Ear Disease Flashcards
what 10 questions would you want to ask a patient presenting with ear disease
- Hearing loss?
- Tinnitus?
- Vertigo?
- Otalgia?
- Ear discharge?
- Facial weakness?
- Previous ear surgery?
- Nasal symptoms?
- Neurological symptoms?
- Family history
+/- paediatric questions
What are the three types of hearing loss
Conductive
Sensorineural
Mixed
Lower motor neuron vs upper motor neurone facial weakness S&Ss
All parts of face not moving? - lower motor neurone lesion
Forehead still moving? - upper motor neurone/stroke
What are the five most common causes of conductive hearing loss
Otitis externa
Acute otitis media
Otitis media with effusion (glue ear)
Cholesteatoma
Perforation
Otitis externa is ________________ of the skin of the ear canal that is ______________ infective
Otitis externa is inflammation of the skin of the ear canal that is almost always infective
What two types of infection are associated with otitis externa
Bacterial & fungal
Otitis externa aetiology/ risk factors
Water, cotton buds, skin conditions
What acute group is most commonly affected by acute otitis media
Children
What two conditions is acute otitis media commonly associated with
URTIs
Glue ear
Chronic otitis media is otitis media that has last for _____________ or longer
3 months
Otitis media with effusion in children is associated with….
Eustachian Tube Dysfunction or Obstruction
Acute otitis media
Otitis media with effusion in adults is associated with….
Rhinosinusitis
Nasopharyngeal carcinoma
Nasopharyngeal lymphoma
Otitis media with effusion diagnosis
Conductive Hearing Loss with flat tympanogram
NOTE: kids often present with change in behaviour or problem with speech development instead of hearing loss
Otitis media with effusion in kids treatment options
Wait & see (for eustachian tube development)
Hearing aids
Grommet insertion
Adenoidectomy
Perforation of the tympanic membrane is commonly associated with……
Acute Otitis Media (& sometimes trauma)
What would the tympanic membrane look like in acute otitis media
Red & bulging
Ear perforation treatment
Usually resolves on its own
Pathophysiology of cholesteatoma
Growth of keratinising squamous epithelium in middle ear
Collection of dead skin cells & keratin in middle ear
As it expands it erodes bone
Cholesteatoma histological appearance
squamous epithelium with abundant keratin production, associated inflammation
Is Cholesteatoma congenital or acquired
usually acquired but can be congenital
What is cholesteatoma association with
chronic otitis media or perforated tympanic membrane
Cholesteatoma clinical features
hearing loss, discharge, complications
What complication would you expect if acute otitis media associated with cholesteatoma was to spread laterally
Subperiosteal abscess
(infection/swelling at back of ear)
(makes ear stick out)
What complication would you expect if acute otitis media associated with cholesteatoma was to spread medially
Sensorineural Hearing Loss /Tinnitus / Vertigo / Facial Palsy
What complication would you expect if acute otitis media associated with cholesteatoma was to spread superiorly
Brain abscess or meningitis
What complication would you expect if acute otitis media associated with cholesteatoma was to spread posteriorly
Venous sinus thrombosis
What test can be used to identify a brain abscess
CT with contrast (pus doesn’t take up contrast)
Cholesteatoma investigations
Otoscopy
Cholesteatoma management
Mastoid surgery to remove the sac of debris, reconstruction
Otosclerosis presentation
Gradual onset conductive hearing loss that progresses more rapidly during pregnancy (usually affects women)
Otosclerosis treatment
Hearing aids OR
Surgical replacement of stapes bone through stapedectomy
Otosclersois on audiometry
What is presbycusis
Degenerative disorder of the cochlear resulting in hearing loss (usually at high frequencies)
Presbycusis audiometry findings
Presbycusis management
High-frequency-specific hearing aid
What noise is usually affected in presbycusis
High frequency noises
What happens in noise induced hearing loss
Cochlear damage
How does noise induced hearing loss present on audiometry
- Sensorineural hearing loss
- Characteristically has a dip at 4 kHz
What drugs are associated with sensorineural hearing loss
- Gentamicin and other aminoglycosides
- Chemotherapeutic drugs - cisplatin, vincristine
- Aspirin and NSAIDs (in overdose)
Drug induced hearing loss treatment
Stop drug
What is a vestibular schwannnoma
Benign tumour arising in Internal Auditory Meatus
Vestibular Schwannoma presentation
Hearing loss, tinnitus and imbalance
Vestibular Schwannoma diagnosis
MRI scan
Vestibular Schwannoma treatment
What two types of trauma are associated with hearing loss
Direct trauma to ear
Head injury/ skull fracture
How can a skull fracture cause conductive hearing loss
Ossicle dislocation
How can a skull fracture cause sensorineural hearing loss
Nerve or cochlear damage
What type of hearing loss caused by skull fracture can be treated
Conductive (very little can be done for sensorineural)
