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ENT > Ear Disease > Flashcards

Ear Disease Flashcards

1
Q

what are the 3 types of hearing loss?

A

conductive
sensorineural
mixed

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2
Q

air bone gap on audiometry?

A

air conduction = lower line (circles and crosses)
bone conduction = upper line (triangles)
gap between lines = air bone gap

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3
Q

what is otalgia?

A

ear pain

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4
Q

how may facial weakness present (in conjunction with ear disease)?

A

can be complete or incomplete

upper vs lower motor neurone lesions

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5
Q

give an sign of ear disease outwith the ear

A

facial weakness

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6
Q

how do you know which ear the ear drum if from from a picture?

A

con of light is anterior

handle of malleus always extends backwards

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7
Q

what is otitis externa and what usually causes it?

A

inflammation of the skin of the ear canal
usually infective - bacterial or fungal
causes = water (common in swimmers), cotton buds, skin conditions (eczema, psoriasis etc)

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8
Q

how does otitis externa present?

A

pain
itchy
discharge/exudate in ear canal

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9
Q

what is acute otitis media associated with?

A

young children
associated with URTI
associated with glue ear

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10
Q

what does otits media look like?

A

no light reflex
red and angry
ear drum looks like its about to burst (can be bulging)

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11
Q

what happens if the ear drum bursts in acute otitis media?

A

patients often feel better as pus can drain out

ear drum usually heals

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12
Q

why is glue ear associated with acute otitis media?

A

fluid sitting behind the ear drum for at least 3 months (by definition of glue ear)
stagnant fluid allows microorganisms to grow

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13
Q

chronic otitis media includes what 3 things?

A

otitis media with effusion (glue ear)
cholesteatoma
perforation

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14
Q

otitis media with effusion is associated with dysfunction or obstruction in what structure?

A

eustachian tube
- not letting gas escape from middle ear so the gas is absorbed giving low pressure
results in thick, glue like fluid

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15
Q

name 3 causes of otitis media with effusion in adults?

A

usually an underlying cause in adults

  • rhinosinusitis
  • nasopharyngeal carcinoma
  • nasopharyngeal lymphoma
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16
Q

how can otitis media with effusion affect hearing?

A

can cause hearing loss (flat tympanogram)

- remember hearing loss presents differently in children to adults

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17
Q

how is glue ear managed?

A

usually left to see if they resolve on their own
antibiotics if ear infection
hole made in tympanic membrane (myringotomy) which allows drainage and normalisation of pressure
- grommet can be inserted to keep the whole open

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18
Q

2 common causes of perforation?

A

acute otitis media

trauma (skull fracture, trauma directly to the ear, cotton buds)

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19
Q

how is perforation managed?

A

usually heal spontaneously (in the absence of infection)

- therefore advice patient to keep water out of ear etc

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20
Q

what is cholesteatoma?

A

presence of keratin within the middle ear

erodes surrounding bone causing hearing loss, discharge and other complications

21
Q

how is cholesteatoma managed?

A

generally required surgical excision and reconstruction

22
Q

what does cholesteatoma look like?

A

can have loss of bone (e.g no visible incus)
build up of keratin, dead skin cells, infection etc)
ear drum pulled very thin over components of middle ear

23
Q

white dot in the ear drum?

A

probably the head of stapes

24
Q

pars tensa and pars flacida?

A 
tensa = lowere part of tympanic membrane
flacida = upper part
25
Q

what is retraction?

A

where the ear drum is stretched tight over the components of the middle ear
almost see through and almost vacuum packed over middle ear components
can occur in the pars tensa and pars flacida

26
Q

//drainage of the brain???

A

lateral sinus, sigmoid sinus > jugular …. > jugular vein

27
Q

possible medial complications of acute otitis media and cholesteatoma?

A

Sensorineural hearing loss
tinnitus
vertigo
facial palsy (damage to facial nerve)

28
Q

superior complications of AOM and cholesteatoma?

A

brain abscess

meningitis

29
Q

posterior complications of AOM and cholesteatoma?

A

venous sinus thrombosis

30
Q

how does acute mastoiditis present?

A

affected ear sticking out

soft, red and tender behind ear

31
Q

what structure is defined by a signet ring on CT scan?

A

lateral semi-circular canal

32
Q

what should middle ear space look like on CT?

A

black
- should be filled with air
ossicles should be visible

33
Q

loss of ossicles and middle ear cavity filled with something other than air shown on CT suggests what?

A

cholesteatoma

34
Q

large circular mass with white ring outline on CT in a patient with AOM or cholesteatoma or both suggests what?

A

brain abscess

35
Q

what is otosclerosis?

A

familial fixation of stapes footplate

36
Q

how does otosclerosis present?

A

gradual onset conductive hearing loss
- normal at birth, begins in teens/20s
more common in women
progresses more rapidly in pregnancy

37
Q

how is otosclerosis managed?

A

stapedectomy

hearing aids

38
Q

what is presbycusis?

A

sensorineural hearing loss due to ageing
high frequency hearing loss
variable onset

39
Q

how does noise-induced hearing loss present?

A

classically has a dip in hearing at 4kHz

patients often have occupation involving lot of noise

40
Q

name 3 groups of drugs which can cause sensorineural hearing loss

A 
gentamicin and other aminoglycosides
chemotherapy drugs (cisplatin, vincristine)
aspirin and NSAIDs (in overdose)
41
Q

what is a vestibuar schwannoma and how does it present?

A

benign tumour arising in the internal acoustic meatus derived from the neural sheath of vestibular nerve
presents with hearing loss, tinnitus and imbalance (as tumour is on vestibular nerve)

42
Q

how is vestibular schwannoma diagnosed?

A

MRI
enhanced (white) area at cerebellopontine angle (angle between cerebellum and pons)
- can be a smooth swelling or cystic

43
Q

menieres classically presents with hearing loss in high or low frequency?

A

low

44
Q

what type of trauma can cause hearing loss and what types?

A

direct trauma to ear
head injury
can cause any of the 3 types

45
Q

haemotympani?

A

blood in the middle ear
can be seen as dark red colour behind the tympanic membrane
can cause conductive hearing loss

46
Q

cone of light on tympanic membrane?

A

visible phenomenon which occurs upon examination of the tympanic membrane with an otoscope. Shining light on the tympanic membrane causes a cone-shaped reflection of light to appear in the anterior inferior quadrant.

47
Q

battle’s sign?

A

brusing over the mastoid

- suggests base of skull fracture

48
Q

give 3 possible features of a skull fracture?

A

hearing loss (conductive/sensorineural)
facial palsy
CSF leak

ENT (21 decks)

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