Ear disease Flashcards
What type of tuning fork is used to test hearing?
512 Htz
Where is the tuning fork placed in rinnes test? What about in webers test?
Rinnes - base of tuning fork is placed on mastoid process
Webers - base of tuning fork is placed on bony prominence of the head
What is a pure tone audiogram used for?
Detecting hearing loss and differentiating between high/low frequency and conductive/sensorineural loss
How are the left and right ears denoted on an audiogram respectively?
Left - crosses
Right - circles
How is bone conduction denoted on an audiogram?
Square bracket
What is a tympanogram?
Test of pressure within the patients ear (air forced into ear)
What type of scope is used to examine the ear?
Otoscope
How can the common symptoms of ear disease be remembered?
6 D’s -
Deafness Discomfort Discharge Dizziness Din din (tinnitus) Defective facial movement (paralysis)
What classifications of deafness are there?
Conductive
Sensorineural
Mixed
Central
Where is the pathology in conductive deafness?
External or middle ear
Where is the pathology in sensorineural deafness?
Sensory - cochlea
Neural - auditory nerve
Where is the pathology in mixed deafness?
External/middle ear + Cochlea/auditory nerve
Where is the pathology in central deafness?
Brain
Which nerves can be involved in ear discomfort (earache)?
Trigeminal (maxillary and mandibular branches)
Facial
Glossopharyngeal
Vagus
Nb - remember pain is often referred
What pathologies can cause discharge to come from the ear?
Acute otits media
Chronic otitis media
Skull fractures (cerebrospinal fluid)
Iatrogenic (surgery)
Into which two broad categories can dizziness be classified?
Central (brain)
Peripheral (ear pathology - with/without hearing loss)
How may dizziness induced by central pathology present?
Dizziness + acute lisp
What is tinnitus?
An abnormal sound not coming from an external source - normal in silence but abnormal when there is ambient noise
What type of tinnitus should always be investigated?
Unilateral tinnitus
How is tinnitus treated?
Adaptation strategies/techniques
Hearing aids
Are facial palsies relating to the ear upper or lower motor neurone pathologies?
Lower most often
How can lower and upper motor neurone pathologies be clinically differentiated?
Upper - bilateral palsy
Lower - unilateral palsy
Is itch a feature of otitis externa?
Often
What are rare complications of acute otitis media?
Brain abscess
Mastoiditis
How is non-resolving otitis media with effusion treated?
Grommet insertion
Hearing aid
Which two types of patients often get otitis media with effusion?
Children with cleft palate
Children with down’s syndrome
How is chronic otitis media managed?
Antibiotics + myringoplasty
What type of hearing loss does ear drum perforation cause?
Conductive (should resolve as ear drum heals)
What is a cholesteatoma?
Keratinised squamous cell epithelium within the middle ear
What is primary acquired cholesteatoma?
Cholesteatoma which arises due to perforation of the tympanic membrane (chronic otitis media)
Why does the ear drum retract/perforate in otitis media with effusion?
Due to the negative pressure within the ear
What are the types of cholesteatoma?
Congenital/Derlacki - SC epithelium trapped in mastoid bone during embryogenesis (conductive hearing loss as it expands, ear drum will be intact)
Primary acquired - chronic negative airway pressure causes retraction and perforation of tympanic membrane causing abnormal placement of SC
Secondary acquired - insult to the tympanic membrane (AOM, trauma, surgery, etc) causes abnormal placement of SC
How is cholesteatoma investigated?
CT of temporal bone
How is cholesteatoma managed?
Surgical removal
What are the possible complications of otitis media?
Abscess
Facial paralysis
Thrombophlebitis
Mastoiditis
What is a bezoids abscess?
Abscess in sternocledomastoid
Cholesteatoma is locally destructive but not malignant. T/F
True
Define acute otitis media, otitis media with effusion and chronic otitis media
AOM - acute inflammation of the middle ear
OME/glue ear - effusion in middle ear caused by negative pressure due to eustachian tube dysfunction (precede OR follow AOM)
COM - mucosal (perforation of tympanic membrane) or squamous (tympanic membrane retraction +/- cholesteatoma)
What is otitis media with effusion associated with?
Parental smoking
Early entry into child care
Not breastfeeding
Feeding infants while lying down
