Ear Diseases

Question 1

what are the possible symptoms of ear disease

Answer 1

hearing loss
tinnitus
vertigo 
otalgia 
ear discharge 
facial weakness
nasal symptoms 

previous ear surgery
FHx

Question 2

what are the types of hearing loss

Answer 2

conductive
sensorineural
mixed

Question 3

what is normal hearing on audiometry

Answer 3

0-20

Question 4

what is otalgia

Answer 4

ear pain

Question 5

when should you considered referred otalgia

Answer 5

if ear looks normal and no history suggesting ear problem

Question 6

what is an incomplete facial palsy

Answer 6

have palsy and weakness but have retained some movement

Question 7

what are the possible signs of ear disease

Answer 7

discharge 
swelling 
bleeding 
masses 
external scars 
changes in ear drum 
swelling over mastoid 
facial weakness 
hearing loss

Question 8

what are the features of a normal ear drum

Answer 8

cone of light (always anterior)
lateral process of the malleous
pars flaccida (flaccid portion at top)
pars tensa (tense main portion)

Question 9

what is otitis externa

Answer 9

inflammation of the skin of the ear canal

almost always infections (bacterial or fungal- esp if used antibiotics then colonised by fungi)

Question 10

what are common causes of otitis externa

Answer 10

water, cotton buds, skin conditions (e.g. eczema)

Question 11

what are the symptoms of otitis externa

Answer 11

itchy
discharge 
sore 
ear canal swollen 
can follow an upper respiratory tract infection

Question 12

what are the risk factors for acute otitis media

Answer 12

children 1-3 
males
smoking in house
day/care nursery attendance
not breast fed 
craniofacial abnormalities

Question 13

what are the symptoms of acute otitis media

Answer 13

systemically unwell
pain (younger children may pull at their ear)
malaise
irritability, crying, poor feeding, restlessness
fever
coryza/rhinorrhoea
vomiting

Question 14

what is acute otitis media

Answer 14

inflammation of the middle ear

may be cause by bacteria or viruses

Question 15

what are the signs of acute otitis media

Answer 15

no light reflex
bulging ear drum
air fluid level may be present

Question 16

what can chronic otitis media cause

Answer 16

otitis media with effusion (glue ear)
cholesteatoma
perforation

Question 17

who gets otitis media with effusion

Answer 17

more common in children

associated with eustachian tube dysfunction or obstruction (e.g. inflamed adenoids)

Question 18

what should you consider in adults with otitis media with effusion

Answer 18

consider causes (something obstructing eustachian tube)
rhinosinusitis
nasopharyngeal carcinoma
nasopharyngeal lymphoma

Question 19

what are the features of otitis media with effusion

Answer 19

conductive hearing loss
flat tympanogram
children HL may present as behavioural problems, delayed language development
mild intermittent ear pain
may have balance problems
history of recurrent ear infections, URTI or nasal obstructions

Question 20

why is the ear drum yellow in otitis media with effusion

Answer 20

as colour of the fluid behind the eardrum

Question 21

what is the treatment for otitis media with effusion

Answer 21

reassurance- self limiting condition, 90% complete resolution in one year (although recurrence is common)
observation
is hearing <25 dB and persisting for more than 3 months:
-grommet
-could do adenoidectomy
-hearing aid

consider decongestants, antihistamines or steroids if due to nasal congestion

Question 22

does the effusion drain out of the grommet

Answer 22

no, allows air into ear to equalise the pressure

Question 23

what can cause ear drum perforation

Answer 23

commonly AOM

trauma

Question 24

do ear drum perforations heal

Answer 24

yes, usually heal spontaneously with no problems- may need surgical repair if very large hole

Question 25

what is a cholestestoma

Answer 25

the presence of keratinising squamous epithelium within the middle ear, or mastoid has independent growth causing expansion and resorption of the underlying bone

Question 26

what is external canal cholesteatoma

Answer 26

focal erosion of external bone with accumulation of keratin

Question 27

what are the symptoms of cholesteatoma

Answer 27

conductive hearing loss ear discharge resistant to antibiotics tinnitus ``` can also get: otalgia altered taste (facial nerve) dizziness (erosion into semicircular canal) facial nerve weakness ```

Question 28

what are the risk factors for cholesteatoma

Answer 28

middle ear disease, eustachian tube dysfunction, prior otological surgery, traumatic blast injury to ear, congenital abnormalities (cleft palate, craniofacial abnormalities, turners or downs syndrome)

Question 29

what is the management for cholesteatoma

Answer 29

generally requires surgical excision and reconstruction

Question 30

what are the possible complications of AOM and cholesteratoma

Answer 30

SNHL, tinnitus, vertigo, facial palsy brain abscess, meningitis venous sinus thrombosis mastoiditis (causes swelling under periosteum which pushes ear forward)

Question 31

what is otosclerosis

Answer 31

where one or more foci of irregularly laid spongy bone replace normal dense bone of the otic capsule (in bony labrynth) results in fixation of the stapes footplate

Question 32

who gets otosclerosis

Answer 32

women more commonly affected- usually in teens/20s | familial

Question 33

what are the symptoms of otosclerosis

Answer 33

gradual onset conductive hearing loss, vertigo, tinnitus

Question 34

how is otosclerosis treated

Answer 34

stapectomy | or hearing aids

Question 35

what is sensorineural hearing loss

Answer 35

hearing loss where the cause is within the inner ear/ sensory organ or the vestibulocochlear nerve

Question 36

what is presbycusis

Answer 36

old age hearing loss - sensorineural hearing loss caused by gradual changes in the inner ear (usually high frequency)

Question 37

what is the classic sign of noise induced hearing loss

Answer 37

classical dip at 4 kHz

Question 38

what type of hearing loss is noise induced

Answer 38

sensorineural

Question 39

what drugs can cause (SN) hearing loss

Answer 39

``` gentamicin + other aminoglycosides chemotheraputic drugs (cisplatin, vincristine) aspirin and NSAIDs in overdose ```

Question 40

what is a vestibular schwannoma

Answer 40

benign tumour arising in the internal acoustic meatus from the myelin-forming cells of the vestibulocochlear nerve

Question 41

how does a vestibular schwannoma present

Answer 41

hearing loss, tinnitus and imbalance (grows slowly so patients often adjust to changes in balance)

Question 42

how do you diagnose a vestibular schwannoma

Answer 42

MRI

Question 43

what is the treatment for a vestibular schwannoma

Answer 43

need to consider risks of surgery and benefit | symptoms might not be that bad, wont grow

Question 44

what type of hearing loss is menieres

Answer 44

sensorineural

Question 45

what type of hearing loss can trauma cause

Answer 45

conduction, sensorineural or mixed

Question 46

what is a haemotympanium

Answer 46

middle ear filled with blood

Question 47

what is a battles sign

Answer 47

bruising over the mastoid- suggests a base of skull fracture

Question 48

what are the complications of a skull fracture

Answer 48

hearing (conductive/ SN), facial palsy, CSF leak, brain damage