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ENT SOH > Ear conditions > Flashcards

Ear conditions Flashcards

1
Q

Name the 6 D’s

A 
Deafness
Discomfort 
Discharge 
Dizziness
Din Din (tinnitus) 
Defective movement of the face (CN VII palsy)
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2
Q

Otitis externa - definition

A

Inflammation of the outer ear canal

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3
Q

Otitis externa - who commonly gets it?

A

Swimmers

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4
Q

Otitis externa - bacterial causes (2)

A

Staph aureus

Pseudomonas aerginosa

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5
Q

Otitis externa - fungal causes (2)

A

Aspergillus niger

Candida albicans

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6
Q

Otitis externa - clinical features

A

Redness and swelling of the skin of the outer ear canal
Initially itchy
Can become sore and painful
Discharge / increased amounts of earwax

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7
Q

Otitis externa - can hearing be affected?

A

Yes

- if the canal becomes blocked (e.g. by swellings or secretions)

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8
Q

Otitis externa - management

A

Suction clean the ear (instant relief)
Keep the ear clean and dry until it recovers
May need antimicrobials/antibiotics if bacterial

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9
Q

Otitis externa - malignant otitis - definition

A

Extension of the otitis externa into the bone surrounding the ear canal (mastoid and temporal bones)

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10
Q

Otitis externa - malignant otitis - cause

A

Pseudomonas aerginosa

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11
Q

Otitis externa - malignant otitis - clinical features

A

Pain

Headache

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12
Q

Otitis externa - malignant otitis - signs

A

Facial nerve palsy (drooping face on side of the lesion)

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13
Q

Otitis externa - malignant otitis - investigations

A 
Inflammatory markers (raised)
Imaging (to see extent of osteitis)
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14
Q

Acute otitis media - definition

A

Acute inflammation of the middle ear with/without an accumulation of fluid

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15
Q

Acute otitis media - who gets it

A

Infants and children

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16
Q

Acute otitis media - cause

A 
Usually viral (URTI) 
Occasionally bacterial (strep pneumonia, haemophilus influenza, moraxella catarrhalis, strep pyogenes)
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17
Q

Acute otitis media - pathogenesis

A

Often an URTI which involves the middle ear due to the extension of infection up the eustachian tube. This causes fluid/pus accumulation in the middle ear.

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18
Q

Acute otitis media - clinical features

A 
Screaming child in middle of night 
Earache (otalgia)
Discharge (if tympanic membrane perforates) 
Conductive hearing loss 
Fever 
Lethargy
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19
Q

Acute otitis media - investigations

A

Otoscopy (red and inflamed ear drum)
Swab pus (if discharge present)
DO NOT regular biopsy (only if alternative differential diagnosis needs exclusion)

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20
Q

Acute otitis media - management (if less than 4 days)

A

Most self limiting, resolve within 4 days

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21
Q

Acute otitis media - management (if more than 4 days)

A

First line: oral amoxicillin

Second line: oral erythromycin

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22
Q

Acute otitis media - management with antibiotics should be topical/oral?

A

Oral

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23
Q

Otitis media with effusion - definition

A

Glue ear
This is not an infection
Accumulation of fluid behind an intact ear drum (without signs/symptoms of acute inflammation)

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24
Q

Otitis media with effusion - pathogenesis

A

Eustachian tube gets anatomically blocked and the middle ear is unable to equalise the pressure with the atmospheric environment (nasopharynx end of eustachian tube)
Build up of negative pressure and fluid accumulated in middle ear space

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25
Q

Otitis media with effusion - causes of eustachian tube blockage

A

Enlarged adenoid tonsils
Recurrent URTI
Recurrent AOM

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26
Q

Otitis media with effusion - who gets it

A

Children

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27
Q

Otitis media with effusion - clinical features

A 
Hearing loss (conductive) 
NO earache, fever, irritability
Middle ear effusion
Impaired tympanic membrane mobility 
Speech delay
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28
Q

Otitis media with effusion - examinations

A 
Otoscopy 
- tympanic membrane retraction 
- reduced tympanic membrane mobility 
visible middle ear fluid/bubbles 
Tuning fork test 
- conductive hearing loss
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29
Q

Otitis media with effusion - investigations

A

Audiometry
- conductive hearing loss
Tympanometry
- flat line due to presence of fluid suggests a middle ear effusion

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30
Q

Otitis media with effusion - initial management

A

Watchful waiting for 3 months

- may resolve naturally

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31
Q

Otitis media with effusion - management after 3 months duration

A

If bilateral and clinical features persist then refer to ENT

  • under 3: grommets
  • if grommets don’t work: re-insert grommets and adenoidectomy
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32
Q

Otitis media with effusion - complications

A

Recurrent attacks of AOM

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33
Q

Otitis media with effusion - complications of grommets

A 
Infection
Fall out early 
Fall into middle ear cavity 
Persistent perforation
Swimming/bathing issues
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34
Q

Chronic otitis media - definition

A

Persisting acute otitis media causes a hole to form in the ear drum resulting in chronic otitis media

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35
Q

Cholesteatoma - definition

A

Keratinised squamous epithelium in the middle ear where it shouldn’t be
Abundant keratin production in the middle ear

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36
Q

Cholesteatoma - pathology

A

Lots of surface flakes
- large pink areas on histology slides
High cell turnover
Cystic swelling in middle ear (due to loss of movement of keratin)

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37
Q

Cholesteatoma - what should the normal lining of the middle ear be and what is it in this condition?

A

Normal: cuboidal/columnar glandular epithelium

Cholesteatoma: keratinised squamous epithelium

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38
Q

Cholesteatoma - what are the 2 types

A

Acquired

Congenital

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39
Q

Cholesteatoma - which is more common: acquired/congenital?

A

Acquired

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40
Q

Cholesteatoma - the tympanic membrane is in tact / perforated in acquired cholesteatoma?

A

Perforated

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41
Q

Cholesteatoma -the tympanic membrane is in tact / perforated in congenital cholesteatoma?

A

In tact

42
Q

Cholesteatoma - clinical features

A

Associated inflammation
Lots of flakes
Discharge

43
Q

Cholesteatoma - investigations

A

CT: densities of cholesteatoma
MRI: poor localisation of bony landmarks

44
Q

Vestibular schwannoma - definition

A

Benign tumour of peripheral nerves (schwann cells)
Connective tissue tumour
Associated with the vestibular portion of CN VIII

45
Q

Vestibular schwannoma - where are they found

A

Within temporal bone
At angle between pons and cerebellum
Causes significant compression of brain stem

46
Q

Vestibular schwannoma - pathology

A

Lots of elongated, streaming nuclei
Spindle cell morphology
Verocey bodies

47
Q

Vestibular schwannoma - what condition are they commonly associated with?

A

Neurofibromatosis

48
Q

type 1 neurofibromatosis

A 
Wide spread 
Bony defects 
Cafe au last spots 
Axillary freckling
Lisch nodules in eye
49
Q

type 2 neurofibromatosis

A

Young patient

50
Q

BPPV - definition

A

Benign positional paroxysmal vertigo

Common inner ear balance disorder

51
Q

BPPV - what usually happens to the granules of crystals that are attached to the hair cells in the utricle?

A

They fall to the bottom due to gravity

52
Q

BPPV - what happens to the granules of crystals in the utricle in BPPV?

A

They become loose and float freely in the fluid

They collect in the cupola of the semicircular canal

53
Q

BPPV - which semicircular canal is most commonly affected?

A

Posterior

54
Q

BPPV - causes

A

Head trauma
Ear surgery
Idiopathic

55
Q

BPPV - classic presentation

A

Patient turns over in bed and the room spins
Patient bends forward and room spins
Patient puts head up and room spins

56
Q

BPPV - clinical features

A

Repeated, brief episodes of vertigo with movement
Vertigo usually lasts less than 1 minute
May have several attacks per day
No hearing loss or tinnitus

57
Q

BPPV - examinations

A

Hallpike’s test
Epley manoeuvre
Semont manoeuvre
Brant-Daroff exeercises

58
Q

BPPV - examinations - hallpike’s test

A

Pt lie down from sitting postion with head turned to one side
Patient must keep eyes open as you are looking for eye movements (nystagmus)
Patients with nystagmus will have BPPV

59
Q

BPPV - Common diagnostic eye sign

A

Nystagmus

60
Q

BPPV - management

A

Do the manoeuvres

61
Q

Mineres disease - definition

A

Swelling of endolymph compartment which causes the perilymph and endolymph fluids to mix
Not common

62
Q

Mineres disease - cause

A

Unknown

63
Q

Mineres disease - clinical features

A

Recurrent spontaneous rotational vertigo

Tinnitus on affected side

64
Q

Mineres disease - which type of hearing loss is it associated with?

A

Sensori-neural hearing loss

65
Q

Mineres disease - management

A 
Supportive treatment 
Tinnitus therapy 
Hearing aids 
Grommet insertion 
Intratympanic gentamicin/steroids 
Surgery
66
Q

Vestibular neuronitis - definition

A

Affects the vestibular nerve (balance)

67
Q

Vestibular neuronitis - cause

A

Viral

68
Q

Vestibular neuronitis - clinical features

A

Prolonged vertigo for number of days
Nausea
No associated tinnitus or hearing loss

69
Q

Vestibular neuronitis - management

A

Self limiting

Vestibular sedatives

70
Q

Labrynthitis - definition

A

Affects the whole labyrinth (balance and hearing)

71
Q

Labrynthitis - cause

A

Viral

72
Q

Labrynthitis - clinical features

A 
Prolonged vertigo 
- sudden onset vertigo on day 1 which improves over the following days 
Nausea
Tinnitus 
Hearing loss
73
Q

Labrynthitis - management

A

Self limiting

74
Q

Oscillopsia - definition

A

When there is no vestibular output

Loss of the vestibular ocular reflex (VOR)

75
Q

Oscillopsia - clinical features

A

Eyes constantly bouncing around as they can’t focus on the environment

76
Q

Oscillopsia - cause

A

Gentamicin

77
Q

Tinnitus - management

A

Try to adapt to the noise and ‘throw it away’

Mask the noise

78
Q

Nystagmus - definition

A

Quick flickering of eyes

79
Q

Serous discharge means middle ear pathology is MORE/LESS likely

A

Less

80
Q

Cholesteatoma - management

A

Mastoid surgery

- to remove the squamous debris

81
Q

Perforated tympanic membrane - causes

A

Trauma

Chronic middle ear infection

82
Q

Otosclerosis - definition

A

New bony deposits occur in the base of the stapes

83
Q

Otosclerosis - who gets it

A

Females, middle aged, hereditary

84
Q

Otosclerosis - management

A

Hearing aids

Stapes surgery

85
Q

What is the commonest cause of deafness?

A

Presbycusis

86
Q

Presbycusis - definition

A

Degenerative disorder of the cochlea

Age related hearing loss

87
Q

Presbycusis - what type of hearing loss does it produce

A

Sensorineural

88
Q

Presbycusis - lower frequencies are affected most. True or false?

A

False

- higher frequencies are affected most

89
Q

Vertigo which lasts seconds-minutes

A

BPPV

90
Q

Vertigo which lasts minutes-hours

A

Meniures disease

91
Q

Vertigo which lasts hours-days

A

Labrynthitis

92
Q

Which semicircular canal is most affected by BPPV?

A

Posterior

93
Q

BPPV symptoms become less severe on repeated movements. True or false?

A

True

94
Q

What diagnoses BPPV?

A

A positive hallpike test

95
Q

Management of BPPV ?

A

Epley manouevre

96
Q

What does gentamicin do to the ear?

A

It destroys the vestibular epithelium

Can lead to hearing loss

97
Q

What is another name for vestibular schwannoma?

A

Acoustic neuroma

98
Q

Where does vestibular schwannoma usually occurs?

A

Angle between the pons and the cerebellum

99
Q

Vestibular schwannoma clinical features?

A

Unilateral hearing loss
Vertigo occurs later on
CN palsies: CN V, VI, VII, IX, X

100
Q

Vestibular schwannoma investigation

A

MRI scan

ENT SOH (9 decks)

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