Ear Diseases

Question 1

List the main clinical examination/investigations done for the ear

Answer 1

Tuning fork
Proton audiogram
Tympanogram
Otoscopy

Question 2

What are the two main tests done with the tuning fork?

Answer 2

Rinne test

Weber test

Question 3

Describe the Rinne test

Answer 3

Place low-frequency tuning fork over mastoid, then quickly position fork 1-2cm from auditory canal
Ask the patient which is louder

Question 4

Describe the Weber test

Answer 4

Place vibrating tuning fork over centre of forehead and ask patient which ear they hear better in

Question 5

How is a tympanogram carried out? What would a flat line on tympanogram suggest?

Answer 5

Inject air into ear + record pressure changes

Fluid in the ear

Question 6

List the main symptoms of the ear (think of the D’s)

Answer 6

Discharge
Discomfort
Dizziness
Deafness (conductive or sensorineural)
Din din (tinnitus)
Defective facial movement

Question 7

The most common cause of earache in adults is referred pain. True/False? Where is pain most commonly referred from?

Answer 7

True

6Ts: Teeth, TMJ, throat, tonsils, trigeminal, tongue

Question 8

List the nerves involved in referred pain to the ear

Answer 8

CN V3
CN VII
CN IX
CN X
C2, C3 spinal nerves

Question 9

What is the pattern of pain in acute otitis media?

Answer 9

Crescendo-decrescendo

Intense pain that then goes away once pus is drained

Question 10

If a patient has no hearing loss, the cochlea is unaffected. True/False?

Answer 10

True

Question 11

List the main causes of otitis externa

Answer 11

Bacterial - pseudomonas, S. aureus
Idiopathic
Trauma - scratching, cleaning
Allergy
Chemicals
Humidity
Swimming

Question 12

What is the Lehman term for otitis media with effusion?

Answer 12

Glue ear (fluid behind eardrum due to vacuum of the middle ear in the absence of infection)

Question 13

How is glue ear treated?

Answer 13

Monitor for up to 3 months
Grommet insertion
Adenoidectomy
Hearing aid

Question 14

What is the antibiotic of choice for unresolved otitis media?

Answer 14

Amoxicillin

Question 15

What is cholesteatoma? List some causes

Answer 15

Presence of squamous epithelium in the middle ear

Eardrum perforation
Retracted eardrum
Down’s/Turner syndrome
Congenital

Question 16

Select from below those which apply to acute otitis media:
Earache/fever/irritability
Exudate
Opaque eardrum
Bulging eardrum
Hearing loss

Answer 16

Earache/fever/irritability
Opaque eardrum
Bulging eardrum (not always)

Question 17

Select from below those which apply to otitis media with effusion:
Earache/fever/irritability
Exudate
Opaque eardrum
Bulging eardrum
Hearing loss

Answer 17

Exudate
Hearing loss
N.B. eardrum may be opaque but fluid will be seen

Question 18

Who usually gets glue ear and why?

Answer 18

Children ages 2-8 yrs

Short Eustachian tube means infection can travel easily + less ventilation of middle ear

Question 19

List signs of otitis externa

Answer 19

Pain
Discharge
Tragal tenderness

Question 20

Outline management for otitis externa

Answer 20

Aural toilet
Antibiotics for infection
Surgery to close perforated drum if chronic

Question 21

State the aetiology of acute otitis media

Answer 21

Often after viral URTI which enters the middle ear and pushes the ear drum outwards
Pneumococcus, HI, streps, staph

Question 22

Outline management for otitis media

Answer 22

Analgesia

Antibiotics if unresolved

Question 23

Outline the diagnostic tests and results used in glue ear

Answer 23

Audiogram (conductive deficit - air-bone gap)
Impedence audiometry (flat tympanogram)

Question 24

List early and late symptoms of cholesteatoma

Answer 24

EARLY: discharge, deafness
LATE: Headache, pain, facial paralysis, vertigo

Question 25

Outline diagnosis and management for cholesteatoma

Answer 25

CT/MRI

Surgery