Ear disease

Question 1

What are the 6 symptoms of ear disease?

Answer 1

Deafness 
Discomfort 
Discharge 
Dizziness
Din Din (tinnitus) 
Defective movement of face

Question 2

What is conductive hearing loss?

Answer 2

Issue with ear canala. drum or middle ear where sound is just not getting in

Question 3

Examples of causes of conductive deafness

Answer 3

Ear wax 
Otitis media 
Otitis Externa 
Barotrauma 
Otosclerosis 
Cholesteatoma

Question 4

What is sensorineural hearing loss?

Answer 4

Can be sensory (cochlear) or neural (acoutstic nerve) - sound is getting in but not being sensed

Question 5

What is central deafness?

Answer 5

If all ear function are working well deafness an be caused by brain issues e.g. stroke

Question 6

What is the most common reason for earache in adults?

Answer 6

Referred pain

Question 7

What nerves can cause ear ache?

Answer 7

CN V, VII, IX, X

C2, C3

Question 8

What is otorrhoea?

Answer 8

Discharge from the ear

Question 9

How is the pain described in AOM?

Answer 9

Crescendo pain

Question 10

Causes of otorrhoea?

Answer 10

AOM
COM
CSF

Question 11

How is tinnitus first line treated?

Answer 11

Adaptation therapy

Question 12

Which condition is often seen in keen swimmers?

Answer 12

Otitis Externa

Question 13

What are the most common bacterial causes of OE?

Answer 13

Haem influenzae

Stre penumonaie

Question 14

What are the 2 most common causes of fungal OE?

Answer 14

Aspergillus

Candida

Question 15

What is the treatment of otitis externa?

Answer 15

Suction cleaning

Antifungals (clotrimoxazole)

Question 16

First line antibiotic in OM

Answer 16

Amoxicillin (clarythromycin)

Question 17

What is a rare but serious complication of AOM?

Answer 17

Intracranial complications

Question 18

What is glue ear?

Answer 18

Fluid behind intact ear drum in the abscence of overt infection

Question 19

Management of OME

Answer 19

Watch for up to 3 months if not put in ventilation tube to drain

Question 20

What is chronic OM?

Answer 20

Perforation that hasn’t healed

Question 21

Treatment of chronic OM

Answer 21

Treat with antibiotics to dry up then operate to close it

Question 22

What is a cholesteatoma?

Answer 22

Squamous epithelium in middle ear

Question 23

Causes of cholesteatoma?

Answer 23

Can go through perforation

Ear drum retracted back

Question 24

What is the most common investigation of the ear?

Answer 24

CT scan of temporal bone

Question 25

What is vertigo?

Answer 25

A sensation of movement, usually spinning

Question 26

What is the clinical relevance of the VOR?

Answer 26

Nystagmus will be observed in vestibular pathologies | Drection of nystagmus will depend on involved structures

Question 27

What are important to ask in a history of a dizzy patient?

Answer 27

``` Triggers? Time course? Associated symptoms? Precipitators? Alleviating factors? Medication? Alcohol? ```

Question 28

Examination of dizzy patients?

Answer 28

``` Otoscopy Buerological (esp. eye movements) BP including lying/standing Balance system Audiometry ```

Question 29

Common nto ear related causes of dizziness

Answer 29

Postural dizziness Side effect of medication Psychogenic & interaction with imbalance

Question 30

What is the commonest cause of vertigo on looking up?

Answer 30

BPPV

Question 31

Causes of BPPV

Answer 31

Head trauma Ear surgery Idiopathic

Question 32

Pathophysiology of BPPV?

Answer 32

Otolith matieral from utricle is displaced into semicircular canals

Question 33

Which SSC is BPPV most common in?

Answer 33

Posterior SSC

Question 34

What can BPPV be confused with?

Answer 34

Vertebrobasilar insufficieny

Question 35

How is VBI diagnosed?

Answer 35

Other symptoms of impaired circulation in posterior brain associated with the vertigo (e.g. visual disturbance, weakness, numbness)

Question 36

Clinical presentation of BPPV

Answer 36

Vertigo on: - looking up - turning in bed (often worse to one side) - First lying down in bed at night - on first getting out of bed in the morning - bending forward - rising from bending - moving head quickly (often only in one direction) Brief episodes No associated tinnitus, hearing loss, aural fullness

Question 37

How is BPPV evaluated clinically?

Answer 37

Hallpike's test

Question 38

Management of BPPV

Answer 38

Epley manoeuvre | Brandt-Daroff exercises

Question 39

What is Hallpikes test?

Answer 39

Lie patient back with head off end of bed as quickly as possible Tell patient to keep eyes open and look for nystagmus

Question 40

How long does a patient have to wait in each position of the epley manouevre?

Answer 40

30 secs - 1 min

Question 41

Clinical presentation of vestibular neuronitis

Answer 41

Prolonged vertigo (days) No associated tinnitus or hearing loss Probable viral aetiology May be viral prodomal symptoms

Question 42

What is vestibular neuronitis?

Answer 42

Inflammation of vestibular nerve

Question 43

Clinical features of labrynthitis

Answer 43

Prolonged vertigo (days ) May be asociated tinnitus or hearing loss Probable viral aetiology Mat be viral prodromal symptoms

Question 44

Treatment of vestibular neuronitis & labbyrinthitis

Answer 44

Supportive management

Question 45

Features of Menieres disease

Answer 45

History of recurrent, spontaneous, rotational vertigo with at least 2 episodes

Question 46

Management of Meniere's disease

Answer 46

``` Supportive treatment during episodes Tinnitus therapy Hearing aids Grommet insertion Intratympanic gentamicin/steroids ```

Question 47

What percentage of migraine sufferers have spontaneous attacks of vertigo & ataxia?

Answer 47

25%

Question 48

How is definite migranoius vertigo diagnosed?

Answer 48

Episodic vestibular symptoms of at leat moderate severity (interfere but not impede daily activities) Migraine according to the international headache society criteria Other causes ruled out

Question 49

What is otosclerosis?

Answer 49

Inherited disorder causing progressive deafness due to gradual ossification of the inner ear