis will not alter hearing

62
Q

What causes Vestibular Neuritis?

A

Reactivation of latent type 1 HSV in Vestibular Ganglion

Commonly preceded by URTI

63
Q

What causes Labyrinthitis?

A

Usually viral in origin
Bacterial is dangerous (passes between anatomical connections)
May be associated with systemic disease

64
Q

How does Vestibular Neuritis present?

A

Sudden spontaneous vertigo

Nausea and Vomiting

65
Q

How does Labyrinthitis present?

A

Sudden spontaneous vertigo
Nausea and Vomiting
Hearing Loss
Tinnitus

66
Q

Name three clinical investigations you could do for suspected Labyrinthitis/VN

A

Head Impulse Test
Nystagmus (consistent and unilateral)
Skew

67
Q

What is the Head Impulse Test?

A

Fix patients gaze on your nose then move their head sharply
Patient should maintain gaze, not lag (saccades)

Not +ve in stroke

68
Q

How is Labyrinthitis investigated?

A

Culture and sensitivity if middle ear effusions are present

CT - Mastoiditis

69
Q

How is Labyrinthitis managed?

A

Sudden unilateral hearing loss - Emergency ENT

Reassurance - lie still in acute attacks and become mobile as soon as possible

Medication - Prochloperazine or Antihistamines

70
Q

What is Menieres Disease?

A

Distension of membranous labyrinth due to excess endolymph

Risks - Allergies, Autoimmunity, Genetic succeptibility

71
Q

Describe the diagnostic criteria for Menieres

A

2 x 20 minute vertigo
Hearing Loss
Tinnitus and /or aural fullness

72
Q

Name five investigations for Menieres

A 
Full Neurological exam
Pure tone audiometry
MRI IAM
Video Head Impulse testing 
ECG
73
Q

What is an important management step in Menieres?

A

Inform DVLA

74
Q

How should acute attacks in Menieres disease be managed?

A

Prochlorperazine

IM Steroid injection (followed by tapered oral)

75
Q

Describe the prophylactic management of Menieres

A

Low salt
Low caffiene

Trial of betahistine or diuretics

76
Q

Describe the surgical management of Menieres

A

Endolympatic Sac Decompression

Labyrinthectomy (causes loss of hearing)

77
Q

What does BPPV stand for?

A

Benign Paroxysmal Positional Vertigo

78
Q

Describe the pathophysiology of BPPV

A

Hairs embedded in Otoliths experience the movement of endolymphs depending on position

If otoliths become detached, there will still be movement - vertigo

Normally idiopathic but can occur after head injury

79
Q

Name four risk factors for BPPV

A

Older Age
Women
Menieres (co diagnosis in 30%)
Anxiety Disorders

80
Q

How does BPPV present?

A

Vertigo promoted by head movement
Attacks are sudden onset and last 20-30 seconds
Nausea
Symptoms worse in morning

81
Q

What would you want to examine in BPPV

A

Cranial Nerve
External Ear
Tympanic Membrane

82
Q

What is the diagnostic test for BPPV?

A

Dix Hallpike

Sit patient up so they’re looking at you at a 45 degree angle, then suddenly lower so head is off the bed

Observe for nystagmus

83
Q

What does the direction of Nystagmus in BPPV indicate about the canals?

A

Vertical and Rotary - Posterior Canal

Horizontal - Horizontal canal

84
Q

BPPV is self limiting over a number of weeks but can reoccur. What should you advise the patient?

A

Notify DVLA
Get out of bed slowly
Epleys Manouvre (Dix Hallpike but wait for Nystagmus to subside then rotate 90 degrees and sit patient up)

85
Q

Give a differential diagnosis for BPPV

A

Vestibular Migraine

86
Q

Name two other causes of hearing loss

A

Acoustic Neuroma

Otosclerosis

87
Q

Otosclerosis is caused by the pathological increased bone turnover. Give four risk factors

A

Genetics (Autosomal Dominant)
Oestrogen
Viral
Lack of fluoride

88
Q

How does Otosclerosis present?

A

Progressive hearing loss and tinnitus
Low volume speech

Stapes gradually becomes adhered to oval window

89
Q

How is Otosclerosis managed?

A

Bilateral hearing aids
Bisphosphonates or NaF
Stapedectomy or Stapedotomy

90
Q

What is Tinnitus?

A

The perception of sound when no external sound is present

Most people hear tinnitus at some pint but it is usually masked by external sounds

91
Q

There are two types of tinnitus: Pulsatile and Non Pulsatile. What is Pulsatile tinnitus ?

A

Synchronous with heartbeat due to turbulent flow reaching cochlea

Causes: Carotid Atherosclerosis, AV Malformation, Pagets, Otosclerosis

92
Q

There are two types of tinnitus: Pulsatile and Non Pulsatile. What is Non Pulsatile tinnitus ?

A

Buzzing/high pitched/clicking

Causes: Presbyacusis, Menieres, Drugs

93
Q

Name three drugs associated with Tinnitus

A

Loop Diuretics
NSAIDs
Salicyclates

94
Q

How is Tinnitus investigated?

A

MRI (if unilateral to exclude Acoustic Neuroma)
Pulsatile - CT/MR Angiography
Tinnitus Functional Index

95
Q

How is Tinnitus managed?

A

Reassurance
Address underlying cause
Coping mechanisms/Noise generator

96
Q

Name three causes of Conductive Hearing Loss

A

Excess earwax
OME
Otosclerosis

97
Q

Name three causes of Sensorineural Hearing Loss

A

Presbyacusis
Noise Induced
Acoustic Neuroma

98
Q

Aside from Webers and Rinnes, Pure Tone Audiometry is used to investigate reduced hearing. What is this?

A

Evaluates the quietest sound that can be heard in each ear

Must exclude wax/infection beforehand

99
Q

Describe the difference in audiometry graphs between Presbyacusis and Menieres

A

Menieres - hearing loss at a lower frequency

Presbyacusis - hearing loss at a higher frequency

100
Q

Describe four surgical management options for reduced hearing

A

Bone anchored hearing aid
Cochlea Implant
Stapedectomy and Prosthesis
Tympanoplasty

101
Q

Give three management options for excess wax

A

Topical Olive Oil/Sodium Bicarbonate
Microsuction
Syringing

102
Q

Name three congenital and two acquired causes of childhood deafness

A

Congenital - Rubella, Ear Atresia, Ossicular Abnormalities

Acquired - Hypoxia, Jaundice, Meningitis, Head Injury

103
Q

What is Ramsey Hunt Syndrome?

A

Reactivation of Herpes Zoster in geniculate ganglion

104
Q

What are the motor branches of the facial nerve?

A

Within facial canal - Nerve to Stapedius

Prior to Parotid - Posterior Auricular, Nerve to Digastic, Nerve to Omohyoid

Within Parotid - Temporal, Zygomatic, Buccal, Mandibular, Cervical

105
Q

Name five clinical features of Ramsay Hunt Syndrome

A
  • Vesicular rash on ipsilateral ear/hard palate/ anterior 2/3 of tongue
  • Hearing loss
  • Ipsilateral facial weakness
  • Drooling
  • Hyperacusis
106
Q

How is facial paralysis graded?

A

House Brackmann (I - IV)

107
Q

Ramsey Hunt Syndrome is a clinical diagnosis. What features would point towards an alternative?

A

Systemic Illness
Hearing abnormalities
Forehead sparing

108
Q

What are the main management points for Ramsey Hunt Syndrome?

A

Analgesia
Steroids +PPI
Aciclovir

Eye care

109
Q

What particular things would you want to note in a child with reduced hearing?

A 
Age of first word
Milestones
Vocab extent 
Pain/Discharge
Imbalance
DH
110
Q

Name three syndromes that include deafness

A

Waadenberg (+Heterochromia and wide nasal bridge)

Jervell Lange Nielson

CHARGE

111
Q

What is an electronic hearing aid?

A

Consists of ear piece, amplifier and microphone

T Setting - allows electromagnetic induction to block background noise

112
Q

Why do Electronic Hearing Aids work better for conductive hearing loss?

A

Sensorineural causes recruitment - loud sounds are heard exceptionally loudly

113
Q

Name three disadvantages to electronic hearing aids

A

Feedback
Otorrhoea
Dead Battery

114
Q

Name two environmental aids to help deaf people

A

Doorbells changed to buzzers/flashing lights

Telephones can be fitted with T Induction

115
Q

Name three conditions to avoid in someone who has to lip read

A

Poor background lighting
Beard and Moustache
Covering face with hand

116
Q

What is a Cochlear Implant?

A

Processor converts speech into electrical signals, transmitted to electrode in cochlea which then stimulates nerve

Used when abnormal cochlea but normal cochlear nerve

117
Q

What is a contraindication to Cochlear Implant?

A

Middle ear infection

118
Q

Give four otological causes of Otalgia

A

Otitis Externa
Furunculosis
Otitis Media
Acute Ototic Barotrauma

119
Q

Name a non otological cause of Otalgia

A

Referred pain (Tonsillitis, Teeth, TMJ)

120
Q

Name two causes of watery otorrhoea

A

Eczema of external ear

CSF

121
Q

Name two causes of purulent otorrhoea

A

AOM

Furunculosis

122
Q

Name two causes of bloody otorrhoea

A

Trauma

AOM

123
Q

Name a cause of foul smelling otorrhoea

A

Cholesteotoma

124
Q

Define Vertigo

A

Illusion of rotary movement - worse in the dark

125
Q

The causes of vertigo can be diagnosed based on time frame. Give two causes of vertigo lasting ‘seconds’

A

Postural Hypotension

BPPV

126
Q

The causes of vertigo can be diagnosed based on time frame. Give two causes of vertigo lasting ‘mins to hours’

A

Menieres

Labyrinthitis

127
Q

The causes of vertigo can be diagnosed based on time frame. Give two causes of vertigo lasting ‘hours to days’

A

Ototoxicity

Central vestibular disease

128
Q

Give three non otological causes of Vertigo

A

Migraine
TIA
Epilepsy

129
Q

What are the three commonest causes of episodic vertigo?

A

BPPV
Menieres
Migraine

130
Q

What would investigations of Otosclerosis show?

A

Tympanogram - normal type A

Pure Tone Audiometry - Carhart notch (dip at 2kHz)

131
Q

Name five things you would want to determine in a Tinnitus History

A

PHUCD

Pulsation or non
Hearing Loss
Unilateral of Bilateral
Constant or intermittent
Dizziness

Year 4 Neuro and Special Senses (8 decks)

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