Ear Flashcards
Classify the common causes of dysequilibrium according to duration?
Seconds
- Benign Paroxysmal Positional Vertigo (BPPV)
- Positional Hypotension
- Cervical Spondylosis
Minutes - Hours
- Labyrinthitis
- Meniere’s disease
Hours - Days
- Vestibular neuritis
- Labyrinthine failure
- Drugs
What are the signs/symptoms of Vestibular neuritis?
Acute vertigo lasting a few days
Nausea and vomiting
NO hearing loss
Usually in middle aged
What is the management of vestibular neuritis?
Supportive
What is the signs/symptoms of Meniere’s disease?
(Endolymph hydrops - idopathic inner ear disorder)
Vertigo lastings mins - hours
Tinnitis - worst before an attack
Unilateral paroxysmal fluctuation sensorineural hearing loss
Aural fullness
Symptoms may subside after 10-20 years
What is the management of Meniere’s disease?
Medical
- Low sodium diet
- Diuretics
- Dietary restrictions
- Intra-tympanic aminoglycoside administration
Surgical
- For failed medical management
- Endolymph sac decompression
- Vestibular nerve sections
- Labyrinthectomy (ablates hearing)
What are the signs/symptoms of BPPV?
Rotatary vertigo lasting seconds
Acute onset
Nausea
Normal neuro exam
What is the management of BPPV?
Epley’s manouvre
Step 1: Start sitting up on a bed, with your legs flat on the bed in front of you. Turn your head 45 degrees to the left.
Step 2: Lie down, keeping your head turned to the left. Wait 30 seconds.
Step 3: Turn your head to the right 90 degrees, until it’s facing 45 degrees to your right side. Wait 30 seconds.
Step 4: Roll over onto your right side before sitting up.
List the possible causes of conductive hearing loss
EAC:
- Wax
- Exostoses
Tympanic Membrane
- Perforation
- CSOM
Middle Ear
- Middle Ear Effusion
- Otitis Media with Effusion
- Ossicular chain dysfunction
- Otosclerosis
List the possible causes of sensorineural hearing loss
Age Related
Noise Induced
Drugs
- Aminoglycosides
- Streptomycin injections for TB
- Cytotoxic - chemo drugs
Syphilis
Acoustic neuroma
Vascular
- DM
- HPT
Labyrinthitis
Perilymph fistula
Genetic (idiopathic)
What are the important things to note in a patient who complains of hearing loss?
SOCRATES
- Site
- Onset
- Character
- Radiation
- Associated factors - Tinnitis, Disequilibrium
- Time
- Exacerbating/relieving factors
- Severity (pain history)
What clinical tests can be done to assess hearing loss?
Loock test
Rinne
Weber
How could you investigate hearing loss?
Objective
- Tympanometry
- Oto-Acoustic Emission
- Brainstem audiometry
- MRI
Subjective
* Pure tone Audiometry
Classify hearing loss
Mild: 25-40 dB
Moderate: 40-60 dB
Severe: 60-90 dB
Profound: >90 dB
What is the management of obstructive earwax induced hearing loss?
Syringing
When would you not syringe an ear?
When there is a known perforation coz’ it can introduce infection
Discuss the management of traumatic perforations
Dry perforations
- Should heal within a day
- Keep dry
If wet control infection and get dry
- Dry mopping
- Boric Acid Powder
- Quinolone Drops
Classify Chronic Supperative Otitis Media
With Cholesteotoma
Without Cholesteotoma
TB
- More aggressive on local structures
- CN7 palsy
- White patches
- Multiple perforation
- Ossicular destruction/exposed
What are the complications of CSOM?
TM perfs
Ossicular Chain Damage
Chronic Hearing Loss
Discuss Otitis Media with Effusion (Glue Ear)
Most common cause of acquired conductive hearing loss in children - Unusual in adults
ET dysfunction resulting in negative pressure in middle ear > Body compensated & fills space with effusion
Causes..
- Enlarged adenoids
- URTI
- Sinusitis
- Bronchitis
NB if persists >3/52 exclude:
* Chronic Sinusitis / Nasophar. Ca.
Treat the cause
Discuss Tympanosclerosis
Scar tissue formation in the tympanic membrane
Associated with Grommets
Very seldom causes hearing loss > Reassure
Discuss Otosclerosis
Overgrowth of bone fixes stapes footplate
Familial
Signs:
- Conductive HL
- Bilateral
- No other cause
Management
* Hearing aid + Stapedectomy
What are the 3 characteristic inner ear symptoms of sudden sensorineural hearing loss?
Sensorineural hearing loss
* 30 dB loss over 3 adjacent frequencies over 3 days
Tinnitus
Vertigo
What is the management of sudden sensorineural hearing loss?
ENT emergency
High dose Steriods - 1mg/kg for 10days
Vasodilators - Betahistine
Serial audiometry
Discuss Presbyacusis
Age-related hearing loss
> 60 years
Characteristics:
- Hi>low (Sloping Audiogram)
- Decrease speech discrim.
- Recruitment (compensation)
- Decreased Dynamic Range
Managed with Hearing Aid
Discuss noise-induced hearing loss
Prolonged exposure >80-90 dB
Characteristic loss @ 4 kHz
Associated tinnitus
Managed with Hearing aid
List 3 Ototoxic drugs
Aminoglycosides
Streptomycin
Cytotoxic chemotherapy drugs
What are the signs of Otitis media with Effusion
Retracted Tympanic membrane
Reduced tympanic membrane mobility
Air fluid levels
Bubbles
What are the signs of Chronic Otitis Media?
Foul smelling discharge
- TM discharge
- Cottage cheese like
Granulation tissue
Polyp
Hearing loss
What are the symptoms and signs of Acute Otitis Media?
Pain (otalgia)
Fever
Erythematous Tympanic membrane
Bulging tympanic membrane
Immobile tympanic membrane
Exudate
What is the management of acute otitis media?
Usually due to URTI
Oral ceftriaxone
Analgesia
What is the management of chronic otitis media?
Aural Toilet
Dry mopping
Topical treatment
- Boric Acid powde
- Topical Ciprofloxacin
- Topical Corticosteriods
- Topical antifungal (if fungal)
What are the signs and symptoms of Cholesteatomas?
An abnormal skin growth - Keratin debris
Classification
- Congenital
- Acquired
Symptoms
- Foul smelling discharge
- Conductive hearing loss
- Pressure/fullness in the ear
- Dysequilibrium
- Facial weaknesss
What is the management of cholesteatoma?
Excision
What are the complications of cholesteatoma?
Meningitis
Intra-cranial abscess
Erosion of ossicular bones
What are sites of referred otalgia?
TMJ dysfunction
Dental abscess
Sinusitis
Tonsilitis
Pharyngitis
Throat malignancy
Cervical pain
What are the causes of otalgia due to problems in/around the ear?
External ear:
- Otitis externa
- Herpes zoster oticus (ramsey hunt syndrome)
- Auricular cellulitis
- Necrotising (malignant Otitis extrena)
Middle/Inner ear
- Acute otitis media
- Otitis media with effusion
- Mastoiditis
- Traumatic perforation
What are the Acute causes of otitis externa?
Acute otitis externa
Granular myringitis
Auricular cellulitis
Herpes zoster Otica
Acute fungal otitis externa
What are the chronic causes of otitis externa?
Necrotising otitis externa
Eczema
Seborrhoeic dermatitis
What is the clinical presentation of acute otitis externa
1-2 day history of progressive ear pain
Itching
Purulent discharge
Conductive HL
Feeling of fullness/pressure in the ear
Exposure to water
What would you find on examination of acute otitis externa
Pain on manipulation of the auricle
Inflammed EAC
Swollen ear canal
Scanty pasty discharge (purulent)
TM difficult to visualise
What is the management of acute otitis externa?
Aural toilet (synringing and dry mopping)
AB’s - Ciprofloxacin
Topical steroids - Quadriderm
Keep ear dry!
What is the clinical presentation of herpes zoster otica
Otalgia - Burning pain
May have a facial palsy
Vessicles in and around the EAC 3-7 after onset of pain
Maybe have SNHL due to cranial nerve palsy
What is the management of herpes zoster otica?
Acycolvir
Oral steroids
Corneal protection - is there is facial nerve palsy
What is the clinical presentation of necrotising otitis media?
Uncontrolled DM / Immunocompromised / Elderly
Causative organism = Pseudomonas
Discharge = Green, persistent
Deep boring pain
Granuloma in EAC
Facial nerve palsy - if progressive to skull base osteomyelitis
What is the management of necrotising otitis externa?
Refer to ENT
IV ABs - Ciprofloxacin
Analgesia
Controle co-morbids
A patient presents with discharge and facial nerve palsy, provide a DDx
TB Ear!
Herpes zoster otica
Necrotising otitis externa
What are the indications for syringing an ear?
Hearing loss due to wax impaction
Discharging Otitis externa without a perforation
? wet perforation
FB that will not swell - crayons / toys
What are the contraindications for syringing an ear?
Dry perforation
Fresh traumatic perforation
FB that will swell - Batteries/vegetables
What are the indications for dry mopping?
After syringing
Otitis externa with discharge
Otitis media with discharge
