Ear Disease Flashcards
what are the 3 types of hearing loss?
conductive
sensorineural
mixed
air bone gap on audiometry?
air conduction = lower line (circles and crosses)
bone conduction = upper line (triangles)
gap between lines = air bone gap
what is otalgia?
ear pain
how may facial weakness present (in conjunction with ear disease)?
can be complete or incomplete
upper vs lower motor neurone lesions
give an sign of ear disease outwith the ear
facial weakness
how do you know which ear the ear drum if from from a picture?
con of light is anterior
handle of malleus always extends backwards
what is otitis externa and what usually causes it?
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)
how does otitis externa present?
pain
itchy
discharge/exudate in ear canal
what is acute otitis media associated with?
young children
associated with URTI
associated with glue ear
what does otits media look like?
no light reflex
red and angry
ear drum looks like its about to burst (can be bulging)
what happens if the ear drum bursts in acute otitis media?
patients often feel better as pus can drain out
ear drum usually heals
why is glue ear associated with acute otitis media?
fluid sitting behind the ear drum for at least 3 months (by definition of glue ear)
stagnant fluid allows microorganisms to grow
chronic otitis media includes what 3 things?
otitis media with effusion (glue ear)
cholesteatoma
perforation
otitis media with effusion is associated with dysfunction or obstruction in what structure?
eustachian tube
- not letting gas escape from middle ear so the gas is absorbed giving low pressure
results in thick, glue like fluid
name 3 causes of otitis media with effusion in adults?
usually an underlying cause in adults
- rhinosinusitis
- nasopharyngeal carcinoma
- nasopharyngeal lymphoma
how can otitis media with effusion affect hearing?
can cause hearing loss (flat tympanogram)
- remember hearing loss presents differently in children to adults
how is glue ear managed?
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
2 common causes of perforation?
acute otitis media
trauma (skull fracture, trauma directly to the ear, cotton buds)
how is perforation managed?
usually heal spontaneously (in the absence of infection)
- therefore advice patient to keep water out of ear etc
what is cholesteatoma?
presence of keratin within the middle ear
erodes surrounding bone causing hearing loss, discharge and other complications
how is cholesteatoma managed?
generally required surgical excision and reconstruction
what does cholesteatoma look like?
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
white dot in the ear drum?
probably the head of stapes
pars tensa and pars flacida?
tensa = lowere part of tympanic membrane flacida = upper part
what is retraction?
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
//drainage of the brain???
lateral sinus, sigmoid sinus > jugular …. > jugular vein
possible medial complications of acute otitis media and cholesteatoma?
Sensorineural hearing loss
tinnitus
vertigo
facial palsy (damage to facial nerve)
superior complications of AOM and cholesteatoma?
brain abscess
meningitis
posterior complications of AOM and cholesteatoma?
venous sinus thrombosis
how does acute mastoiditis present?
affected ear sticking out
soft, red and tender behind ear
what structure is defined by a signet ring on CT scan?
lateral semi-circular canal
what should middle ear space look like on CT?
black
- should be filled with air
ossicles should be visible
loss of ossicles and middle ear cavity filled with something other than air shown on CT suggests what?
cholesteatoma
large circular mass with white ring outline on CT in a patient with AOM or cholesteatoma or both suggests what?
brain abscess
what is otosclerosis?
familial fixation of stapes footplate
how does otosclerosis present?
gradual onset conductive hearing loss
- normal at birth, begins in teens/20s
more common in women
progresses more rapidly in pregnancy
how is otosclerosis managed?
stapedectomy
hearing aids
what is presbycusis?
sensorineural hearing loss due to ageing
high frequency hearing loss
variable onset
how does noise-induced hearing loss present?
classically has a dip in hearing at 4kHz
patients often have occupation involving lot of noise
name 3 groups of drugs which can cause sensorineural hearing loss
gentamicin and other aminoglycosides chemotherapy drugs (cisplatin, vincristine) aspirin and NSAIDs (in overdose)
what is a vestibuar schwannoma and how does it present?
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)
how is vestibular schwannoma diagnosed?
MRI
enhanced (white) area at cerebellopontine angle (angle between cerebellum and pons)
- can be a smooth swelling or cystic
menieres classically presents with hearing loss in high or low frequency?
low
what type of trauma can cause hearing loss and what types?
direct trauma to ear
head injury
can cause any of the 3 types
haemotympani?
blood in the middle ear
can be seen as dark red colour behind the tympanic membrane
can cause conductive hearing loss
cone of light on tympanic membrane?
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.
battle’s sign?
brusing over the mastoid
- suggests base of skull fracture
give 3 possible features of a skull fracture?
hearing loss (conductive/sensorineural)
facial palsy
CSF leak
