Ear Diseases Flashcards
what are the possible symptoms of ear disease
hearing loss tinnitus vertigo otalgia ear discharge facial weakness nasal symptoms
previous ear surgery
FHx
what are the types of hearing loss
conductive
sensorineural
mixed
what is normal hearing on audiometry
0-20
what is otalgia
ear pain
when should you considered referred otalgia
if ear looks normal and no history suggesting ear problem
what is an incomplete facial palsy
have palsy and weakness but have retained some movement
what are the possible signs of ear disease
discharge swelling bleeding masses external scars changes in ear drum swelling over mastoid facial weakness hearing loss
what are the features of a normal ear drum
cone of light (always anterior)
lateral process of the malleous
pars flaccida (flaccid portion at top)
pars tensa (tense main portion)
what is otitis externa
inflammation of the skin of the ear canal
almost always infections (bacterial or fungal- esp if used antibiotics then colonised by fungi)
what are common causes of otitis externa
water, cotton buds, skin conditions (e.g. eczema)
what are the symptoms of otitis externa
itchy discharge sore ear canal swollen can follow an upper respiratory tract infection
what are the risk factors for acute otitis media
children 1-3 males smoking in house day/care nursery attendance not breast fed craniofacial abnormalities
what are the symptoms of acute otitis media
systemically unwell
pain (younger children may pull at their ear)
malaise
irritability, crying, poor feeding, restlessness
fever
coryza/rhinorrhoea
vomiting
what is acute otitis media
inflammation of the middle ear
may be cause by bacteria or viruses
what are the signs of acute otitis media
no light reflex
bulging ear drum
air fluid level may be present
what can chronic otitis media cause
otitis media with effusion (glue ear)
cholesteatoma
perforation
who gets otitis media with effusion
more common in children
associated with eustachian tube dysfunction or obstruction (e.g. inflamed adenoids)
what should you consider in adults with otitis media with effusion
consider causes (something obstructing eustachian tube)
rhinosinusitis
nasopharyngeal carcinoma
nasopharyngeal lymphoma
what are the features of otitis media with effusion
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
why is the ear drum yellow in otitis media with effusion
as colour of the fluid behind the eardrum
what is the treatment for otitis media with effusion
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
does the effusion drain out of the grommet
no, allows air into ear to equalise the pressure
what can cause ear drum perforation
commonly AOM
trauma
do ear drum perforations heal
yes, usually heal spontaneously with no problems- may need surgical repair if very large hole
what is a cholestestoma
the presence of keratinising squamous epithelium within the middle ear, or mastoid
has independent growth causing expansion and resorption of the underlying bone
what is external canal cholesteatoma
focal erosion of external bone with accumulation of keratin
what are the symptoms of cholesteatoma
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
what are the risk factors for cholesteatoma
middle ear disease, eustachian tube dysfunction, prior otological surgery, traumatic blast injury to ear, congenital abnormalities (cleft palate, craniofacial abnormalities, turners or downs syndrome)
what is the management for cholesteatoma
generally requires surgical excision and reconstruction
what are the possible complications of AOM and cholesteratoma
SNHL, tinnitus, vertigo, facial palsy
brain abscess, meningitis
venous sinus thrombosis
mastoiditis (causes swelling under periosteum which pushes ear forward)
what is otosclerosis
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
who gets otosclerosis
women more commonly affected- usually in teens/20s
familial
what are the symptoms of otosclerosis
gradual onset conductive hearing loss, vertigo, tinnitus
how is otosclerosis treated
stapectomy
or hearing aids
what is sensorineural hearing loss
hearing loss where the cause is within the inner ear/ sensory organ or the vestibulocochlear nerve
what is presbycusis
old age hearing loss - sensorineural hearing loss caused by gradual changes in the inner ear
(usually high frequency)
what is the classic sign of noise induced hearing loss
classical dip at 4 kHz
what type of hearing loss is noise induced
sensorineural
what drugs can cause (SN) hearing loss
gentamicin + other aminoglycosides chemotheraputic drugs (cisplatin, vincristine) aspirin and NSAIDs in overdose
what is a vestibular schwannoma
benign tumour arising in the internal acoustic meatus from the myelin-forming cells of the vestibulocochlear nerve
how does a vestibular schwannoma present
hearing loss, tinnitus and imbalance (grows slowly so patients often adjust to changes in balance)
how do you diagnose a vestibular schwannoma
MRI
what is the treatment for a vestibular schwannoma
need to consider risks of surgery and benefit
symptoms might not be that bad, wont grow
what type of hearing loss is menieres
sensorineural
what type of hearing loss can trauma cause
conduction, sensorineural or mixed
what is a haemotympanium
middle ear filled with blood
what is a battles sign
bruising over the mastoid- suggests a base of skull fracture
what are the complications of a skull fracture
hearing (conductive/ SN), facial palsy, CSF leak, brain damage
