Ear

Question 1

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

Answer 1

otitis media with effusion (glue ear)

Question 2

what are the 6 Ds of ear disease?

Answer 2

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

Question 3

what are the different types of deafness?

Answer 3

• conductive
• sensorineural
• mixed
• central

Question 4

what kind of hearing loss is common in the elderly?

Answer 4

sensorineural

Question 5

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

Answer 5

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

Question 6

what different processes can cause discharge from the ear?

Answer 6

acute otitis media
chronic otitis media
CSF

Question 7

when is CSF coming from the ear seen most?

Answer 7

after trauma

Question 8

when is tinnitus most noticable for the patient?

Answer 8

when they are in a quiet place without distraction

Question 9

common name for otitis media with effusion?

Answer 9

glue ear

Question 10

what is glue ear?

Answer 10

fluid behind the eardrum in the absence of infection

Question 11

what can a child with glue ear present with?

Answer 11

sound can be muffled, deafness

Question 12

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

Answer 12

insertion of gromets or a hearing aid

Question 13

what can chronic otitis media lead to?

Answer 13

perforation in the TM

Question 14

what causes a cholesteatoma?

Answer 14

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

Question 15

what is the name for a congenital cholesteatoma?

Answer 15

Derlacki

Question 16

what is vertigo?

Answer 16

a sensation of movement, usually spinning when patient is stationary

Question 17

how many vestibular end-organs does the labyrinth contain?

Answer 17

5

Question 18

what kind of movement does the semicircular canals sense?

Answer 18

rotational

Question 19

what does the maculae of the utricle and saccule sense?

Answer 19

gravity

Question 20

what diseases cause dizzyness that originates in the inner ear?

Answer 20

BPPV
Meniere’s disease
vestibular neuronitis

Question 21

what is nystagmus?

Answer 21

involuntary, uncontrolled, rapid eye movements from side to side

Question 22

what is the vestibulo-ocular reflex?

Answer 22

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

Question 23

what is the function of the vestibulo-ochlear reflex?

Answer 23

to stabilise images on the retina during head movement

Question 24

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

Answer 24

to the right

Question 25

what can be observed in the eyes in vestibular pathologies?

Answer 25

nystagmus

Question 26

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

Answer 26

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

Question 27

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

Answer 27

- Meiniere's Disease - BPPV - Vestibular Neuronitis - Labyrinthitis - Migrainous Vertigo

Question 28

what does BPPV stand for?

Answer 28

benign positional paroxysmal vertigo

Question 29

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

Answer 29

BPPV

Question 30

causes of BPPV?

Answer 30

head trauma, ear surgery, idiopathic

Question 31

what causes dizzyness in BPPV?

Answer 31

otolith material from utricle displaced into semicircular canals.

Question 32

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

Answer 32

posterior semi circular canal

Question 33

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

Answer 33

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

Question 34

in BPPV, what often brings on the vertigo?

Answer 34

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

Question 35

how long does the vertigo in BPPV normally last?

Answer 35

minutes - brief episodes

Question 36

is there associated hearing loss or tinnitus with BPPV?

Answer 36

no

Question 37

is there aural fullness in BPPV?

Answer 37

No

Question 38

is there a clear positional triggers in BPPV?

Answer 38

yes

Question 39

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

Answer 39

hours

Question 40

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

Answer 40

yes

Question 41

is there aural fullness in Meniere's disease?

Answer 41

yes

Question 42

is there clear positional triggers in Meniere's disease?

Answer 42

no

Question 43

how long can the episodes of vertigo last in labyrinthitis?

Answer 43

days-weeks

Question 44

is labyrinthitis associated with hearing loss or tinnitus?

Answer 44

yes

Question 45

is there aural fullness in labyrinthitis?

Answer 45

no

Question 46

is there clear positional triggers in labyrinthitis?

Answer 46

no

Question 47

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

Answer 47

days-weeks

Question 48

is vestibular neuronitis associated with hearing loss or tinnitus?

Answer 48

no

Question 49

is there aural fullness in vestibular neuronitis?

Answer 49

no

Question 50

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

Answer 50

because you want to observe for nystagmus

Question 51

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

Answer 51

approx 30 seconds

Question 52

what manoeuvre can be done to try manage BPPV?

Answer 52

epley manoeuvre

Question 53

what exercise can patients with BPPV be advised to do?

Answer 53

brandt-daroff exercise

Question 54

what can preceed vestibular neuronitis?

Answer 54

viral symptoms

Question 55

what is vestibular neuronitis?

Answer 55

inflammation of the vestibular nerve

Question 56

what often causes vestibular neuronitis?

Answer 56

virus

Question 57

what is the managment of vestibular neuronitis and labyrinthitis?

Answer 57

supportive managment with vestibular sedatives

Question 58

diagnostic indicators for Meniere's disease?

Answer 58

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

Question 59

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

Answer 59

sensorineural hearing loss

Question 60

what should be avoided to prevent Meniere's disease?

Answer 60

salt, betahistine, caffeine, alcohol, stress

Question 61

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

Answer 61

grommet insertion, intratympanic gentamicin/steroids, surgery

Question 62

what are the 2 main features of definite migranous vertigo?

Answer 62

episodic vestibular symptoms of atleast moderate severity and migraines

Question 63

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

Answer 63

- migranous symptoms during vertigo - migraine-specific precipitants of vertigo - response to anti-migranous drugs

Question 64

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

Answer 64

- migranous headache - photophobia - phonophobia - visual or other aura