Ear Conditions Flashcards
Describe how to perform Rinne’s test
Tap s 512Hz tuning fork and hold close to the patients ear and then place firmly on the mastoid process. Ask which the patient heard loudest. Do in both ears.
Explain the results of Rinne’s test.
If bone conduction is heard louder than air conduction (negative) then the patient has conductive hearing loss
Describe Webers test.
A 512Hz tuning fork is tapped and held in the middle of the patients forhead. Ask they patient which ear they hear the noise louder in or if they are both the same.
Explain the results of Webers test
If there is normal hearing the patient will hear the noise the same in both ears. If there is conductive hearing loss then the patient will hear the sound loudest in the affected ear. If there is sensorineural hearing loss then the sound will be heard loudest in the unaffected ear
What does this audiogram show?
Conductive hearing loss
What does this audiogram show?
Bilateral sensorineural hearing loss
What does this audiogram show?
Presbyicusis (age related hearing loss)
What does this audiogram show?
Menierre’s disease
What intrauterine infections put children at an increased risk of deafness?
Toxoplasmosa, Rubella, Cytomegalovirus, Herpes and HIV (TORCH infections)
How should you hold the ear to examine in an adult patient?
Retract bacwards and pull upwards
What position should the ear be in for examination in a child?
Pulled backward
On examination with an auroscope you see a thickened, whitish ear drum, what dies this indicate?
Previous repeated infections
You see dullness of the ear drum when examining with an auroscope. What might this indicate?
Fluid in the middle ear cavity
An 82 year old patient complains that she has to turn the television up louder and has difficulty hearing her daughter speak. She says it is equally bad in both ears.
Presbycusis
What part of the ear is damaged in presbycusis?
The cochlea. Can be due to loss of hair cells (sensory), loss of ganglion cells (neural) strial atrophy (metabolic) or mixed.
What would you do for a patient with presbycusis?
High frequency hearing aid.
Is presbycusis sensorineural hearing loss or conductive hearing loss?
Sensorineural
Describe what happens in osteosclerosis and why this causes deafness
Abnormal bone forms around the footplate of the stapes and prevents its normal movement. This causes conductive deafness.
A pregnant lady comes to you complaining of hearing loss. Her examination is normal and her audiogram shows conductive hearing loss. She know her grandmother went deaf at around 40 so she is very worried.
Osteosclerosis
What are the possible treatments for osteosclerosis?
Hearing aid
Replacement of the stapes bone with a prosthesis.
A 60 year old man comes in complaining of tinnitus and hearing loss.
Noise induced hearing loss (Caused by cochlear damage) and on audiogram you can see the characteristic loss at 4kHz
A 56 yeah old lady presents to you with worsening hearing loss. She says she finds constants harder to hear than vowels. She has also noticed she has problems balancing hersefl and can no longer stand on one leg. What do you think is wrong and what is the first line investigation.
Vestibular schwannoma
MRI of the head
What is a vestibular schwannoma?
A benign tumour nerve tumour on the vestibular portion of the vestibulocochlear nerve, in the internal auditory meatus.
You are reviewing the MRI scan of a 24 year old patient who presented with hearing loss. There are bilateral vestibular schwannoma. Why is this?
Could be a sign of neurofibromatosis type 2
A patient presents with unilateral hearing loss and also loss of corneal sensation. SHe has also noticed her balance has worsened.
Large unilateral vestibular schwannoma which is encroaching on the trigeminal nerve (this is what causes the loss of corneal sensation)
What investugation should be performed on all patients presenting with a unilateral sensorineural hearing loss and why?
MRI brain. To excule a vestibular schwannoma
A patient presents with hearing loss, tinnitus and vertigo. Her audigram shows unilateral sensorineural hearing loss and on examination she has no corneal reflex.
Vestibular schwannoma
A patient presents to you in a GP surgery with sudden onset profound hearing loss. What do you do?
Send to hospital as an emergency and arrange MRI
A 10 year old girl presents with her mother. Her ears are itchy and sore and her mum has noticed there is a lot of wax. One examination the ear is tender and on looking inside, the lining is red and there appear to be some debris.
Ottitis externa
What is the most common bacterial infecting organism in otitis externa? Name two other possible bacteria that could cause this.
Staph aureus
Proteus
Pseudomonas aeruginosa
List two fungal causes of ottitis externa
Aspergillus niger
Candida albicans
What is the first line treatment for a patient presenting with a 4 day history of ottitis externa?
Topical aural toilet
A girl who you saw a week ago with ottitis externa returns sayign she has had no relief despite cleanign the ear carefully. What do you do?
Swab for culture then treat accordingly.
Results from microbiology come back showing an ottitis externa due to aspergillus niger. What treatment fo you prescribe?
Topical clomitrazole
A patient with recurrent ottitis externa apresents and there is now also widespread cellulitis around the ear also.
Oral flucloxacillin and refer to ENT
What is the treatment for a patient who has bacterial ottitis extrena with oedema.
Ciprofloxacin drops and steroid drops
What organism is usally responsible for a furnurcle in the outer ear canal?
Staph aureus
What treatment would you prescribe for a patient with an extremely painful furnurcle in the ear?
Analgesia
Flucloxacillin given into the ear and then orally.
Severe cases may need incision
A child presents with earche, fever and irritability. On examination the tympanic membrane is opaque.
Acute ottitis media
Why does acute ottitis media usually occur?
An upper respiratory tract infection which has travelled up the eustachian tube
Is AOM usually viral or bacterial?
Viral
What are the four most common bacterial causes of AOM?
Haemophilus influenzae
Strep pyogenes
Strep pneumonia
Staph aureus
Briefly describe the sequence of events in acute ottitis media
- Organism invade the mucous membrane of the middle ear cavity (usually from eustachian tube.
- This causes oedema in the middle ear and causes an increase in pressure and pain.
- The ear drum ruptures if the pressure increases enough and the leaks out through the ear.
- Pain is usualy resolved.
How woudl you treat a patient who presents with AOM. Not pyrexic or systemically unwell.
Analgesia - paracetamol
You have decided you need antibiotics in a child with AOM. Which antibitoic do you use and why?
Amoxiciilin. Gives covergae of haemophilus influenzae also.
A child presents as his mum is worried he cannot hear her problerly and is turnign up the televison very loudly. On examination you see a fluid level behind drum and teh tympanic membrane appears to be dull colour
Ottitis media with effusion
What do you do for ottitis media with effusion?
Watchful waiting
Grommet insertion
Adenotonsillectomy
What is chronic ottitis media
The eardum has perforated but the perforation has not healed, leading to an effusion.
What is a cholesteatoma?
A keratinizing squamous epithelium within the middle ear cleft
A patient presents to you with a foul smelling discharge from the ear. When you exam the ear it is full of a white cheesy material.
Cholesteatoma
What is the treatment for a cholesteatoma?
Mastoid surgery to remove cholesteatoma so that it doesn’t erode the facial nerve or extend intracranially.
List all the nerves that could be causing earache
CNV (Trigeminal)
CN VII (Abducens)
CN IX (Glossopharyngeal)
CN X (Vagus)
C2, C3 (Spinal nerves than provide cutaneous innervation to the skin of the pinna)
What kind of epithelim lines the middle ear?
Cuboidal or columnar glanduler epithelium
