Ear Flashcards by Nuhaa Dollie

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

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What are the signs/symptoms of Vestibular neuritis?

Acute vertigo lasting a few days

Nausea and vomiting

NO hearing loss

Usually in middle aged

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What is the management of vestibular neuritis?

Supportive

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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

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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)

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What are the signs/symptoms of BPPV?

Rotatary vertigo lasting seconds

Acute onset

Nausea

Normal neuro exam

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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.

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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

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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

Labyrinthitis

Perilymph fistula

Genetic (idiopathic)

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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)

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What clinical tests can be done to assess hearing loss?

Loock test

Rinne

Weber

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How could you investigate hearing loss?

Objective

Tympanometry
Oto-Acoustic Emission
Brainstem audiometry
MRI

Subjective
* Pure tone Audiometry

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Classify hearing loss

Mild: 25-40 dB

Moderate: 40-60 dB

Severe: 60-90 dB

Profound: >90 dB

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What is the management of obstructive earwax induced hearing loss?

Syringing

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When would you not syringe an ear?

When there is a known perforation coz’ it can introduce infection

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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

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Classify Chronic Supperative Otitis Media

With Cholesteotoma

Without Cholesteotoma

More aggressive on local structures
CN7 palsy
White patches
Multiple perforation
Ossicular destruction/exposed

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What are the complications of CSOM?

TM perfs

Ossicular Chain Damage

Chronic Hearing Loss

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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

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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