Ear Disease and Adenotonsillar Disease Flashcards
(76 cards)
1
Q
In Rinner hearing test where is the tuning fork placed
A
behind the ear
2
Q
in Weber hearing test where is the tuning fork placed
A
forehead
3
Q
what tuning fork is used for testing hearing
A
512 Hz
4
Q
what can be used to test pressure in the ears
A
tympanogram
5
Q
what is a diagnostic test for many ear conditions
A
OTOENDOSCOPY
- endoscope in mid meatus
6
Q
what are the 6 D’s of ear conditions
A
Deafness Discomfort Discharge Dizziness Din Din (tinnitus) Defective movement of face
7
Q
what is central hearing loss
A
all other areas working but still do not hear. i.e. patient has had a stroke and now cannot hear.
8
Q
where is the problem in conductive hearing loss
A
problem in either the ear drum, inner ear and canal causing hearing loss
9
Q
where is the problem in sensorineural hearing loss
A
sensory - cochlear problem
neural - acoustic nerve problem
10
Q
what nerves can cause earache
A
V VII IX X C2, C3
11
Q
what can cause otorrhoea/discharge from the ear
A
AOM
COM
CSF
12
Q
what can be the cause of a defective facial movement
A
lower motor neurone
facial palsy
13
Q
Hx of Otitis externa
A
minimal discharge - watery
very itchy
very painful
tragal tenderness
14
Q
what organisms is the commonest cause of otitis externa
A
pseudomonas
2nd - staph aureus
15
Q
complications for otitis externa
A
hearing loss
canal stenosis
16
Q
Tx of otitis externa
A
Aural toilet
Anti-fungal drops e.g. Sofradex
17
Q
Hx of AOM
A
rapid onset of pain
fever
irritability
viral UTI symptoms
18
Q
Tx of AOM
A
analgesia
Amoxicillin 5 days but not always needed
19
Q
what is otitis media with effusion also known as
A
Glue Ear
20
Q
Sx of OME
A
hearing impairment poor speech language delay inattention poor behaviour ear infections/URTI
21
Q
Ex of OME
A
Retracted or bulging drum
Can look dull, grey or yellow
22
Q
Ix of OME
A
Audiograms - looking for conductive hearing loss
Impedance audiometry - look for flat tympanogram
23
Q
Tx of OME
A
Usually resolves over time
3 monthly review
Hearing aid - reserved for persistent bilateral OME
Surgery - if hearing loss, GROMMETS
24
Q
what is COM
A
inflammation of middle ear fluid of several months duration
25
Sx of COM
hearing loss - if perforated ear drum
discharge (intermittently)
little pain
26
Tx of COM
Antibiotics therapy
27
can you get a congenital cholesteatoma
yes
28
Ix of ear problems
CT
29
what is the main function of tonsils
Trap bacteria and viruses on inhalation
Expose to immune system
Antibodies produced by the immune cells in the tissue
Help to prime immune system and help to prevent subsequent infections.
30
what is Waldeyer's ring
Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
31
what is Waldeyer's composed of
Tonsils (Palatine Tonsil)
Adenoids (Pharyngeal Tonsil)
Lingual Tonsil
32
histology of tonsils and adenoids
tonsils - Specialized squamous
adenoids - Ciliated pseudostratified columnar
33
aetiology of acute tonsillitis
majority viral
- EBV
- Rhinovirus, Influenza, Parainfluenza, Enterovirus, Adenovirus
can be bacterial
- strep pyogenes/GABHS (most common)
- H. influenza
- s. aureus
34
Sx of viral tonsillitis
```
Malaise
Sore throat, mild analgesia requirement
Temperature
Able to undertake near normal activity
Possible lymphadenopathy
Lasts 3-4 days
```
35
Sx of bacterial tonsillitis
```
Systemic upset,
Fever
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy
Lasts ~1 week, requires antibiotics to settle.
```
36
what is centor criteria
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
37
how is the score calculated in centor criteria
Age 44 subtract 1 point
0 or 1 points - No antibiotic
2 or 3 points - Should receive an antibiotic if symptoms progress
4 or 5 points - Treat empirically with an antibiotic
38
Tx of tonsillitis
Viral
- supportive
Bacteria
- Penicillin 10 days 500mg
- Clarithromycin if allergic
39
what is peritonsilar abscess a complication of and what is it
acute tonsillitis
| bacteria between muscle and tonsil produce pus
40
what is the classic history of peritonsilar abscess
Unilateral throat pain and odynophagia
Trismus (spasm of jaw)
3-7 days of preceding acute tonsillitis
41
what is seen on examination of a peritonsilar abscess
Medial displacement of tonsil and uvula to contralateral side of the infection
Concavity of palate lost
42
what is a peritonsilar abscess also known as
quincy
43
Tx of peritonsilar abscess
Aspiration
| Antibiotics
44
what is infectious mononeucleosis and what causes it
Glandular fever
EBV
45
signs of Glandular fever
```
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
```
46
what is NOT prescribed in glandular fever and why
Ampicillin or amoxicillin
| Can cause generalised macular rash
47
features of chronic tonsillitis
```
Chronic “sore throat”
“Malodorous breath”
Presence of tonsilliths
Peritonsillar erythema
Persistent tender cervical lymphadenopathy
```
48
what are symptoms of obstructive adenoid hyperplasia
Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME
49
what are symptoms of obstructive tonsil hyperplasia
Snoring and other symptoms of sleep disturbance
Muffled voice
?Dysphagia
50
what can cause unilateral tonsillar enlargement
neoplastic
non-neoplastic
- acute infective, chronic infective
- hypertrophy, congenital
51
what is OME/Glue ear
Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
52
what is linked with OME
smoking households
| recurrent URTI
53
what is not a symptoms of OME
ear pain/otalgia
54
signs of OME
TM retraction
Reduced TM mobility
Altered TM colour
Visible ME fluid/bubbles
55
signs of AOM
ear drum bulging and red
56
Tx of OME to begin with
“Watchful waiting”
60% resolved @ 1/12
90% resolved @ 3/12
Review @ 3/12
- Otoscopy
- PTA
- Tympanometry
57
Tx of OME after 3 months w/ symptoms of deafness, delay speech or poor balance
referral
3y/o first intervention
- grommets
> 3y/o second intervention
- grommets and adenoidectomy
58
complications of grommets
```
Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues
```
59
what is important to find out in the history of dizziness
```
Triggers?
Time Course?
Associated symptoms?
Precipitators?
Alleviating factors?
Medication? - alcohol can also make you dizzy
```
60
common causes of dizziness
postural dizziness
| side effect of medication
61
what is BPPV
Benign Positional Paroxysmal Vertigo
| commonest cause of vertigo looking up
62
what causes BPPV
Head trauma, ear surgery, idiopathic
Otolith material from utricle displaced into semicircular canals. Most commonly in posterior SCC.
63
Sx of BPPV
sudden rotational vertigo lasting more than 30 seconds by head-turning
NO tinnitus, headache, ataxia, facial numbness, dysphage
64
when do BPPV get vertigo
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
65
Ix for BPPV
Hallpike's Test
66
Tx for BPPV
Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercise
67
what is vestibular neuronitis
Prolonged vertigo (days)
No associated tinnitus or hearing loss
Probable viral aetiology
Viral prodromal symptoms
68
what is labyrinthitis
Prolonged vertigo (days)
MAY be associated tinnitus or hearing loss
Probable viral aetiology
May be viral prodromal symptoms
69
Tx for vestibular neuronitis/labyrinthitis
Supportive management
| Generally self-limiting
70
what is Meniere's Disease
dilatation of the endolympahtic spaces of the membranous labyrinth cases vertigo
71
Diagnosis of Meniere's Disesase
History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
Occurrence of or worsening of tinnitus on the affected side
Occurrence of aural fullness on the affected side
Documented SNHL on at least one occasion
Other causes excluded
72
Sx of Meniere's disease
```
vertigo around 12 hours
nausea/vomiting
fullness in the ear
uni/bi-lateral tinnitus
sensorineural deafness
```
73
Mx of Meniere's disease
```
Supportive treatment during episodes
Tinnitus therapy
Hearing Aids
Prevention
Gentamicin/steroids
```
Surgery
- Grommet/Meniette
74
what can make Meniere's disease worse
Salt / Betahistine / caffeine / alcohol / stress
75
what antibiotic can cause ear damage/hearing loss
Gentamicin
76
Migrane + Vertigo dizziness
```
Vertigo
Ataxia
Phonophobia (fear of loud noises)
Fluctuating Hearing loss
Motion sickness
```
