Ear

Question 1

3 divisions of the ear

Answer 1

outer
middle
inner

Question 2

What 3 components make up the outer ear?

Answer 2

Pinna
External auditory meatus
lateral tympanic membrane

Question 3

What structures are in the middle ear?

Answer 3

Ossicles - malleus, incus , stapes
Facial nerve
eustacian tube

Question 4

What part of the ear does the eustacian tube link up with?

Answer 4

Middle ear

Question 5

What is the part of the middle ear located being the pars flaccida known as?

Answer 5

Attic

Question 6

What is the inner ear comprised of?

Answer 6

Cochlea 
Semicircular canals (vestibule and labyrinth)

Question 7

What does the cochela do?

Answer 7

creates electrical impulses to the cochlea nerve

Question 8

What do the vestibule and labyrinth do?

Answer 8

balance

Question 9

The Eustachian tube connects the middle ear with what?

Answer 9

nasopharynx

Question 10

What is the mastiod process and how does this relate to middle ear infection?

Answer 10

Bony lump behind pinna

mastiod air cell system opens directly to middle ear so infection can spread causing mastioditis

Question 11

What is conductive hearing loss and what part(s) of the ear does it involve?

Answer 11

Interruption to the hearing system in the external or middle ear

Question 12

What is sensorineural hearing loss and what structures are involved?

Answer 12

hearing process is interrupted at the cochlea or auditory nerve

Question 13

What test can help distinguish between conductive and sensorineural hearing loss?

Answer 13

tuning fork test

Question 14

What type of hearing test is this?:

Place someone in a sound proof room. Present with series of sounds and measure bone and air conduction in each ear.

Answer 14

Pure tone audiometry

Question 15

What type of hearing test is this?:

Presenting stimulus to ear and measuring the resultant changes of electrical activity in the nervous system

Answer 15

evoked/electrical response audiometry

Question 16

What type of hearing test is subjective and requires cooperation?

Answer 16

Pure tone audiometry

Question 17

Which type of hearing test is subjective and can therefore be used to assess hearing in children?

Answer 17

Electrical response audiometry

Question 18

What are otoacoustic emissions and what are they used to assess?

Answer 18

Electrical signal generated by the inner ear in response to sound.
Used to assess hearing in babies

Question 19

What is tympanometry?

Answer 19

Blowing a small current of air into ear to measure distensibility of ear drum and middle ear.

Question 20

4 gestational infections that can lead to congenital sensorineural hearing loss?

Answer 20

Toxoplasmosis
Rubella
cytomegalovirus
herpes

Question 21

What is the acquired sensorineural hearing loss associated with aging known as?

Answer 21

Presbyacusis

Question 22

What are 3 infective causes of acquired sensorineural hearing loss?

Answer 22

Meningitis
Mumps
Measles

Question 23

4 causes of acquired conductive hearing loss?

Answer 23

Wax
Glue Ear
Otitis externa
Chronic suppurative otitis media

Question 24

Why is it important to treat blunt trauma to the ear quickly?

Answer 24

If there is bleeding between the skin and the cartilage

the cartilage can necrose due to insufficient blood supply and then your left with a cauliflower ear

Question 25

What is haematoma auris?

Answer 25

Bleeding between skin and cartilage in pinna

Question 26

What is the best management for haematoma auris?

Answer 26

drain the blood | pressure dressing

Question 27

Wehn should syringing of earwax be avoided?

Answer 27

If the eardrum is perforated

Question 28

What is otitis externa an infection of?

Answer 28

Skin of the external ear canal

Question 29

What is otitis externa also known as?

Answer 29

Swimmer's ear

Question 30

What organisms commonly cause otitis externa?

Answer 30

Pseudomonas | Staphylococcus

Question 31

Symptoms of otitis externa?

Answer 31

Pain Itching Sometimes a fetid discharge

Question 32

What is the treatment of otitis externa?

Answer 32

Clean the ear Keep it dry Short course of antibiotic drops

Question 33

What can excessive and prolonged use of antibiotic drops lead to?

Answer 33

Change of normal flora | Fungal infection - otomycosis

Question 34

What are Exostoses and what is the condition also known as?

Answer 34

Broad based bony swellings in the external ear and are thought to be an inflammatory response to cold water exposure. Surfer's ear

Question 35

What are osteomas and how do they differ from exotoses?

Answer 35

``` Benign bony tumour of the external ear canal. More common in men unilateral not a result of cold water exposure narrower pedunculated ```

Question 36

What is necrotising otitis externa?

Answer 36

progressive osteomyelitis of the of the temporal bone resulting from otitis externa

Question 37

Which patients are most at risk of necrotising otitis externa?

Answer 37

Patients with compromised immunity | (poorly controlled diabetes

Question 38

Symptom of necrotising otitis externa?

Answer 38

Severe, unremitting, deep seated pain that does not respond to analgesics

Question 39

What type of organism usually causes acute otitis media?

Answer 39

Virus - ascending via the Eustachian tube.

Question 40

In what age group is acute otitis media usually seen?

Answer 40

Children - they have shorter, wider and more horizontal Eustachian tubes and an immature immune system,

Question 41

4 key features of acute otitis media

Answer 41

otalgia fever deafness otorrhea (if fetid this suggests anaerobic organism)

Question 42

How does a bacterial infection compare with a viral one in acute otitis media.

Answer 42

Viral are short lived | Bacterial may last for a week or more

Question 43

What makes acute otitis media so painful?

Answer 43

Build up of pus and therefore pressure behind tympanic membrane.

Question 44

How is the intense pain often relived in acute otitis media?

Answer 44

Eardrum bursts, relieving pressure

Question 45

several weeks after a bout of AOM the parents notice that their kid is still a little deaf. Whayt could cause this and is this normal?

Answer 45

There can still be some residual fluid in the middle ear for several weeks, causing some deafness and yes this is normal.

Question 46

How dos the mastoid relate to AOM and what is a known complication?

Answer 46

Mastoid abcess

Question 47

What is the key to management of AOM?

Answer 47

Analgesia | Antibiotics - not always required

Question 48

If an ear drum perforates but fails to heal and causes recurrent bouts of discharge, what is this condition?

Answer 48

chronic suppurative otitis media

Question 49

What would a patient with chronic suppurative media complain of?

Answer 49

Discharge from ear | Increasing deafness

Question 50

3 treatment options for a perforated eardrum?

Answer 50

- reassurance and advice on water caution - antibiotics and water caution - myringoplasty

Question 51

What type of antibiotics are toxic to the inner ear?

Answer 51

aminoglycosides

Question 52

What is a cholesteatoma?

Answer 52

Following a perforated eardrum, squamous epithelium migrates from the outer ear to the middle ear and collects in a mass.

Question 53

How do complications arise from a cholesteatoma?

Answer 53

the mass can become erosive and gradually eat away at the bone and soft tissue

Question 54

What 3 locations can infection resulting from cholesteatoma spread to

Answer 54

Brain facial nerve inner ear

Question 55

What 5 things would make you suspect cholesteatoma in a patient with a perforated eardrum?

Answer 55

``` persistent smelly discharge no improvement with drops severe hearing loss dizziness unexplained neurological signs symptoms ```

Question 56

7 complications of cholesteatoma?

Answer 56

``` Meningitis facial palsy acute mastoiditis labyrinthitis intercranial abscess venous sinus thrombosis ```

Question 57

What is persistent fluid in the middle ear for 3 months or more known as?

Answer 57

Otitis media with effusion/Glue Ear

Question 58

What is the most common cause of hearing loss in children?

Answer 58

OME

Question 59

Between what ages is OME most prevalent?

Answer 59

2-7 years

Question 60

At what time of year is OME more prevalent?

Answer 60

Winter months

Question 61

What are two possible causes of OME?

Answer 61

Infection | Eustachian tube dysfunction

Question 62

What other tissue is associated with OME?

Answer 62

Adenoids

Question 63

Children with what 2 conditions are most susceptible to OME?

Answer 63

Down's syndrome | cleft palate

Question 64

Aside from hearing loss what else might parents of children with OME also notice?

Answer 64

Dizziness | Clumsiness

Question 65

Is pain usually associated with OME?

Answer 65

No

Question 66

What is OME likely to impact if left unchecked?

Answer 66

Schooling | Behaviour

Question 67

How will the ear drum appear in a case of OME?

Answer 67

fluid level or a translucent ear drum

Question 68

What are the management steps for OME?

Answer 68

Wait 3 months Mod-severe deafness? - grommets or hearing aid Recurrent glue ear - adenectomy

Question 69

What is it important to reassure parents about regarding OME?

Answer 69

It's a common condition that shouldn't affect the child's hearing in the long term.

Question 70

Define tinnitus

Answer 70

Noise in the ear or head in the absence of stimulus

Question 71

Is most tinnitus subjective or objective?

Answer 71

Subjective - heard only by pt

Question 72

Is tinnitus usually bilateral or unilateral

Answer 72

bilateral

Question 73

If tinnitus is pulsatile what does this suggest?

Answer 73

Due to adjacent blood vessel in head or neck

Question 74

What is age related hearing loss known as?

Answer 74

Presbycusis

Question 75

Why does unilateral tinnitus warrant a more urgent referral than bilateral tinnitus?

Answer 75

Very rarely can be a symptom of an intercranial tumour.

Question 76

Why is it important to take a drug history when a pt complains of tinnitus?

Answer 76

Many drugs, such as aspirin have a side effect of tinnitus

Question 77

What medical conditions are associated with tinnitus?

Answer 77

HTN | anaemia

Question 78

How long does it take most traumatic tympanic perforations to heal?

Answer 78

around 6 weeks

Question 79

What should pts be advised to do in the event of a tympanic perforation?

Answer 79

Keep ears dry to avoid infection

Question 80

What can arise from blunt trauma to the middle ear?

Answer 80

Haemotympanum

Question 81

What will a haemotympanum result in and what is the management of this?

Answer 81

Conductive deafness | Will usually resolve itself

Question 82

If hearing loss persists after a haemotympanum has resolved, what may have occurred and what do you do?

Answer 82

Ossicular injury | May require reconstructive surgery

Question 83

What type of hearing loss can occur with a temporal bone fracture?

Answer 83

Conductive Sensorineural Mixed

Question 84

What may happen to the tympanic membrane following a temporal bone fracture?

Answer 84

Perforation | Haemotympanum

Question 85

What are the possible symptoms of a temporal fracture?

Answer 85

``` Deafness Otalgia Otorrhoea - blood/csf Rhinorrhoea - blood/csf vertigo ```

Question 86

What is the Battle sign, when do you check for it and what does it indicate?

Answer 86

Ecchymosis of the post auricular skin Following head injury Fracture of the temporal bone

Question 87

What is the racoon sign, when do you check for it and what does it indicate?

Answer 87

Ecchymosis of the periorbital skin Following head injury Fracture of the temporal bone

Question 88

What type of investigation is necessary following a suspected temporal bone fracture?

Answer 88

CT head

Question 89

Following head trauma what examination is required of the ear?

Answer 89

Tuning fork and pure tone audiometry