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ENT > ear conditions > Flashcards

ear conditions Flashcards

1
Q

5 important ear related symptoms to ask about

A 
vertigo/dizziness
discharge
hearing loss
tinnitus 
pain
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2
Q

causes of referred ear pain (6 Ts)

A 
teeth
tongue
throat
trigeminal
TMJ
tonsil
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3
Q

commonest causative organism of otitis media

A

strep pneumoniae

also haemophilus influenzae, moraxella catarrhalis

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4
Q

key presenting features of acute otitis media

A 
EAR PAIN
generally unwell - fever irritability
kids
discharge if perforation
(potential hearing loss more common in OME)

red, bulging tympanic membrane

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5
Q

main risk of otitis media

A

perforation of tympanic membrane - discharge

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6
Q

management of otitis media

A

conservative, most resolve within 3days-week

delayed antibiotics or if significantly ill/immunocompromised = amoxicillin or clarithromycin if pen allergy

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7
Q

key features of otitis media with effusion (glue ear)

A

acute hearing loss without unwell symptoms - longer term hearing loss than otitis media
no ear pain

poor school performance - behaviour problems, speech delay

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8
Q

appearance of otitis media with effusion on otoscopy

A

dull/retraction of tympanic membrane with air bubble or visible fluid level

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9
Q

management of otitis media with effusion

A

conservative for 3 months

post 3 months

  • <3yrs = grommets
  • > 3yrs
    • first = grommets
    • second intervention = grommets + adenoidectomy

(if nasal symptoms adenoids may be considered earlier)

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10
Q

cholesteatoma

A

abnormal collection of keratin + squamous eoithelial cells in middle ear
benign but can invade local tissues, nerves + bones of middle ear

can predispose infections

male predominance

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11
Q

cholesteatoma presentation

A

foul discharge from ear
unilateral condictive hearing loss
pearly white mass in middle ear

as expands - infection, pain, vertigo, facial nerve palsy

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12
Q

histological findings of cholesteatoma

A

squamous epithelium with abundant keratin production

assoc inflammation

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13
Q

cholesteatoma investigations

A

otoscopy = abnormal build up of whitish debris or crust in upper tympanic membrane

CT head = confirm diagnosis
MRI = assess invasion damage

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14
Q

management of cholesteatoma

A

surgical removal

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15
Q

discharge from ear after multipal course of topical antibiotics

A

fungal infection otitis externa - ab killed friendly bacteria

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16
Q

bacterial causes of otitis externa

A 
staph aureus
pseudomonas aeruginosa (immunocomp)
17
Q

pseudomonas aeruginosa

A

gram neg aerobic rod-shaped bacteria

18
Q

otitis externa presentation

A

ear pain
discharge
itchiness
conductive hearing loss if ear becomes blocked

19
Q

management of otitis externa

A

conservative for 3 days then sofradex (drops, combo of antibiotic + steroid)

20
Q

malignant otitis externa

A

found in immunocompromised
pseudommonas aeruginosa
infection spreads + progresses to mastoid + temporal bone osteomyelitis

21
Q

otitis externa malignant presentation

A 
diabetes or immunosuppress
severe otalgia
severe temporal headaches
fever
non-resolving otitis externa with worsening pain
facial nerve palsy
22
Q

investigations + management of malignant otitis externa

A

diagnosis = CT
biopsy + culture

emergency admission
IV antibiotics

23
Q

otosclerosis

A

gradual remodelling of small bones of middle ear leading to conductive hearing loss

mainly affects base of stapes where it attaches to oval window - prevents from transmitting sound effectively

commoner in women - progresses rapidly in pregnancy

24
Q

mode of inheritence of otosclerosis

A

autosomal dominant

25
Q

otosclerosis presentation

A

hearing loss (conductive)
tinnitus
under 40yrs
affects lower pitch more - female speech EASIER to hear

26
Q

management of otosclerosis

A

conservative = hearing aids

stapedectomy = prosthetic replacement of stapes

27
Q

noise induced hearing loss audiometry

A

classical dip at 4kHz on audiometry

28
Q

drugs that can cause hearing loss

A

gentamicin + other aminoglycosides
chemo drugs - cisplatin, vincristine

aspirin + NSAIDs in overdose

29
Q

bilateral vestibular schwannoma (acoustic neuroma)

A

neurofibromatosis type 2

30
Q

vestibular schwannoma (acoustic neuroma)

A

benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear VIII) that innervates inner ear

most unilateral + assoc with long exposure to loud noise
SLOW GROWING

31
Q

presentation of vestibular schwannoma

A

aged 40-60 with gradual onset unilateral -
sensorineural hearing loss
tinnitus
dizziness or imbalance (not vertigo as slow growing)
aural fullness

ENT (11 decks)

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