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Ear, Nose, and Throat Diseases > Ear Conditions > Flashcards

Ear Conditions Flashcards

1
Q

Tinnitus: Definition

A

Tinnitus is perception of sounds in the ears when there is no external auditory stimuli.
» ringing, rushing, roaring, buzzing, hissing, pulsing

Tinnitus is a symptom, not a diagnosis

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2
Q

Tinnitus: Epidemiology

A

1 in 7 adults in UK
Commonly associated with age-related hearing loss.

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3
Q

Tinnitus: Aetiology

A

Aetiology and pathophysiology poorly understood.
Usually believed to be due to damage to the cochlea and central processing of sounds.

Can be worsened by certain medications: aspirin, NSAIDS, diuretics, chemotherapy and aminoglycosides.
Some of these are reversable with cessation of medications, and others are not.

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4
Q

Tinnitus: Risk Factors

A

Noise induced is most common-
» Factory work
» Construction worker
» Military equipment
» Loud music at clubs or concerts
» Loud headphones

Strongly correlated with noise-induced hearing loss

Aneurysm
Hypertension
Diabetes
Obesity
High cholesterol
Anxiety disorders

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5
Q

Tinnitus: Investigation

A

Examination-
History&raquo_space; unilateral/bilateral, with/without hearing loss
Full ENT Exam
Jaw Exam for TMJ
Neuro Exam

Otoscopy and audiometry exam

Blood tests- Glucose, FBC, thyroid function

Pulsation tests- check neck head, BP, heart beat and murmurs, vascular sounds

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6
Q

Tinnitus: Management

A

Urgent referral if worsening: ENT or Neuro

Treat underlying causes if known

Screen and manage medication

Hearing aids and sound therapy

Tinnitus-masking devices for management

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7
Q

Mastoiditis: Definition

A

Inflammation or infection of the mastoid bone.

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8
Q

Mastoiditis: Epidemiology

A

Rare, rising incidence due to antibiotic resistance

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9
Q

Mastoiditis: Aetiology

A

Infection from middle ear spreads to mastoid bone.

Leads to bone erosion and possible formation of a subperiosteal (below periosteum) abscess.

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10
Q

Mastoiditis: Risk Factors

A

Immunocompromised
Otitis Media
Cholesteatoma

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11
Q

Mastoiditis: Symptoms and Signs

A

A systemically unwell child with severe pain.
Protruding ear.
Erythema&raquo_space; redness
Fluctuance&raquo_space; soft and bouncy
Pain over the mastoid area
Fever
High WBC

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12
Q

Mastoiditis: Investigations

A

Clinical

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13
Q

Mastoiditis: Management

A

Admit for IV antibiotics
Consider head CT for confirmation

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14
Q

Mastoiditis: Complications

A

Potential for meningitis or labyrinthitis

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15
Q

Otitis Media with Effusion: Definition

A

Glue-like fluid behind tympanic membrane without signs of infection

Secondary to-
Incomplete resolution of AOM
Obstruction of Eustachian tube

Most common cause of acquired conductive hearing loss in children.

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16
Q

Otitis Media with Effusion: Epidemiology

A

Common in 6 months - 4 years
30% of children
Higher incidence in cleft palate and down syndrome
Most common in winter

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17
Q

Otitis Media with Effusion: Aetiology

A

Fluid build up in middle ear stops eardrum vibrating properly

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18
Q

Otitis Media with Effusion: Risk Factor

A

Winter
AOM
Down syndrome
Allergic rhinitis
Frequent URTI

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19
Q

Otitis Media with Effusion: Symptoms

A

Concerns with hearing
Speech and language development delay
Balance problems
Popping sounds
Mild otalgia
Aural fullness

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20
Q

Otitis Media with Effusion: Signs

A

TM may appear normal or:

Amber or grey in colour
Loss of light reflex
Opacification
Presence of air bubbles or an air-fluid level
Retracted TM with prominent malleus and incus

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21
Q

Otitis Media with Effusion: Investigation

A

Clinical examination

Pneumatic Otoscopy&raquo_space; allows to push some air into ear&raquo_space; should see reduced TM mobility

Audiometry&raquo_space; determines presence and extent of hearing loss

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22
Q

Otitis Media with Effusion: Management

A

Refer to ENT
Watchful waiting for 3 months&raquo_space; OME often resolves spontaneously.

Do NOT offer: Antibiotics, antihistamines, mucolytics, decongestants, or steroids.

Surgical Intervention: Myringotomy with grommet insertion may be considered to restore hearing.
Auto-inflation: Can be used as a non-invasive option to open up Eustachian tube.
Recurrent Cases: May require adenoidectomy&raquo_space; remove adenoids to help drainage from middle ear.

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23
Q

TM Perforation: Definition

A

Hole or tear in tympanic membrane&raquo_space; ear drum

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24
Q

TM Perforation: Epidemiology

A

Anyone

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25
Q

TM Perforation: Aetiology

A

Trauma
Abuse&raquo_space; Red Flag
Foreign body
Forceful ear irrigation
Barotrauma
Acute Otitis Media (AOM)
Chronic Otitis Media (COM)

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26
Q

TM Perforation: Symptoms

A

Otalgia&raquo_space; ear pain
Otorrhoea&raquo_space; ear discharge
Sudden hearing loss
Tinnitus
Dizziness

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27
Q

TM Perforation: Signs

A

Bloody and/or purulent otorrhoea
Perforated tympanic membrane that is visible on otoscopy
Decreased hearing in the affected ear

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28
Q

TM Perforation: Investigation

A

Clinical examination
Otoscopy

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29
Q

TM Perforation: Management

A

Most TM perforations heal spontaneously within 2 months.

Avoid inserting anything into the affected ear.
Keep the ear dry; use caution while showering or bathing.
Apply a warm, moist compress for pain relief.

Use acetaminophen or ibuprofen for pain.
Consider antibiotics if the perforation is related to infection.
Refer for potential surgical intervention if the perforation does not heal.

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30
Q

Cholesteatoma: Definition

A

Accumulation of squamous epithelium (skin cells) and keratin debris in the middle ear.

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31
Q

Cholesteatoma: Aetiology

A

Long standing eustachian tube dysfunction
» retraction of eardrum
» can trapped epithelium infected and this can proliferates
» can become inflamed and infected

32
Q

Cholesteatoma: Symptoms and Signs

A

Hearing loss
Chronic purulent aural discharge
Crust in upper part of eardrum
TM could be perforated

33
Q

Cholesteatoma: Investigation

A

Ear exam&raquo_space; Otoscopy
CT to find extent of lesion and to do surgical assessment

34
Q

Cholesteatoma: Management

A

Urgent referral to ENT (2 week)
Surgical excision

35
Q

Otitis Externa: Definition

A

Inflammation of external ear and ear canal

Localised&raquo_space; inflammation of hair follicle&raquo_space; can turn into a boil
Diffused&raquo_space; inflammation of canal that spreads&raquo_space; can be acute or chronic

36
Q

Otitis Externa: Aetiology

A

Bacterial: Pseudomonas aeruginosa, Staphylococcus aureus.

Fungal: Aspergillus, Candida.

Skin diseases: Seborrheic dermatitis, allergic/contact dermatitis, psoriasis.

Physical trauma

Swimming: moisture trapped in the ear canal can contribute to infection.
Pseudomonas aeruginosa likes water&raquo_space; swimmers at higher risk

37
Q

Otitis Externa: Symptoms

A

Acute onset of pruritus&raquo_space; itching
Otalgia&raquo_space; ear pain
Hearing loss
Aural fullness
Otorrhoea&raquo_space; ear discharge
Pain or discomfort when moving the jaw or chewing

38
Q

Otitis Externa: Signs

A

Erythema (redness) and swelling of the ear canal and/or external ear
Ear canal oedema (swelling)
Purulent (pus-like) or serous (clear) discharge
Increased otalgia when the tragus or pinna is moved
Inflamed tympanic membrane (if visible; may be obscured by swelling)

39
Q

Otitis Externa: Investigation

A

Clinical diagnosis

Ear swab for bacterial and fungal cultures in cases of treatment failure, recurrent or chronic infections, or when the infection extends beyond the external auditory canal.

40
Q

Otitis Externa: Management

A

General self-care&raquo_space; avoid swimming, painkiller, keep ears dry, avoid cotton buds

Localise OE&raquo_space;
If abscess can create an incision and drain fluid.
Oral antibiotic if signs on systemic illness or boil formation

Diffuse OE&raquo_space;
Topical antibiotic with/without topic corticosteroid-
Gentamicin, ciprofloxacin, neomycin // betamethasone or prednisolone
Ear wick if extensive swelling

Oral antibiotic if systemic illness or recurrent.

41
Q

Malignant OE: Definition

A

Malignant Necrotising Otitis Externa
A severe form of otitis externa that progresses to osteomyelitis.

Osteo&raquo_space; bone
mye&raquo_space; muscle
litis&raquo_space; inflammation

42
Q

Malignant OE: Epidemiology

A

Increases due to predisposing conditions

43
Q

Malignant OE: Risk Factors

A

Trauma
Alcohol
Drug
Chronic steroid use
TB
Immunosuppression
HIV

44
Q

Malignant OE: Symptoms

A

Constant deep otalgia (pain)
Vertigo
Profound hearing loss

45
Q

Malignant OE: Signs

A

Fever

Palsy of cranial nerves-
VII (facial nerve)
XII (glossopharyngeal nerve)

46
Q

Malignant OE: Investigation

A

CT scan&raquo_space; will show destruction of bone and muscle

47
Q

Malignant OE: Management

A

Emergency Admission
IV antibiotics

48
Q

Cerumen Impaction: Definition

A

Accumulation of cerumen&raquo_space; earwax.
Also include sebum, dead cells, sweat, hair and dust.

49
Q

Cerumen Impaction: Aetiology

A

Cerumen (earwax) naturally cleans, protects, and lubricates the external auditory canal.

Impaction occurs when an accumulation of cerumen leads to symptoms.

50
Q

Cerumen Impaction: Symptoms and Signs

A

Conductive hearing loss
Aural fullness
Otorrhoea&raquo_space; ear discharge
Tinnitus
Dizziness

51
Q

Cerumen Impaction: Investigation

A

Visualisation and clinical otoscopy examination

52
Q

Cerumen Impaction: Management

A

Manual removal: by a healthcare professional.

Aural irrigation: using a syringe, if no contraindications are present.

Cerumenolytic agents: topic agents to soften cerumen, aiding in manual removal or irrigation.

Micro-suction: For safe removal, particularly in more complex cases.
Complication if perforated TM, history of ear surgery, active dizziness, recurrent ear infections.

53
Q

Vertigo: Definition

A

Vertigo is a feeling like you or everything around you is spinning.
It’s more than just feeling dizzy.

54
Q

Vertigo: Epidemiology

A

Not a diagnosis&raquo_space; a symptom

Can be central (brain) or peripheral (ear)

55
Q

Peripheral Vertigo: Aetiology

A

Usually medically less serious, but potentially life-disrupting-

Benign Paroxysmal Positional Vertigo
Otitis Media
Labyrinthitis
Vestibular neuronitis
Foreign body or wax in ear
Acoustic Neuroma&raquo_space; tumour of 8th cranial nerve&raquo_space; vestibucochlear nerve
Motion Sickness

56
Q

Central Vertigo: Aetiology

A

Usually more medically serious, can sometimes go undetected or less disruptive to lifestyle-

Stroke
Temporal Lobe Epilepsy
Tumor
Post-concussive syndrome
Vertebral Artery Insufficiency
Basilar Artery Migraine
Multiple Sclerosis

57
Q

Peripheral Vertigo: Symptoms and Signs

A

Sudden onset
Severe intensity
Lasts for a few minutes and is intermittent
Unidirectional, horizontal nystagmus&raquo_space; rapid, uncontrolled eye movement
Worse with specific head position
No focal neurological findings&raquo_space; no peripheral weakness, haven’t speech fine, reflexes fine, sensations fine
Some hearing loss or tinnitus

58
Q

Central Vertigo: Symptoms and Signs

A

Gradual onset
Mild intensity
Lasts for hours to days, and is constant in duration
Multidirectional and Vertical nystagmus&raquo_space; rapid, uncontrolled eye movement
No particular head position worsens it
May have focal neurological findings&raquo_space; peripheral weakness, loss of speech, reflexes, or sensation
Normal hearing

59
Q

Benign Paroxysmal Positional Vertigo: Definition

A

Disorder of inner ear characterised by repeated episodes of positional vertigo

Benign&raquo_space; doesn’t cause further illness
Paroxysmal&raquo_space; temporary and sudden onset
Positional&raquo_space; related to change in body position
Vertigo&raquo_space; causes false sensation of spinning

60
Q

Benign Paroxysmal Positional Vertigo: Aetiology

A

Caused by loose calcium carbonate debris in semi-circular canals of inner ear

With head movement, debris move in canals&raquo_space; inner ear fluid (endolymph) movement disrupted
» induces symptom of vertigo

61
Q

Benign Paroxysmal Positional Vertigo: Risk Factors

A

Head injury
Prolonged recumbent position&raquo_space; rolling over in bed
Ear surgery
Previous of inner ear pathology
Age

62
Q

Benign Paroxysmal Positional Vertigo:
Symptoms and Signs

A

Episodic vertigo
Nausea
Rare vomiting
Imbalance or falling
Worse in mornings

No hearing loss or tinnitus
No neurological abnormalities

63
Q

Benign Paroxysmal Positional Vertigo: Investigation

A

Clinical&raquo_space; take history

Dix - Hallpike Manoeuvre&raquo_space; looking for nystagmus of eyes&raquo_space; rhythmic oscillation of eyes&raquo_space;
» patient sits on bed with legs out
» move face 45 degrees
» quickly lower them onto bed so head off bed
» check eyes for rapid movement

64
Q

Benign Paroxysmal Positional Vertigo: Management

A

Epley Manoeuvres to reposition debris in semi-circular canals
» turn head 45 degrees towards affected side
» lie down keeping head turned for 30 seconds
» turn head 90 degrees towards unaffected side for 30 seconds
» turn another 90 degrees by moving body to unaffected side for 30 seconds
» sit up keeping head turned

If severely dehydrated from vomiting, may need IV fluids
Advice patient to avoid provoking movements
Help patient learn to “self-Eppley”

After 4 weeks, refer if symptoms not resolved-
No improvement with repeat manoeuvres
Atypical nystagmus

Consider imaging and further referral

65
Q

Meniere’s Disease: Definition

A

Chronic long-term conditions affecting the inner ear, balance, and hearing

66
Q

Meniere’s Disease: Aetiology

A

Cause unknown in most patients
Possible abnormal endolymph production and absorption&raquo_space; accumulation of fluid

67
Q

Meniere’s Disease: Risk Factors

A

Autoimmune disease
Metabolic disturbances involving balance of sodium/potassium levels of inner ear
Viral infection
Head trauma
Migraine headaches

68
Q

Meniere’s Disease: Symptoms

A

Episodic attacks lasting from 20 minutes to an hour

Vertigo
Hearing loss
Tinnitus&raquo_space; noise in ear
Aural fullness

69
Q

Meniere’s Disease: Signs

A

Nystagmus during attacks

70
Q

Meniere’s Disease: Investigation

A

Refer ENT or Audiovestibular medicine to confirm diagnosis

Diagnostic criteria includes-
More than 2 vertigo episodes lasting 20mins-12hrs
Fluctuating hearing, tinnitus, or aural fullness of affected ear
Hearing loss confirmed by audiometry testing

71
Q

Meniere’s Disease: Management

A

No cure&raquo_space; understanding of Meniere’s pathophysiology is limited

Rapid relief&raquo_space; prochlorperazine eases dizziness and vomiting&raquo_space; take medicine when attack starts

Betahistine&raquo_space; antihistamine to prevent attacks

Lifestyle&raquo_space; very low salt diet, avoid caffeine/alcohol/tobacco, regular exercise
Avoid heights, do not swim alone, DVLA must be alerted

SAFETY NETTING

72
Q

Vestibular Neuritis: Definition

A

Infection or inflammation of the vestibular nerve

73
Q

Vestibular Neuritis: Epidemiology

A

Most common in 30-60 year olds
Men and women equally affected

74
Q

Vestibular Neuritis: Aetiology

A

Inflammation of vestibulocochlear nerve

Often occurs in conjunction with or after viral infection of body, head, or neck
Occasionally provoked by immunisation

75
Q

Vestibular Neuritis: Symptoms and Signs

A

Abrupt onset of peripheral vertigo&raquo_space; days-weeks
Cannot walk or balance without falling
Nausea and vomiting&raquo_space; dehydration or electrolyte imbalances

Typically present at emergency care

76
Q

Vestibular Neuritis: Management

A

No treatment&raquo_space; wait for infection to clear

Prochlorperazine&raquo_space; dopamine receptor blocker&raquo_space; rapid relief
DO NOT USE STEROIDS&raquo_space; don’t help and side effects are too severe to justify

Refer to ENT

Ear, Nose, and Throat Diseases (2 decks)

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