Ear Flashcards
Problems with the external ear
Cellulitis Chondritis Perichondrtis may notice bulging of the ear due to mastoiditis Deformity of ear, microtia, sinus Scars
External auditory canal
Furunculosis - infected follicle that may need lancing Otitis externa - swimmers ear malignant otitis externa BarotraumaTMJ Dysfunction
Middle ear
Otitis media Otitis media with effusion Chronic otitis media CSOM Cholesteatoma Mastoiditis
Main types of deafness
Conductive - mechanical prior to the staled foot plate impaired sound transmission
Sensiorneural -post stapes foot plate, central or vestibular apparatus, sound transmits normally but is not sensed properly
Types of tinnitus
Objective where the examiner can hear it
Subjective where the examiner can’t hear it
What is an acoustic neuroma
Tumour of the Schwann cells of the superior vestibular nerve
Benign subarachnoid tumour Cause problem mechanically Can cause sensorineural deafness And ipsilateral tinnitus Large tumour ipsilateral cerebrally signs or inc ICP Numb face trigeminal compression
Types of vertigo
Peripheral - often severe and may be accompanied by loss of balance, n/v dec hearing, tinnitus, nystagmus,usually horizontal and sweating.
Central - usually less severe hearing loss and tinnitus less common
Types of peripheral vertigo
Ménière’s disease BPPV Vestibular failure Labyrinthitis Superior semi circular dehiscence
Central causes of vertigo
Acoustic neuroma MS Head injury Migraine associated dizziness Vertebrobasilar insufficiency
Exam and tests done in vertigo
CNs Ears Test cerebellum function and reflexes Hall pike Head thrust If clinical doubt request audio entry +-electronystagmography
Important questions to ask in vertigo history
Sensation spinning, dizzy, balance, pass out
Differentiate seizure, syncope and vertigo
Duration of spinning
Which way is the spin
Positional trigger
Features of BPPV
Attaches of sudden rotational vertigo lasting >30 secs are provoked by head turning
Other otological symptoms are rare
causes the movement of otoliths/otoconia that stimulate the semi circular canals
Establish important negative in hx
-not lasting forever
- no focal neuro signs
- no speech Motor sensory signs
Hall pike postive
Tx usually self limiting try Epley manoeuvre
Feature of ménière’s
Caused by dilation of the endolymphatic spaces of the labyrinth
Sudden attacks of vertigo lasting 2-4 hours
Nystagmus always present
Fullness in ears
+-tinnitus
Followed by vertigo
Unknown cause
Tx acute Prochlorperazine
Labyrinthectomy but would be deaf on that side
Features of acute vestibular failure
Sudden attacks of unilateral vertigo and vomiting in prev well person Often following URTI 1-2 days improves over a week Nystagmus away from the effected side Audiogram needed if hearing loss Prochlorperizine
