Ear Flashcards
What is otosclerosis?
When the normal bone is replaced by vascular spongy bone
What type of hearing loss does otosclerosis cause?
Progressive conductive deafness (stapes becomes fixed to the oval window).
What are the features of otosclerosis?
Autosomal dominant
Onset usually 20-40 years
Conductive deafness
Tinnitus
Positive family history
Tympanic membrane usually normal
Can be precipitated by pregnancy
What is the management of otosclerosis?
Hearing aid
Stapedectomy
What is the management for auricular haematomas?
Same-day assessment by ENT - to prevent cauliflower ear
Usually treated with incision and drainage
What is an auricular haematoma?
bleeding between the cartilage and perichondrium
this can restrict blood supply and lead to necrosis of the connective tissue
What is the treatment for a burst tympanic membrane?
No treatment - review in 2 weeks
Should have resolved within 6-8 weeks - if not, refer to ENT
Antibiotics only indicated if the perforation occurs after an episode of acute otitis media
What is acute otitis media?
An infection of the middle ear
Usually preceded by an URTI but is usually a secondary bacterial infection
What are the common causes of acute otitis media?
Streptococcus pneumonia
Haemophilus influenza
Moraxella catarrhalis
What are the signs and symptoms of acute otitis media?
Otalgia
Fever in half
Hearing loss
recent URTI
Ear discharge (if tympanic membrane perforation)
Bulging tympanic membrane
Erythematous tympanic membrane
What is the management of acute otitis media?
Usually self limiting - analgesia alone. Parents advised to seek help if symptoms don’t resolve within 3 days.
Antibiotics if:
- symptoms >4 days
- systemically unwell
- immunocompromised
- <2 years with bilateral otitis media
- otitis media with perforation
What antibiotics are given for acute otitis media?
5-7 days of amoxicillin
Penicillin allergy - erythromycin or clarythromycin
What is vestibular neuronititis?
A cause of vertigo that develops following a viral infection
What are the signs of vestibular neuronitits?
Recurrent vertigo attacks lasting hours or days
Nausea and vomiting
Horizontal nystagmus
NO HEARING LOSS OR TINNUTIS
HiNTs exam - done to distinguish vestibular neuronitis from a posterior circulation stroke
What is the management of vestibular nerutonitis?
- Buccal or intramuscular prochlorperazine
- Short course of prochlorperazine or antihistamines (cinnarizine, cyclising or promethazine)
- Vestibular rehabilitation exercises - for chronic symptoms
What is benign paroxysmal positional vertigo?
Characterised by sudden onset dizziness and vertigo triggered by changes in head position
One of the most common causes of vertigo
What are the features of benign paroxysmal positional vertigo?
Vertigo triggered by a change in head position
Associated nausea
Episodes last 10-20 seconds
What will be seen on dix-hallpike test in BPPV?
Patient experiences vertigo
Rotational nystagmus
What is the treatment for BPPV?
Employ manoeuvre - successful in 80% of cases
Medication - Betahistine (limited value)
Mean age of diagnosis is 55
50% will have recurrence of BPPV within 3-5 years after diagnosis
What is acute labrynthitis?
Inflammation of the labyrinth if the inner ear
Most commonly viral
What are the symptoms of acute labyrinthitis?
Acute onset
Diziness
Nausea
Unilateral hearing loss (sensorineural hearing loss)
Sudden onset
Preceding or concurrent symptoms of URTI
Unidirectional horizontal nystagmus
Gait disturbance
What is the main difference between labyrinthitis and vestibular neuritis?
Labyrinthitis affects both the vestibular nerve and labyrinth so causes both vertigo and hearing loss
Neuritis only affects the vestibular nerve so there is no hearing impairment
What is the management of acute labyrinthitis?
Episodes are usually self limiting
Prochlorperiazine or antihistamines might help the sensation of dizziness
What is Meniere’s disease?
A disorder of the inner ear of unknown cause
Characterised by excessive pressure
What are the main features of Menieres disease?
Vertigo - most prominent symptom
Tinnitus
Sensorineural hearing loss
Sensation of aural fullness/pressure
Symptoms resolve within 5-10 years
Majority of patients will be left with a degree of hearing loss
Psychological distress is common
What is the management of Menderes disease?
ENT assessment
Inform the DVLA
Acute attacks - Buccal or intramuscular prochlorperazine
Prevention - Vestibular rehabilitation exercises or betahistine
What is the management for sudden-onset sensorineural hearing loss?
Urgent referral to ENT
Most cases are idiopathic
MRI is done to rule out vestibular schwannoma
Treatment for all: 7 days oral prednisolone
What is the name given to age-related hearing loss?
Presbycusis
What are the features of presbycusis?
Occurs Bilaterally
Progressive sensorineural hearing loss
High pitched sounds are most difficult to hear
What medications can cause tinnitus?
Aspirin
NSAIDs
Loop diuretics
Quinine
Aminoglycosides
What are the causes of otitis external?
Bacterial: Staphylococcus aureus, pseudomonas aeurginosa, fungal
Seborrhoea dermatitis
Contact dermatitis
Recent swimming
What are the features of otitis external?
Ear pain
Itch
Discharge
What is the treatment for otitis external?
First-line:
- Topical antibiotics +/- steroid
- removal of debris from canal
Second-line:
- Oral antibiotics (flucloxacillin)
- swab of ear canal
Failure to respond - referral to ENT
What is malignant otitis external?
When there is an extension of otitis external infection into the bony ear canal and the soft tissues
IV antibiotics may be required
More common in elderly diabetics
What are the symptoms of acoustic neuromas (Vestibular schwannoma)?
Cranial nerve VIII: Vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
Cranial nerve V: Absent corneal reflex
Cranial nerve VII: Facial palsy
What is an acoustic neuroma?
A benign tumour
What is a cholesteatoma?
A non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction.
What are the main features of a cholesteatoma?
Most common in aged 10-20
Increased risk in patients born with a cleft palate
Foul smelling, non-resolving discharge
Hearing loss
Other: (If local invasion)
Vertigo
Facial nerve palsy
Cerebellopontine angle syndrome
What is the management of choelsteotoma?
Referred to ENT for surgical removal
What is glue ear?
Otitis media with an effusion
What are risk factors for glue ear?
Male
Siblings with glue ear
Winter and spring
Bottle fed
Day care attendance
Parental smoking
What are the common features of glue ear?
Peaks at 2 years old
Hearing loss is the presenting complaint - most common cause of conductive hearing loss in childhood)
Secondary problems may occur - speech, language delay, behavioural and balance problems
What is the treatment for glue ear?
Grommet insertion - stop functioning after 10 months
adenoidectomy
what is Ramsay hunt syndrome?
Herpes zoster oticus - caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
What are the features of Ramsay hunt syndrome?
Auricular pain
Facial nerve palsy
Vesicular rash around the ear
Vertigo
Tinnitus
What is the treatment for Ramsay hunt syndrome?
Oral acyclovir - 7 days
Oral prednisolone - 5 days
