Ear Conditions (General and OME)

Question 1

Describe what you do in Rhinne’s test?

Answer 1

Put the tuning fork beside of the patient’s ear, and then on the mastoid process and ask them which they hear louder

Question 2

What finding would be abnormal in Rhinne’s test and what would it suggest?

Answer 2

Hearing the vibration louder on the mastoid suggests a conductive hearing loss

Question 3

What size tuning fork should be used for Rhinne and Weber’s test?

Answer 3

512 decibels

Question 4

Describe what you do in Weber’s test?

Answer 4

Place the tuning fork on the patient’s forehead and ask which ear they can hear the sound in loudest or if it is equal

Question 5

What will be the result of Weber’s test if the individual has conductive hearing loss?

Answer 5

Sound will be localised to the affected side

Question 6

What will be the result of Weber’s test if the individual has sensorineural hearing loss?

Answer 6

Sound will be localised to the non-affected side

Question 7

Weber’s test can detect how severe a hearing loss?

Answer 7

5db

Question 8

Rhinne’s test can detect how severe a hearing loss?

Answer 8

20db

Question 9

What investigation is diagnostic of most external-middle ear conditions?

Answer 9

Otoendoscopy

Question 10

What causes conductive hearing loss?

Answer 10

A defect in the passage through the ear e.g. middle ear/eardrum damage

Question 11

Damage where causes sensory and neural hearing loss?

Answer 11

Inner ear damage, sensory = cochlea, neural = CNVIII

Question 12

Why are sensory and neural hearing losses grouped together?

Answer 12

Because an audiogram cannot distinguish between the two

Question 13

What tends to be the cause of sensory hearing loss and why?

Answer 13

Exposure to loud noise causing damage to the cochlea

Question 14

What type of problem tends to cause neural hearing loss?

Answer 14

Tumours of the brain

Question 15

What causes central hearing loos?

Answer 15

Problems at the brain e.g. stroke, cva

Question 16

What nerves are associated with ear sensation?

Answer 16

V, VII, IX, X and C2, 3

Question 17

Discomfort in the ear usually comes from where?

Answer 17

Referred pain from the larynx/pharynx

Question 18

If a patient presents with earache and no obvious cause, where should you always look?

Answer 18

In the throat

Question 19

What diseases most commonly cause discharge (otorrhoea)?

Answer 19

Acute or chronic otitis media

Question 20

In order to have discharge from the ear, what must have occurred?

Answer 20

Ruptured tympanic membrane

Question 21

How can CSF leak from the ears?

Answer 21

The lining of the ears is a type of dura since it lies under the middle cranial fossa

Question 22

If a patient presents with dizziness, what should you always ask about?

Answer 22

Hearing loss

Question 23

Dizziness alone usually comes from damage where?

Answer 23

Vestibular area

Question 24

Dizziness with hearing loss usually comes from damage where?

Answer 24

Vestibular area and cochlea

Question 25

Operating on the middle ear can risk what?

Answer 25

Facial nerve paralysis

Question 26

What are some drugs which can cause hearing loss?

Answer 26

Aminoglycosides, furosemide, aspirin

Question 27

What is a classic presentation of acute otitis media?

Answer 27

Child wakes up in the middle of the night crying

Question 28

The prevalence of OME tends to tail off after what age?

Answer 28

8

Question 29

OME is more common in which sex?

Answer 29

Males

Question 30

What are some factors which increase incidence of OME?

Answer 30

Daycare, older siblings, smoking household, recent recurrent URTI

Question 31

OME is more likely to occur if the child has what?

Answer 31

Recurrent URTI or AOM, prematurity, craniofacial/genetic abnormalities, immunodeficiency

Question 32

Does OME cause ear pain?

Answer 32

No

Question 33

What are some signs of OME?

Answer 33

TM retraction, visible fluid in the middle ear

Question 34

What type of hearing loss does OME cause?

Answer 34

Conductive

Question 35

How is OME treated initially?

Answer 35

Watch and wait- review at 3 months

Question 36

If OME is persistent at 3 months, what is the management?

Answer 36

Refer- grommet insertion 1st line, adenoidectomy 2nd line or if nasal symptoms

Question 37

Grommets will fall out within how long?

Answer 37

A few months