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5thyr > Ear > Flashcards

Ear Flashcards

1
Q

Name some peripheral causes of vertigo?

A
  • Benign paroxsymal positional vertigo (BPPV)
  • Vestibular neuritis
  • Meniere disease
  • Otoscleroris
  • Labrynthitis
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2
Q

List some central causes of vertigo?

A
  • MS
  • Acoustic neuroma
  • Vestibular migraine
  • CV disease
  • Cerebellopontine angle and posterior fossa meningiomas
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3
Q

How does BPPV present?

A 
-Episodic vertigo 
   • sudden onset 
   • provoked by head turning 
   • last >30 secs 
   • other symptoms rare (NO HEARING LOSS)
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4
Q

How is BPPV diagnosed?

A

Establish important negatives:

  • NOT persistent vertigo
  • NO speech, visual, motor or sensory problems
  • NO tinnitus, headache, ataxia, facial numbness, dysphagia

Hallpike test +ve

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5
Q

What is the dix hall pike test?
How do you do it?
What is a positive test?

A

Dix-hallpike test is DIAGNOSTIC for BPPV

  • Lower down on coach head turned to 45 degree angle
  • Nystagmus=+ve test
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6
Q

What is the Eply manoeuvre?

A

Eply manoeuvre is TREATMENT for BPPV

-move head 90 degrees (from R>L) then tilt so they are looking at floor

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7
Q

What is an acoustic neuroma?

A

Usually painless benign subarachnoid tumours that cause problems by local pressure, and then behave as SOL

Rare = 1 / 100,000 / year

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8
Q

Where do acoustic neuromas usually arise?

A

Superior vestibular Schwann cell layer

Sometimes called vestibular schwannoma

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9
Q

How do acoustic neuromas present?

A

Acoustic neuroma
-Ipsilateral tinnitus +/- sensorineural deafness
(cochlear nerve vompression)
-Disequilibrium common (wobbly)
-Trigeminal compression may give numb face
-Vertigo rare

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10
Q

What investigations are done for an acoustic neuroma?

What is a key differential?

A

MRI scan for ALL PATIENTS WITH UNILATERAL TINNITUS/DEAFNESS

Key differential = meningioma

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11
Q

What is the management of an acoustic neuroma?

A
  • Surgery is difficult and not often needed eg if elderly

- Methods of preserving hearing and facial nerve eg stereotactic radiosurgery

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12
Q

What is the symptoms of ototoxicity?

List some ototoxic drugs?

A

Cause bilateral tinnitis with associated hearing loss

Cisplatin and aminoglycosides (end in mycin) = permanent hearing loss

Aspirin, NSAIDs, quinine, macrolides and loop diuretics are associated with tinnitus and reversible hearing loss

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13
Q 
Which ones cause hearing loss?
Meniers 
BPPV 
Lambrynthitis 
Vestibular neuritis
A
  • BPPV and Vestibular neuritis DO NOT CAUSE HEARING LOSS

- Meniers and Lambrynthitis DO CAUSE HEARING LOSS

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14
Q 
How often is the vertigo?
Meniers 
BPPV 
Lambrynthitis 
Vestibular neuritis
A

BPPV (seconds) and Meniers (minuets) = EPISODIC VERTIGO

Lambrynthitis and Vestibular neuritis = PERSISTANT VERTIGO

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15
Q

What is Meniere’s disease?

A

Disorder of the endolymph volume (labyrinthine fluid) with progressive distention of the labyrinthe

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16
Q

What are the symptoms of Meniere’s disease?

How long do symptoms last?

A

Triad of:

  • Vertigo (with sickness)
  • Tinnitus
  • Hearing loss (sensorineural)

-Preceded by AURAL FULLNESS
-+/- nystagmus
Symptoms are episodic, lasting minutes to hours

17
Q

How can you treat Meniere’s disease? (acute/prophylaxis)

A

Acute:
Prochlorperazine (buccal for severe sickness)

Prophylaxis:

  • Betahistine 16mg/8hr po
  • Limit salt intake

Surgical procedures:
Labyrinthectomy (but causes total ipsilateral deafness)
-medical (Instillation of gentamicin via grommets)

18
Q

What is vestibular neuronitis/labyrinthitis?

A

Inflamation of inner ear (either labrynth or vestibular nerve)

19
Q

How does vestibular neuronitis/labyrinthitis present?

A 
-Sudden and severe PERSISTANT vertigo (days) 
   • does not progressively get worse 
   • worsened by head movements 
-Nausea + vomiting 
-Nystagmus AWAY from affected side

Neuronitis - VERTIGO with no hearing loss or tinnitus
Labyrinthitis -VERTIGO WITH hearing loss + tinnitus

(NB cochlear + SCC = labyrinth)

20
Q

What are common causes of vestibular neuronitis/labyrinthitis?

A

-Often following URTI /herpes simplex reactivation

21
Q

How do you manage vestibular neuronitis/labyrinthitis?

A

Reassure, could take prochlorperazine/antihistamine for vertigo

vestibular rehab if lasting 1+ week

22
Q

How does acute otitis media present?

A
  • Otalgia - might be pulling at ear
  • Malaise
  • Crying, poor feeding, restlessness
  • Fever
  • Vomiting
  • Coryza/rhinorrhoea

Perforation of TM often relieves pain - a child who is screaming and distressed may settle remarkably quickly then ear starts to discharge green pus

23
Q

What is the management of acute OM?

A

Analgesia

Acute OM resolves in 60% in 24hr with no abx

24
Q

When should abx be considered in acute OM?

A

Immediate abx:

  • Systemically unwell
  • Immunocompromised
  • No improvement in symptoms in >4 days

Immediate or 2 day ‘delayed’ abx:
<3 months old
Perforation / discharge
<2yrs with bilateral OM (most commonly caused by Haemophilus influenza)

25
Q

What AB in otitis media?

A

Amoxicillin 40mg/kg/day in 3 divided doses for 5 days

Erythromycin if penicillin allergic

26
Q

When would you admit a child for Otitis media? (based on temp and age)

A

Admission if child < 3 months with temp > 38
or
3-6 months with temp > 39 or suspected comps

27
Q

What is chronic otitis media? (3 types)

A

1) Benign / inactive COM
- Dry tympanic membrane perforation without active infection

2) Chronic serous OM
- Continuous serous drainage
- Typically straw coloured

3) Chronic suppurative otitis media
- Persistent purulent drainage through a perforated tympanic membrane

28
Q

What is the management of COM?

A
  • Take swab
  • Topical or systemic abx based on swab results
  • Aural cleaning
  • Water precautions
  • Careful follow up
  • Surgery
29
Q

When is surgery considered in COM?

A 
Aural cleaning and abx fail
Persistent perforation / discharge 
Conductive hearing loss 
Chronic mastoiditis 
Cholesteatoma formation
30
Q

What are the two surgical procedures offered in COM?

A

Myringoplasty = repair of tympanic membrane alone using a graft

Mastoidectomy = surgical repair of tympanic membrane and ossicles

31
Q

what are the complications of otitis media? (4)

A

Effusion (common)

  • swollen/bulging TM
  • chronic inflammatory process without acute inflammation

Perforation (fairly common)
-May progress to chronic Suppurative Otitis Media

Mastoiditis

  • severe pain
  • forward protrusion of ear w/ tender boggy mass behind ear → can cause meningitis → UEGRNT treatment

Cholesteatoma
-keratinizing squamous epithelium colonizes middle ear due to tympanic membrane retraction

32
Q

What is the leading cause of hearing loss in children?

A

OM with effusion (OME) = glue ear

33
Q

What is the management of OME?

A

Usually transient, mild and resolves spontaneously
50% with bilateral will resolve within 3 months

Observation for 3 months then reassess hearing

Auto-inflation of eustation tube via a balloon through the nose can help during this period

Surgery (Tympanostomy tube / grommets)

34
Q

How may a cholesteatoma present?

A 
Foul discharge +/- deafness
Headache 
Pain 
Facial paralysis 
Vertigo

These symptoms indicate impending CNS complications

35
Q

What are risk factors for cholesteatoma?

A

Chronic otitis media

Trauma

36
Q

What is the management for cholesteatoma?

A

Mastoid surgery to remove the sac of squamous debris

37
Q

What do the otolith organs do?

A

Detect tilt and acceleration/deceleration

There are 2 otolith organs (utricle + saccule)

38
Q

What do the semi-circular canals do?

A

Detect rotation

Control eye movements in the plane of the canal

39
Q

What does dysfunction of semi-circular canals lead to?

5thyr (18 decks)

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