Ears

Question 1

Ear structures

Answer 1

Outer Ear –> Tympanic membrane and ear canal
Middle ear –> Ossicles, facial nerves, Chorda tympani
Inner ear –> Cochlea, semi-circular canals, otolith organs

Question 2

Causes of Conductive hearing loss

Answer 2

Impacted wax, perforated drum, otitis media, foreign body, otitis externa, cholesteatoma, ear atrasia, otosclerosis,

Question 3

Causes of Sensori-neural hearing loss

Answer 3

Congenital –> aplasia of the cochlea, congenital cholesteatoma, congential rubella syndrome
Inflammatory –> viral, measles, meningitis, mumps, autoimmune (muckle-wells syndrome), Ménière’s disease,
Drugs–> gentamicin, furosemide, methotrexate, aspirin
Trauma, loud noises, age, cerebellopontine angle tumour, acoustic neuroma, meningioma

Question 4

Acute Otitis Externa

Answer 4

pain, discharge, inflammed, pseudomonas or staph or fungal

treat with microsuction, steroid/abx drops, analgesia

Question 5

Acute otitis media

Answer 5

common in children after URTI, pain, hearing loss, red/bulging ear drum, pain decreases on rupture
Caused by S. pneuomoniae or HIB
Can give analgesia but most resolve spontaneously

Question 6

Otitis media with effusion

Answer 6

‘Glue ear’, collection of fluid in the middle ear due to either a painless viral URTI, or acute bacterial otitis media. O/E non-purulent fluid in middle ear, can lead to chronic inflammatory changes
treat with surveillance, grommet insertion or hearing aids

Question 7

Chronic suppurative otitis media

Answer 7

involves a perforation of hte drum with a bacterial infection in the middle ear
can cause purulent discharge and/or hearing impairment
can be active, inactive or healed

Question 8

Choleastoma

Answer 8

a destructive, growth of keratinizing squamous epithelium in the middle ear and/or mastoid process
causes painless otorrhoea and hearing loss
Strongly foul smelling. Can penetrate the facial nerve.

Question 9

Complications of otitis media

Answer 9

Intracranial –>meningitis, abscess, venous sinus thrombus

Extracranial –> mastoiditis, facial nerve palsy, labyrinthitis, hearing loss

Question 10

Hearing loss

Answer 10

most speech is 40-50dB and Webers + Rinnes are at 256-512Hz
Air conduction>bone conduction is normal, if not conductive loss
If reduced threshold for both then sensorineural

Question 11

What is presbycusis?

Answer 11

Age related hearing loss

Question 12

Otosclerosis

Answer 12

Abnormal bone growth near the middle ear
Hereditary
Gives conductive hearing loss
Most commonly around the foot of the staples

Question 13

Acoustic neuroma (vestibular schwannomas)

Answer 13

CN VIII- hearing loss, vertigo, tinnitus
CN V- absent corneal reflex
CN VII- facial palsy

Bilateral = neurofibromatosis

Question 14

Causes of otalgia

Answer 14

Acute otitis externa
Malignant otitis externa
Perichondritis - inflamed ear cartilage
Acute otitis media
Referred pain - trigeminal or glossopharyngeal.

Question 15

Causes of Vertigo

Answer 15

BPPV - short, positional, often in the morning. Treat with dick-hall pike mansour