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Medicine and Surgery Mushkies > Ear mushkies > Flashcards

Ear mushkies Flashcards

1
Q

What are the different types of audiometry?

A
  1. Pure Tone Audiometry (PTA)
  2. Tympanometry
  3. Evoked response audiometry
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2
Q

What is pure tone audiometry?

A
  1. Headphones deliver tones at different frequencies and strengths in a sound-proofed room, pt indicates when sound appears and disappears
  2. Thresholds at different frequencies are plotted to give an audiogram
  3. Mastoid vibrator can be used to measure bone conduction threshold
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3
Q

What is tympanometry?

A
  1. Measures the stiffness of the ear drum (evaluates middle ear function)
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4
Q

What is a flat tympanogram a sign of?

A

Mid-ear fluid or perforation

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5
Q

What is a shifted tympanogram a sign of?

A

+/- mid ear pressure

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6
Q

What is evoked response audiometry?

A
  1. Auditory stimulus with measurement of elicited brain response by surface elctrode
  2. Used for neonatal screening (if otoacoustic emission testing negative)
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7
Q

How can you classify the causes of otalgia?

A

Otologic and Non-otologic

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8
Q

How can you classify the otologic causes of otalgia?

A

External Ear
Middle Ear
Inner Ear

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9
Q

How can you classify the non-otologic causes of otalgia?

A 
The 10 T's
TMJ
Tonsil 
Throat
Tube (eustachian)
Teeth
Tongue
Tics (glossopharyngeal)
Trachea
Thyroid
Ten (cranial nerve X)
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10
Q

How does otitis externa present?

A
  1. Watery discharge
  2. Itch
  3. Pain and tragal tenderness
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11
Q

What are the causes of otitis externa?

A
  1. Moisture e.g. swimming
  2. Trauma e.g. fingernails
  3. Absence of wax
  4. Hearing aid
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12
Q

What are the main organisms that cause otitis externa?

A
  1. Mainly pseudomonas

2. Staph aureus

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13
Q

What is the management of otitis externa?

A

Aural toilet with drops

  1. Betamethasone for non infected eczematous OE
  2. Betamethasone with neomycin
  3. Hydrocortsone with gentamicin
  4. Acidifying drops
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14
Q

What is malignant otitis externa?

A

A life-threatening infection which can lead to skull osteomyelitis, where 90% of pts are diabetic

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15
Q

What is the presentation of malignant otitis externa?

A
  1. Severe otalgia worse at night
  2. Copious otorrhoea
  3. Granulation tissue in the canal
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16
Q

What is the treatment of malignant otitis externa?

A
  1. Surgical debridement

2. Systemic Abx

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17
Q

What is bullous myringitis?

A

Painful haemorrhagic blisters on deep meatal skin and tympanic membrane, associated with influenza infection

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18
Q

What is TMJ Dysfunction?

A

A umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints

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19
Q

What are the symptoms of TMJ dysfunction?

A
  1. Earache (referred pain from auriculotemporal nerve)
  2. Facial pain
  3. Joint clicking/popping
  4. Teeth-grinding (bruxism)
  5. Stress (associated with depression)
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20
Q

What is the main sign of TMJ dysfunction?

A

Joint tenderness exacerbated by lateral movements of an open jaw

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21
Q

What is the main investigation for TMJ dysfunction?

A

MRI

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22
Q

What is the management of TMJ dysfunction?

A
  1. NSAIDs

2. Stabilising orthodontic occlusal prostheses

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23
Q

What is the classification of otitis media?

A
  1. Acute
  2. Glue ear (otitis media with effusion)
  3. Chronic (effusion >3m bilat or >6m unilat)
  4. Chronic suppurative (ear discharge with hearing loss and evidence of central drum perforation)
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24
Q

What organisms cause otitis media?

A
  1. Viral

2. Bacterial = Pneumococcus, Haemophilus, Moraxella

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25
Q

What is the treatment for acute otitis media?

A
  1. Paracetamol 15mg/kg

2. Amoxicillin (may use delayed prescrption)

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26
Q

How can you classify the complications of otitis media?

A

Intratemporal
Intracranial
Systemic

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27
Q

What are the intratemporal complications of otitis media?

A
  1. OME
  2. Perforation of tympanic membrane
  3. Mastoiditis
  4. Facial nerve palsy
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28
Q

What are the intracranial complications of otitis media?

A
  1. Meningitis/encephalitis
  2. Brain abscess
  3. Sub/epidural abscess
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29
Q

What are the systemic complications of otitis media?

A
  1. Bacteraemia
  2. Septic arthritis
  3. Infective endocarditis
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30
Q

How may otitis media with effusion (OME/glue ear) present?

A
  1. Inattention at school
  2. Poor speech development
  3. Hearing impairment
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31
Q

What might you see on audiometry with OME?

A

A flat tympanogram

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32
Q

What is the management of OME?

A
  1. Usually resolves spontaneously

2. Consider grommets if persistent hearing loss (s/e = infections and tympanosclerosis)

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33
Q

How does chronic suppurative otitis media present?

A

PAINLESS discharge and hearing loss

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34
Q

What might you see on examination of chronic suppurative otitis media?

A

Tympanic membrane perforation

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35
Q

What is the management of chronic suppurative otitis media?

A
  1. Aural toilet

2. Abx/steroid ear drops

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36
Q

What is a complication of chronic suppurative otitis media?

A

Cholesteatoma

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37
Q

What is mastoiditis?

A

Inflammation of the mastoid process, most commonly as a result of middle-ear inflammation which causes destruction of mastoid air cells with subsequent abscess formation

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38
Q

How does mastoiditis present?

A
  1. Fever
  2. Mastoid tenderness
  3. Protruding auricle
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39
Q

How do you diagnose mastoiditis?

A

CT

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40
Q

What is the management of mastoiditis?

A
  1. IV Abx

2. Myringotomy +/- mastoidectomy

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41
Q

What is a cholesteatoma?

A

A locally destructive expansion of stratified squamous epithelium within the middle ear

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42
Q

What is the classification of cholesteatomas?

A
  1. Congenital

2. Acquired = secondary to attic perforation in chronic suppurative OM

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43
Q

What is the presentation of cholesteatomas?

A
  1. Foul smelling white discharge
  2. Headache, pain
  3. CN involvement = vertigo, deafness, facial paralysis
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44
Q

What do you see on examination with cholesteatomas?

A

Appears pearly white with surrounding inflammation

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45
Q

What are the complications of cholesteatomas?

A
  1. Deafness (ossicle destruction)
  2. Meningitis
  3. Cerebral abscess
46
Q

What is the management of cholesteatomas?

A

Surgery

47
Q

What is tinnitus?

A

The sensation of sound without external sound stimulation

48
Q

How can you classify the causes of tinnitus?

A
  1. Specific
  2. General
  3. Drugs
49
Q

What are the specific causes of tinnitus?

A

MONA HH

  1. Menieres disease
  2. Otosclerosis
  3. Acoustic neuroma
  4. Noise-induced
  5. Head injury
  6. Hearing loss e.g. presbyacusis
50
Q

What are the general causes of tinnitus?

A
  1. HTN

2. Anaemia

51
Q

What are the drug-induced causes of tinnitus?

A
  1. Aspirin
  2. Aminoglycosides
  3. Loop diuretics
  4. Alcohol
52
Q

What is the character of tinnitus?

A

It is constant and pulsatile, and if unilateral is likely to be caused by an acoustic neuroma

53
Q

What might pts with tinnitus have a FHx of?

A

Otosclerosis

54
Q

What examinations might you do in a pt with tinnitus?

A
  1. Otoscopy
  2. Tuning fork tests
  3. Pulse and BP
55
Q

What investigations might you do in a pt with tinnitus>

A
  1. Audiometry and tympanogram

2. MRI if unilateral to exclude acoustic neuroma

56
Q

What is the management of tinnitus?

A
  1. Treat any underlying causes
  2. Psych support: tinnitus retraining therapy
  3. Hypnotics at night may help
57
Q

What is vertigo?

A

The sensation of spinning dizziness and thus is the illusion of movement

58
Q

How do you classify the causes of vertigo?

A
  1. Central
  2. Peripheral/vestibular
  3. Drugs
59
Q

What are the central causes of vertigo?

A
  1. Acoustic neuroma
  2. MS
  3. Vertebrobasilar injury/stroke
  4. Head injury
  5. Inner ear syphilis
60
Q

What are the peripheral/vestibular causes of vertigo?

A
  1. Meniere’s disease
  2. BPPV
  3. Labyrinthitis
61
Q

What are the drug-induced caused of vertigo?

A
  1. Gentamicin
  2. Loop diuretics
  3. Metronidazole
  4. Co-trimoxazole
62
Q

What are the associated symptoms you should ask for with vertigo?

A
  1. N&V
  2. Hearing loss
  3. Tinnitus
  4. Nystagmus
63
Q

What examinations and tests can you do to investigation vertigo?

A
  1. Hearing
  2. Cranial nerves
  3. Cerebellum and gait
  4. Romberg’s (+ive = vestibular/proprioception)
  5. Hallpike manouvre
  6. Audiometry
  7. Calorimetry
  8. LP
  9. MRI
64
Q

What is Meniere’s disease?

A
  1. An auditory disease caused by dilatation of the endolymph spaces of the membranous labyrinth (a.k.a endolymphatic hydrops). It is characterised by an episodic sudden onset of vertigo, low-frequency hearing loss, low-frequency roaring tinnitus and sensation of fullness in the affected ear
  2. Called Ménière’s disease if it is idiopathic.
65
Q

What is Meniere’s syndrome?

A

If the disease is secondary to a known inner-ear disorder

66
Q

How does Meniere’s disease present?

A
  1. Attacks occur in clusters and last up to 12h
  2. Progressive SNHL
  3. Vertigo and N&V
  4. Tinnitus
  5. Aural fullness
67
Q

What does audiometry show in Meniere’s disease?

A

Low-frequency SNHL which fluctuates

68
Q

What is the management of Meniere’s disease?

A 
Medical = Vertigo --> Cyclizine/betahistine
Surgical = Gentamicin instillation via grommets or Saccus decompression
69
Q

What is vestibular neuronitis/viral labyrinthitis?

A

Inflammation of the inner ear due to a virus

70
Q

How does viral labyrinthitis present?

A
  1. Follows a febrile illness e.g. URTI
  2. Sudden vomiting
  3. Severe vertigo exacerbated by head movement
71
Q

What is the management of viral labyrinthitis?

A

Cyclizine –> improvement in days

72
Q

What is BPPV?

A

A peripheral vestibular disorder that manifests as sudden short-lived episodes of vertigo elicited by specific head movements, caused by displacement of otoliths in the semicircular canals

73
Q

How does BPPV present?

A
  1. Sudden rotational vertigo for 30s provoked by head turning
  2. Nystagmus
74
Q

How can you classify the causes of BPPV?

A

Primary and Secondary

75
Q

What are the secondary causes of BPPV?

A
  1. Head injury
  2. Otosclerosis
  3. Viral labyrinthitis
  4. Meniere’s disease
  5. Migraine
76
Q

How do you diagnose BPPV?

A

Dix-Hallpike manoeuvre –> upbeat torsional nystagmus

77
Q

What is the Dix-Hallpike manoeuvre?

A
  1. Patients are lowered quickly to a supine position (lying horizontally with the face and torso facing up) with the head in a lateral position and with the neck extended 30 degrees below horizontal
  2. A positive test is indicated by patient report of a reproduction of vertigo and clinician observation of nystagmus
78
Q

What is nystagmus?

A

Rapid involuntary movement of the eyes

79
Q

What is the management of BPPV?

A
  1. Self-limiting
  2. Epley manoeuvre
  3. Betahistine (histamine analogue)
80
Q

How does the Epley manoeuvre work?

A

It works by allowing free-floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo.

81
Q

How can you classify the causes of adult hearing loss?

A
  1. Conductive

2. Sensorineural

82
Q

What are the causes of conductive hearing loss?

A
  1. External canal obstruction (wax, pus, FB)
  2. Tympanic membrane perforation (trauma, infection)
  3. Ossicle defects (otosclerosis, infection, trauma)
  4. Inadequate eustachian tube ventilation of middle ear
83
Q

What are the causes of sensorineural hearing loss?

A
  1. Drugs = aminoglycosides, vancomycin
  2. Post-infective = meningitis, measles, mumps, herpes
  3. Miscellaneous
84
Q

What are the miscellaneous causes of sensorineural hearing lodd?

A
  1. Meniere’s disease
  2. Multiple Sclerosis
  3. Acoustic Neuroma
  4. Trauma
  5. B12 deficiency
85
Q

What is an acoustic neuroma/vestibular schwannoma?

A

A benign, slow-growing tumour of the superior vestibular nerve

86
Q

What syndrome can acoustic neuromas lead to?

A

Can act as a SOL to cause cerebellopontine angle syndrome (80% of CPA tumours)

87
Q

What syndrome are acoustic neuromas associated with?

A

NF2

88
Q

How do acoustic neuromas present?

A
  1. Slow onset unilateral SNHL, tinnitus +/- vertigo
  2. Headache (ICP)
  3. CN Palsies: 5, 7, 8
  4. Cerebellar signs
89
Q

How do you investigate acoustic neuromas?

A
  1. MRI of cerebellopontine angle (MRI all pts with unilateral tinnitus/deafness)
  2. Pure Tone Audiometry
90
Q

What are differentials for acoustic neuromas?

A
  1. Meningioma
  2. Cerebellar astrocytoma
  3. Metastases
91
Q

What is the management of acoustic neuromas?

A
  1. Gamma knife

2. Surgery (risk of hearing loss)

92
Q

What is otosclerosis?

A

An AD condition characterised by fixation of the stapes at the oval window

93
Q

What is the epidemiology of otosclerosis?

A

2F:1M

94
Q

How does otosclerosis present?

A
  1. Begins in early adult life
  2. Bilateral conductive deafness + tinnitus
  3. Hearing loss improved in noisy places (Paracusis Willisii)
  4. Worsened by pregnancy/menstruation/menopause
95
Q

What is Paracusis Willisii?

A

Paradoxically improved hearing in noise places, most commonly documented in otosclerosis

96
Q

What do you see on Pure Tone Audiometry with otosclerosis?

A

PTA shows dip (Carhart’s notch) @ 2kHz

97
Q

What is the management of otosclerosis?

A

Hearing aid or stapes implant

98
Q

What is presbyacusis?

A

Age-related hearing loss

99
Q

How do you investigate presbyacusis?

A

Pure Tone Audiometry

100
Q

How do you manage presbyacusis?

A

Hearing aid

101
Q

How can you classify the causes of hearing loss in children?

A
  1. Congenital
  2. Perinatal
  3. Acquired
102
Q

How can you classify the congenital causes of hearing loss in children?

A

Conductive and Sensorineural

103
Q

What are the congenital, conductive causes of hearing loss in children?

A
  1. Anomalies of pinna/external auditory canal/TM/ossicles
  2. Congenital cholesteatoma
  3. Pierre-Robin sequence
104
Q

What are the congenital, sensorineural causes of hearing loss in children?

A
  1. Autosomal Dominant = Waardenburg syndrome
  2. Autosomal Recessive = Alport’s syndrome of Jewell-Lange-Nielson syndrome
  3. X-linked = Alport’s syndrome
  4. Infections = CMV, rubella, HSV, toxoplasmosis, GBS
  5. Ototoxic drugs
105
Q

What are the perinatal causes of hearing loss in children?

A
  1. Anoxia
  2. Cerebral palsy
  3. Kernicterus
  4. Infection: meningitis
106
Q

What are the acquired causes of hearing loss in children?

A
  1. Otitis media
  2. Otitis media with effusion
  3. Infection: meningitis, measles
  4. Head injury
107
Q

What are the universal neonatal hearing tests?

A

Otoacoustic emissions test, if abnormal –> audiological brainstem response

108
Q

What are ear exostoses?

A

Smooth, symmetrical bony hypetrophy of ear canals due to cold exposure from e.g. swimming/surfing

109
Q

What are the causes of tympanic membrane perforation?

A
  1. Otitis media
  2. Foreign body
  3. Barotrauma
  4. Trauma
110
Q

What is the big boy name for ear wax?

A

Cerumen auris

111
Q

What is the management of accumulated ear wax?

A
  1. Suction under direct vision with microscope

2. Syringing after 1wk softening with oil

Medicine and Surgery Mushkies (52 decks)

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