Ear-y feeling I know all the answers

Question 1

What is the most important factor in the pathogenesis of middle ear infections?
What produces the pain?

Answer 1

Eustachian tube (dys)function 
Pressure in the middle ear

Question 2

What is the triad of presentation in otitis media?

What is the common presentation age?

Answer 2

Decreased mobility
Red ear drum
Fever
90% <3yrs

Question 3

What percentage of otitis media infections are viral?
What 4 bugs are most common in bacterial infections?
What is the antibiotic treatment?

Answer 3

90%
Bacteria = streptococcus pneumonia, haemophilus influenzae, staph aureus and moraxella catarrhalis
Amoxicillin OR Clarithromycin (penicillin resistance)

Question 4

What are 2 causes of congenital conductive hearing loss?

What are 2 causes of congenital sensorineural hearing loss?

Answer 4

Conductive = Atresia of middle ear and ossicular abnormalities 
Sensorineural = genetic and rubella

Question 5

What are 2 causes of acquired external conductive hearing loss?
What are 3 causes of acquired middle conductive hearing loss?
What are 3 causes of acquired sensorineural hearing loss?

Answer 5

Wax or foreign body, otitis externa
Otitis media with effusion (most common), otosclerosis, trauma
Hypoxia, jaundice, trauma

Question 6

What factors increase the risk of hearing loss in paediatrics?
What antibiotic drug commonly causes hearing damage?

Answer 6

Prematurity 
Low birth weight 
Neonatal jaundice 
Family history 
Gentamicin

Question 7

What does hearing loss, vertigo and tinnitus indicate?
What 3 rules apply to vertigo in Ménière’s disease?
Treatment?

Answer 7

Ménière’s disease
Vertigo = >20mins, horizontal nystagmus and no loss of consciousness
Acute = Anti-histamines, anti-emetics
Chronic = vestibular physiotherapy, diazepam, thiazides

Question 8

What is a topical antibiotic used to treat otitis externa?

What are the 3 active ingredients?

Answer 8

Sofradex

Dexamethasone, gramicidin and framycetin

Question 9

What is a cholesteatoma?

What does it occur secondary to?

Answer 9

Keratinised, desquamated epithelial collection in middle ear OR mastoid
Secondary to tympanic membrane perforation OR primary lesion

Question 10

What is the pathogenesis of primary cholesteatoma?

Answer 10

Eustachian tube dysfunction -> chronic negative middle ear infection -> medial retraction -> chronic inflammation -> epithelial cell proliferation and collection

Question 11

What two bugs are common causes of cholesteatoma?

When does hearing loss occur?

Answer 11

Staph aureus and Pseudomonas Aeruginosa

Late

Question 12

What are 2 complications of cholesteatoma?

What is the pathogenesis?

Answer 12

Mastoiditis and facial nerve palsy

Breakdown of collagen by collagenase, acid protease and phosphatase -> osteoclastic bone resorption -> osteitis

Question 13

What is the medical management of cholesteatoma?

What is the surgical management of cholesteatoma?

Answer 13

Medical = antibiotics, suction and drainage
Surgical = tympanoplasty +/- mastoidectomy
+/- ossicular reconstruction

Question 14

What type of epithelium lines the external auditory canal?

What type of epithelium lines the middle ear?

Answer 14

Keratinised stratified squamous epithelium from pinna to tympanic membrane
Medial tympanic membrane = flat single cuboidal epithelium
Eustachian tube = respiratory epithelium becoming pseudo-stratified as it approaches nasopharynx

Question 15

What is Gerlach tubal tonsil and where is it located?

Answer 15

Lymphoid component of Eustachian tube found in children

Located at rim of Eustachian tube

Question 16

What is the pathophysiology of presbyacusis?

Which tones go first, high or low?

Answer 16

Gradual loss of hair cells in the cochlea and loss of neurones in the cochlea nerve
High tones go first