Ear Disease

Question 1

Name and describe two tests which you can perform with a tuning fork

Answer 1

Renee test - Mastoid – normally air conduction is better than bone – if ear is blocked then the test will change and air conduction will not be as good as bone. Air conduction normal = better than bone conduction.
Weber = ask patient if they hear it in the centre or to one side.

Question 2

Which bone can you see on otoendoscopy?

Answer 2

Handle of malleus

Question 3

What is the pnemonic used when considering possible symptoms of ear disease?

Answer 3

The D principle

• Deafness
• Discomfort
• Dizziness
• Discharge
• Din din i.e. Tinnitus
• Defective movement of face

Question 4

Which two types of hearing loss make up sensorineural?

Why are the two put together?

Answer 4

Sensory = relates to cochlea
Neural = nerve damage (vestibulocochlear nerve)
They look the same on audiogram

Question 5

What is central hearing loss?

Answer 5

To do with perception of sound in the higher centers – can have perfect conduction and functioning cochlea but if brain is not functioning, but they cannot hear

Question 6

What are the four type of hearing loss?

Answer 6

Conductive
Sensorineural
Mixed
Central

Question 7

Which nerve is the most common nervous cause of earache?

Answer 7

CN IX - glossopharyngeal

Question 8

What is otitis media with effusion?

Answer 8

This is the presence of fluid behind an intact ear drum in the absence of infection.

Question 9

What should you do in a Chinese patient presenting with glue ear?

Answer 9

Consider nasopharyngeal carcinoma - do a biopsy

Question 10

What is chronic otitis media?

Answer 10

Perforation of the ear drum which hasn’t healed

Question 11

What is Cholesteatoma?

Treatment?

Answer 11

It’s skin in the wrong place – shouldn’t be in the middle ear.
It’s infection which makes it active - the cytokines etc make it secrete osteoclastic enzymes – eats up the ossicles and the lining of the middle ear.
Mastoidectomy

Question 12

Which criteria is used to classify level of retraction of the eardum?
What is the worst type?

Answer 12

Sade – famous classification of level of retraction of the eardrum i.e. how indrawn it is.
Sade IV – worst – everything is stuck and doesn’t move.

Question 13

What is the definition of glue ear/ otitis media with effusion (OME)/ serous otitis media (SOM)?

Answer 13

Inflammation of the middle ear accompanied by accumulation of fluid with or without the symptoms and signs of acute inflammation.

Question 14

What is acute otitis media?

Answer 14

Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with or without accumulation.

Question 15

Ear ache - should you think OME or AOM?

Answer 15

AOM

Question 16

Is their fluid + hearing loss in AOM and OME?

Answer 16

AOM

• No fluid
• No hearing loss

OME

• Fluid
• Hearing loss

Question 17

Give four factors which increase the incidence of OME

Answer 17

• Day care
• Older siblings
• Smoking household
• Recurrent URTI

Question 18

Give some symptoms of OME

Answer 18

• Deafness
• Poor school performance
• Behavioural problems
• Speech delay
• ?Balance problems
• ?TV volume
• NOT otalgia

Question 19

Give three abnormalities of the tympanic membrane seen on otoendoscopy in OME

Answer 19

• TM retraction
• Reduced TM mobility
• Altered TM colour

Question 20

Treatment of OME?

Answer 20

Watchful waiting
- 60% resolved @ 1/12
- 90% resolved @ 3/12
Review @ 3/12

Question 21

What should you do for OME persistent for > 3/12 with symptoms

• Deafness
• Speech
• Balance?

Answer 21

Refer to ENT

Question 22

Surgical management for OME?

Answer 22

< 3yrs - Grommets
> 3yrs, first intervention - Grommets
> 3yrs, second intervention - Grommets and adenoidectomy
If nasal symptoms, adenoids may be considered earlier

Question 23

What are some long term complications of OME vs Grommets?

Answer 23

Of OME
- Weak evidence of short term speech, language and behavioral development problems
- No clear evidence of long term problems
Of Grommets
- Infection/discharge
- Early extrusion
- Retention
- Persistent perforation
- Swimming/bathing issues