Ear Conditions Flashcards
what ages are affected by cholesteatoma
any age
what is the presentation of cholesteatoma
unilateral pain/discomfort, mild hearing loss, cheesy discharge
what type of hearing loss can cholesteatoma cause
conductive
what is common causes of cholesteatoma
chronic otitis media, trauma or metaplasia
what type of metaplasia occurs in cholesteatoma
middle ear respiratory epithelium becomes keratinized squamous epithelium
what is the pathology of cholesteatoma
keratinous flakes and -ve middle ear pressure cause a vacuum which retracts the TM until it perforates
what is done in primary care for cholesteatoma
otoscope and referral
what is done is secondary care for cholesteatoma and why
diffusion weighted MRI to assess ossicle involvement
what is the management of cholesteatoma
removal under general anaesthetic
what are the complications of cholesteatoma
brain abscess, vertigo, ossicle damage
what is the presentation of meniere’s disease
acute attacks and hearing and balance function destroyed over years, feeling of aural fullness
what happens in an acute attack of meniere’s disease
hours of unilateral tinnitus, nausea and vomiting, nystagmus
what type of hearing loss does meniere’s disease cause
low frequency sensineural loss
how is meniere’s disease diagnosed
exclusion, MRI to exclude vestibular trauma and SOL
what is the management of meniere’s disease in an acute attack
vestibular sedative
what is the prophylaxis of meniere’s disease attacks
betahistine
what is the management of meniere’s disease to stop vertigo (only when hearing completely abolished)
grommet delivering intratympanic gentamicin
what are some risk factors for glue ear
smoking household, premature, recurrent URTI
what age and gender is most commonly affected by glue ear
boys age 2-7
what is the cause of glue ear
chronic otitis media or recurrent AOM
what is the pathology of glue ear
eustachian tube dysfunction causes -ve pressure vacuum retracts TM, effusion behind membrane
what is seen on otoscopy in glue ear
retracted or bulging grey drum, air fluid level behind membrane, bubbles
when to refer glue ear from primary care
> 3 months
what type of hearing loss does glue ear cause
mild conductive loss (20-30)
what is the presentation of glue ear
midl hearing loss, URTIs +- speech delay, no pyrexia no pain, no discharge
what tests are done after referral for glue ear
tympanogram + PTA
what is the initial management of glue ear
wait, review after 3 months
what is the treatment of glue ear and when is it indicated
if persisted >3month and CHL >25 and bilateral grommets + amoxicillin
what is the management of unilateral glue ear
do nothing
what is the management of a recurrence of glue ear
grommets plus adenoidectomy
what is the presentation of benign positional paroxysmal vertigo
when moving head/looking up 30sec-1min episodes of vertigo (room spinning)
what is the pathology of benign positional paroxsymal vertigo
Ca crystals detach from urticle, moving stimulates posterior semicircular canal
what test is diagnostic of BPPV and what is a positive result
dix-hallpike test, nystagmus
what is the management of BPPV
epley maneuver
what are the 4 types of hearing loss
conductive
sensorineural
mixed
central
what is the pathology of conductive hearing loss
effusion/blood/CSF/wax/foreign body obstruct middle ear
what scan is useful in conductive hearing loss
CT
which type of hearing loss is Rinne’s positive in
sensorineural
what is otosclerosis
stapes fixation in round window, conductive hearing loss
is bone or air conduction affected by conductive hearing loss
air conduction
what causes a sensory hearing loss
hair cell damage
is bone or air conduction affected by sensorineural hearing loss
bone and air conduction the same
what type of hearing loss is presbycusis
sensorineural
what type of hearing loss is noised induced hearing loss
sensorineural
what scan is useful in sensorineural hearing loss
MRI
what is the cause of acute otitis media
viral URTI +- secondary bacterial infection spreads via eustachian tube
what bacteria can cause AOM
s. pneumoniae, h. influenzae, s. pyogenes, Moraxella
what bacteria can cause chronic otitis media
pseudomonas
what is seen on otoscopy in acute otitis media
opaque/bulging TM +- TM perforation
what ages are affected by AOM
child/infant
what is the presentation of AOM
otalgia, discharge, fever, lethargy, +- decreased hearing
what causes relief of symptoms in AOM
TM perforates
what is the management of AOM
most self limiting
when are ABx indicated in AOM
less than 2y.o or severe
what ABx are used for AOM
1st PO amoxicillin, 2nd erythromycin
why is amoxicillin used over penicillin in AOM
better oral absorption
what are the common infecting organisms in otitis externa
fungal: Aspergillus/ candida
bacterial: s. aureus/ pseudomonas
what is the general presentation of otitis externa
red, swelling, itch, pain, discharge, >ear wax, +- hearing loss
what is the management of fungal otitis externa
clean + TOP clotrimazole
what is the management of bacterial otitis externa
acetic acid ABx and TOP aural toilet. gentamicin if severe
what is the cause of vestibular neuritis
viral infection
what is the presentation of vestibular neuritis
sudden onset vertigo for days, no tinnitus or hearing loss
what is the management of vestibular neuritis
vestibular sedative, self-limiting
what is the cause of labyrinthitis
viral infection
what is the presentation of labyrinthitis
sudden onset vertigo for days, tinnitus, hearing loss
what is the management of labyrinthitis
vestibular sedative, self-limiting
what is a vestibular schwannoma
benign vestibular nerve tumour in temporal bone
what is seen on histology of a vestibular schwannoma
spindle cells
what condition are you suspicious of in bilateral vestibular schwannoma in a young patient
neurofibromatosis type 2
what is cauliflower ear
pinna haematoma (sub-perichondral haematoma)
what is the management of cauliflower ear
aspirate blood, pressure dressing
give an example of an ototoxic drug
gentamicin
