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ENT week 2 lectures > Ear > Flashcards

Ear Flashcards

1
Q

on a tympanogram, if the line is flat, what does this indicate?

A

otitis media with effusion (glue ear)

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2
Q

what are the 6 Ds of ear disease?

A
  • deafness
  • discomfort
  • discharge
  • dizziness
  • din din (tinnitus)
  • defective movement of face
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3
Q

what are the different types of deafness?

A
  • conductive
  • sensorineural
  • mixed
  • central
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4
Q

what kind of hearing loss is common in the elderly?

A

sensorineural

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5
Q

what nerves can be involved in causing discomfort in the ear?

A

CN V, VII, IX, X and C2, C3

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6
Q

what different processes can cause discharge from the ear?

A

acute otitis media
chronic otitis media
CSF

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7
Q

when is CSF coming from the ear seen most?

A

after trauma

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8
Q

when is tinnitus most noticable for the patient?

A

when they are in a quiet place without distraction

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9
Q

common name for otitis media with effusion?

A

glue ear

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10
Q

what is glue ear?

A

fluid behind the eardrum in the absence of infection

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11
Q

what can a child with glue ear present with?

A

sound can be muffled, deafness

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12
Q

if glue ear doesnt improve with time, how can it be treated?

A

insertion of gromets or a hearing aid

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13
Q

what can chronic otitis media lead to?

A

perforation in the TM

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14
Q

what causes a cholesteatoma?

A

squamous cell epithelium incorrectly positioned in the middle ear (which should be all columnar epithelium)

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15
Q

what is the name for a congenital cholesteatoma?

A

Derlacki

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16
Q

what is vertigo?

A

a sensation of movement, usually spinning when patient is stationary

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17
Q

how many vestibular end-organs does the labyrinth contain?

A

5

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18
Q

what kind of movement does the semicircular canals sense?

A

rotational

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19
Q

what does the maculae of the utricle and saccule sense?

A

gravity

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20
Q

what diseases cause dizzyness that originates in the inner ear?

A

BPPV
Meniere’s disease
vestibular neuronitis

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21
Q

what is nystagmus?

A

involuntary, uncontrolled, rapid eye movements from side to side

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22
Q

what is the vestibulo-ocular reflex?

A

a reflex eye movement that elicits eye movement by stimulating the vestibular system

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23
Q

what is the function of the vestibulo-ochlear reflex?

A

to stabilise images on the retina during head movement

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24
Q

if the head turns quickly to the left, in which direction will the vestibulo-ochlear reflex make the eyes go?

A

to the right

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25
Q

what can be observed in the eyes in vestibular pathologies?

A

nystagmus

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26
Q

what tests should be performed when someone presents with dizzyness initally?

A

otoscopy, neurological exam, BP including lying/standing, balance system, audiometry

27
Q

what are the specific pathologies that affect the inner ear causing dizzyness?

A
  • Meiniere’s Disease
  • BPPV
  • Vestibular Neuronitis
  • Labyrinthitis
  • Migrainous Vertigo
28
Q

what does BPPV stand for?

A

benign positional paroxysmal vertigo

29
Q

what is the most common cause of vertigo on looking up?

A

BPPV

30
Q

causes of BPPV?

A

head trauma, ear surgery, idiopathic

31
Q

what causes dizzyness in BPPV?

A

otolith material from utricle displaced into semicircular canals.

32
Q

which semi-circular canal is most commonly affected by BPPV?

A

posterior semi circular canal

33
Q

BPPV can be confused with Vertebrobasilar insufficiency, but what other symptoms are needed for the diagnosis of VBI?

A

-symptoms of impaired circulation in posterior brain eg visual disturbance, weakness, numbness

34
Q

in BPPV, what often brings on the vertigo?

A

looking up, turning in bed, first lying down in bed, first getting out of bed in morning, bending forward, rising from bending, moving head quickly

35
Q

how long does the vertigo in BPPV normally last?

A

minutes - brief episodes

36
Q

is there associated hearing loss or tinnitus with BPPV?

A

no

37
Q

is there aural fullness in BPPV?

A

No

38
Q

is there a clear positional triggers in BPPV?

A

yes

39
Q

how long does the episodes of vertigo last in Meiniere’s disease?

A

hours

40
Q

is there associated hearing loss or tinnitus with Meniere’s disease?

A

yes

41
Q

is there aural fullness in Meniere’s disease?

A

yes

42
Q

is there clear positional triggers in Meniere’s disease?

A

no

43
Q

how long can the episodes of vertigo last in labyrinthitis?

A

days-weeks

44
Q

is labyrinthitis associated with hearing loss or tinnitus?

A

yes

45
Q

is there aural fullness in labyrinthitis?

A

no

46
Q

is there clear positional triggers in labyrinthitis?

A

no

47
Q

how long does the episodes of vertigo last in vestibular neuronitis?

A

days-weeks

48
Q

is vestibular neuronitis associated with hearing loss or tinnitus?

A

no

49
Q

is there aural fullness in vestibular neuronitis?

A

no

50
Q

in the Dix-Hallpike test, why do you ask the patient not to close their eyes?

A

because you want to observe for nystagmus

51
Q

after lying the patient back in the Dix-Hallpike test, how long is the delay before nystagmus is observed usually?

A

approx 30 seconds

52
Q

what manoeuvre can be done to try manage BPPV?

A

epley manoeuvre

53
Q

what exercise can patients with BPPV be advised to do?

A

brandt-daroff exercise

54
Q

what can preceed vestibular neuronitis?

A

viral symptoms

55
Q

what is vestibular neuronitis?

A

inflammation of the vestibular nerve

56
Q

what often causes vestibular neuronitis?

A

virus

57
Q

what is the managment of vestibular neuronitis and labyrinthitis?

A

supportive managment with vestibular sedatives

58
Q

diagnostic indicators for Meniere’s disease?

A

history of recurrent, spontaneous, rotational vertigo with at least 2 episodes more than 20 mins (often lasting hours)

59
Q

what else must be experienced at least once to diagnose Meniere’s disease?

A

sensorineural hearing loss

60
Q

what should be avoided to prevent Meniere’s disease?

A

salt, betahistine, caffeine, alcohol, stress

61
Q

if Menieres fails to get better with supportive treatment, what can be done?

A

grommet insertion, intratympanic gentamicin/steroids, surgery

62
Q

what are the 2 main features of definite migranous vertigo?

A

episodic vestibular symptoms of atleast moderate severity and migraines

63
Q

what are 3 features that a patient must have atleast one of to be diagnosed with definite migranous vertigo?

A
  • migranous symptoms during vertigo
  • migraine-specific precipitants of vertigo
  • response to anti-migranous drugs
64
Q

what features are associated with probable migranous vertigo that a patient must have atleast one of to meet the diagnostic criteria?

A
  • migranous headache
  • photophobia
  • phonophobia
  • visual or other aura

ENT week 2 lectures (5 decks)

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