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Derm, Opth + ENT > Ear > Flashcards

Ear Flashcards

1
Q

How do you treat meatal swelling?

A

Ribbon gauze soaked in magnesium sulphate

or pope wick changed daily then gentamicin or neomycin

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2
Q

What causes mastoiditis?

A

Breakdown of bony partitions (trabeculae) between mastoid air cells

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3
Q

When should mastoiditis be suspected?

A

Continuous discharge for >10 days

If systemically unwell

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4
Q

Causes of ear pain

A 
Referred pain from CN9 (tonsillitis)
CN10 - carcinoma of pyriform fossa
CN5 mandibular division (upper molars or TMJ)
C2/C3 pain due to posture
Mastoiditis 
OM
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5
Q

Causes of otorrhea

A

Acute = OM or OE
Chronic inflammatory disease
In acute, pain is dominant before discharge

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6
Q

What is subacute suppurative OM?

A

Continuous discharge from ear >3 weeks after OM

Due to mucosal infection or infection of nasopharynx

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7
Q

What is safe chronic suppurative OM?

A

Active mucosal chronic OM
Perforation is central so there is always a rim of ear drum
Involves pars tensa
Discharge arises from secreting mucosa

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8
Q

What is unsafe chronic suppurative OM?

A 
Active chronic with cholesteatoma
May spread intra cranially due to erosion of bone
Atticantral 
Discharge is foul smelling 
May need radical mastoidectomy
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9
Q

Causes of conductive hearing loss

A

Obstruction due to wax, foreign body, debris
Perforation causing reduction in SA of TM - also allows incident sound pressure which causes distortion of sound waves
Discontinuity of ossicular chain - usually due to infection (particularly of long process of incus)
Fixation of ossicular chain due to otosclerosis which immobilises foot of stapes
Eustachian tube blockage (glue ear) - progressive deafness due to accumulation of viscous material

MUST EXCLUDE CARCINOMA OF NP as this can present as conductive hearing loss

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10
Q

Causes of sensorineural hearing loss

A

Bilateral progressive = age, noise damage, drug ototoxicity
Unilateral progressive = meniere’s or acoustic neuroma
Sudden loss = mumps, measles, chicken pox, trauma

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11
Q

Meniere’s

A

Fluctuating hearing levels and recurrent episodes of vertigo

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12
Q

Complications of otitis media

A 
Mastoiditis 
TM perforation 
Labrynthitis 
Meningitis 
Intracranial abscess 
Hearing loss 
Sinus thrombosis 
Damage to facial nerve
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13
Q

Management for otitis media

A

Can resolve spontaneously
Amoxicillin 5-7 days for:
high risk/ systemically unwell pts
Clarithromycin 2nd line

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14
Q

RF for OM

A

Children <4
Passive smoking
Formula fed
Craniofacial abnormalities

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15
Q

S+S of OM

A

Ear pain, tugging of ear

fever, poor feeding, crying, rhinorrhea

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16
Q

What is chronic suppurative OM?

A

Chronic inflammation of middle ear with otorrhoea through perforated TM
Causes ear discharge, hearing loss, hx of OM

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17
Q

What may cause persistent OME?

A

Impaired eustachian tube function
Low grade infection
Persistent local inflammatory reaction
Adenoidal infection or hypertrophy

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18
Q

RF for OME

A

Kids with Downs, cleft palate, CF, PCD, allergic rhinitis

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19
Q

Management of OME

A

Active observation - resolves in 6-12 weeks

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20
Q

What are the types of otitis externa?

A 
Diffuse = involves skin + subdermis of ear canal 
Localised = infection of hair follicle 
Malignant = spread into bone
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21
Q

Bacteria causing OE

A

Pseudomonas aerigenosa or staph aureus

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22
Q

Complications of OE

A

Abscess, inflamed TM, malignant OE

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23
Q

Management of OE

A

Symptomatic relief

Topical tx for infection

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24
Q

What is ear wax made of?

A

Dead flattened cells, cerumen, sebum + foreign substances

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25
Q

RF for impacted ear wax

A 
Narrow or deformed ear canals 
Numerous hairs in ear canals 
Benign bony growths in canal 
Dermatological disease on scalp/ ear
Elderly 
Hx of OE 
Downs
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26
Q

S+S of impacted ear wax

A 
Conductive hearing loss 
Blocked ears 
Ear ache 
Tinnitus 
Itchiness 
Vertigo
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27
Q

Management of impacted ear wax

A

Ear drops for 3-5 days (Sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil drops)
2nd line: ear irrigation
Referral to ENT

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28
Q

What is a cholesteatoma?

A

Abnormal sac of keratinising squamous epithelium + accumulation of keratin within middle ear

29
Q

S+S of cholesteatoma

A

Foul smelling discharge

Conductive hearing loss

30
Q

What images of TM would indicate cholesteatoma?

A

Evidence of discharge
Presence of deep retraction pocket
Crust or keratin in upper part of TM
Perforated TM

31
Q

Management of cholesteatoma

A

Otomicroscope + micro-suctioning

32
Q

dB threshold for deafness

A

0-20

33
Q

What are typical dB levels for a whisper, average home noise + conversational speech?

A 
30 = whisper 
50 = noise 
60 = speech
34
Q

Gradings of hearing loss

A 
25-40 = mild, cannot hear whispers 
40-70 = moderate, cannot hear speech
70-90 = severe, cannot hear shouting
>95 = profound, cannot hear noises that would be painful
35
Q

Causes of hearing loss in children

A 
Conductive = glue ear 
Sensorineural = genetics, intrauterine infection/ drugs, prematurity, infections
36
Q

RF for hearing loss in children

A 
Fam hx 
Infection (rubella, mumps, meningitis)
Ototoxic meds 
Prematurity/ low birth weight 
Craniofacial abnormalities 
Klinefelters/ Turners 
Severe hyperbilirubinemia 
Head injury 
Neurodegenerative disorders
37
Q

Screening for deafness in children

A

Automated otoacoustic emissions test (AOAE)
then Automated auditory brainstem response test (AABR) if this is positive
Pure tone sweep test upon school entry

38
Q

Management of deafness in children

A

Communication support - hearing aids, radio aids, cochlear implants, lip reading, BSL

39
Q

Management of conductive hearing loss

A

Grommets

Auto-inflation

40
Q

Types of hearing aid

A

External
Cochlear implants
Bone anchored hearing aids

41
Q

What is presbyacusis?

A

Hearing loss in older people as they age

Usually bilateral, high pitched sounds most affected

42
Q

RF for presbyacusis

A

Arteriosclerosis
Exposure to loud noise, chemicals or meds
Smoking

43
Q

Management of presbyacusis

A 
Hearing aids
Lip reading 
Hearing assistive devices
Cochlear implants 
Active middle ear implant
44
Q

Difference between vestibular neuritis + labyrinthitis

A 
VN = only vestibular nerve 
L = VN + labyrinth
45
Q

Causes of labyrinthitis

A 
URTI - viral 
Bacterial
Vertebrobasilar ischemia 
Meningitis 
Meniere's 
Ototoxic meds
46
Q

S+S of labyrinthitis

A 
Sudden, spontaneous + severe vertigo 
Not triggered but exacerbated by movement 
N+V 
Hearing loss 
Tinnitus
URTI symptoms
47
Q

What drugs can cause vertigo?

A 
Aminoglycosides
Anti-HTN (amlodipine) 
Anti-depressants 
Benzos
Anti-epileptics
48
Q

Investigations for ?labyrinthitis

A 
Pts fall towards affected side when walking 
HINTS: 
Head impulse test 
Nystagmus check 
Skew deviation (cover/ uncover test)
49
Q

What HINTS results suggest labyrinthitis + ischemic stroke?

A 
labyrinthitis = abnormal head impulse, unidirectional nystagmus + no vertical skew 
stroke = normal head impulse, bidirectional nystagmus + vertical skew
50
Q

Management of labyrinthitis

A

Prochlorperazine or antihistamines

Myringotomy + evacuation of effusion if needed

51
Q

Complications of labyrinthitis

A

Falls
Unilateral hearing loss
BPPV

52
Q

Pathology of acoustic neuroma

A

Tumours of vestibulocochlear nerve arising from Schwann cells of nerve sheath
Usually benign + slow growing
Cause symptoms through mass effect + pressure

53
Q

Difference between CPA tumours + internal auditory canal tumours?

A

CPA can grow without affecting function

Internal canal tumours cause hearing loss or vestibular disturbance early

54
Q

RF for acoustic neuroma

A

Neurofibromatosis

High dose ionising radiation

55
Q

S+S of acoustic neuroma

A

Unilateral/ asymmetrical hearing loss or tinnitus
Impaired facial sensation
Balance problems

56
Q

Investigations for ?acoustic neuroma

A

Audiology

MRI

57
Q

Management of acoustic neuroma

A

Microsurgery
Stereotactic radiosurgery
Observation

58
Q

What features should you examine in nasal trauma/ FB?

A 
Epistaxis or rhinorrhea 
Septal haematoma 
Septal deviation
Lacerations, ecchymoses, swelling
Crepitus 
Facial/ mandibular fracture
Ophthalmoplegia 
Facial anesthesia
59
Q

Management of nasal trauma

A

Ice + analgesia
Refer to ENT if deviation present
Closed reduction

60
Q

Presentation + common FB in nose

A

Nasal obstruction/ persistent offensive discharge from 1 nostril
Beads, buttons, sweets, nuts, seeds, peas

61
Q

When to refer to ENT for FB in nose?

A

Hx of prolonged nasal discharge
FB is in posterior position
Pt is unco-operative

62
Q

Management of nasal FB

A

Use topical anesthetics + vasoconstrictor spray
Blow positive pressure through nose (parents blowing in pts mouth while obstructing unaffected nostril)
Use nasal speculum + hook/ forceps
Use suction
Use Fogarty balloon catheter

63
Q

Presentation of septal perforation

A 
Nasal whistling sound 
Discharge from nose 
Nasal congestion 
Infection 
Epistaxis
64
Q

Pathology of nasal polyps

A

Lesions arising from nasal mucosa
Frequently in clefts of middle meatus
Part of spectrum of chronic rhinosinusitis

65
Q

What are nasal polyps associated with?

A

Asthma
Aspirin sensitivity
Cystic fibrosis
Churg Strauss syndrome

66
Q

S+S of nasal polyps

A 
Nasal airway obstruction 
Discharge 
Dull headaches 
Snoring 
Reduced smell
67
Q

Investigations + management of polyps

A 
Flexible endoscopy (rhinoscopy) 
Topical corticosteroids 
Endoscopic sinus surgery 2nd line
68
Q

Complications of nasal polyps

A

Acute bacterial sinusitis
Sleep disruption
Can lead to craniofacial abnormalities

Derm, Opth + ENT (6 decks)

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