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Yr4 - Neuro + SS > Ears > Flashcards

Ears Flashcards

1
Q

Nerve distribution of ear

A

Upper later surface = auriculotemporal nerve (CN V3)
Lower lateral surface and medial = greater auricular nerve (C3)
Superior medial surface = lesser occipital nerve (C2/3)
External auditory meatus = auricular branch of CN X

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2
Q

Mx of ear lacerations

A

Clean the wound
Primary closure - ensure all exposed cartilage covered with skin
Plastic reconstructive surgery if significant skin loss

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3
Q

Mx of bites to ear

A

Gather hx to determine causative organism
Leave wound open
Irrigate and give abx

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4
Q

Mx of haematoma

A

Can disrupt blood supply to the cartilage -> vascular necrosis
Risk of associated deformity - cauliflower ear
Requires urgent drainage
Pressure dressing to prevent re-accumulation

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5
Q

Mx of tympanic membrane perforation

A

Can cause pain and conductive hearing loss
Often heals alone
- watch and wait
- advise not to get wet
If hasn’t resolved within 6 months consider myringoplasty

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6
Q

Mx of haemotypmanum

A

Blood in middle ear
- often associated with temporal bone fracture
Associated with conductive hearing loss
Self-resolving
Follow up to ensure no residual hearing loss - damage to ossicles

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7
Q

Define otitis externa

A

Diffuse inflammation of external ear canal

- may also involve pinna or tympanic membrane

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8
Q

Epidemiology of otitis externa

A

Life incidence of 10%
Most common 7-12 year old group
Common in warmer temps and humid conditions

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9
Q

Risk factors for otitis externa

A

External ear obstruction - cerumen blockage promotes retention of water/debris
High humidity
Local trauma
Skin disease
Diabetes
Immunocompromised
Prolonged use of topical anti-bacterial - inhibit normal flora

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10
Q

Pathophysiology of otitis externa

A 
Most commonly bacterial infections
- pseudomonas aeruginosa
- staphylococcus aureus
May be fungal
- aspergillus
Breakdown of skin integrity, insufficient cerumen production or blockage of ear canal can predispose to colonisation
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11
Q

Presentation of otitis externa

A 
Rapid onset - within 48 hours
Discharge from ear
Painful ear - tragal tenderness
Ear canal swelling and erythema
Itchy ear
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12
Q

Ix for otitis externa

A 
Pneumatic otoscopy  
- normal in otitis externa
- abnormal in otitis media
Tympanometry
- normal
Swab discharge for culture if resilient
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13
Q

Mx of otitis externa

A 
Topical eardrops empirically
- gentamicin
- ciprofloxacin
- dexamethasone
Topical antifungals 
- acetic acid
Pain mx with simple analgesia
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14
Q

Complications of otitis externa

A

Malignant otitis externa

  • mainly seen in diabetes or immunocompromise
  • infection spreads from soft tissue into the bone
  • presents with chronic ear discharge, deep-seated severe ear pain, cranial nerve palsies
  • granulation tissue in ear canal
  • mx = IV ciprafloxacin as well as topical treatment
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15
Q

Define acute otitis media

A

Infection of middle ear space

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16
Q

Epidemiology of acute otitis media

A

> 80% of children present before 2 years

Peak incidence 6-18 months

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17
Q

Risk factors for acute otitis media

A 
FHx
Young age - shorter, more horizontal and poorly functioning eustachian tube
Absence of breastfeeding
Craniofacial abnormality - cleft palate
Immunological deficiency
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18
Q

Pathophysiology of acute otitis media

A

Middle earl lined with respiratory (pseudostratified columnar) epithelium
- susceptible to infection with resp viruses
Creates effusion
Suppurative inflammatory response
Blockage in eustachian tube creates negative pressure in middle ear
- pressure against tympanic membrane leads to pain

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19
Q

Presentation of acute otitis media

A 
Otalgia - children pull on ear
Preceding URTI symptoms
Bulging tympanic membrane
- purulent middle ear effusion
Myringitis - erythema of tympanic membrane
Sleep disturbance
Fever
Decreased appetite
Discharge
CLINICAL DIAGNOSIS
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20
Q

Mx of acute otitis media

A 
Analgesia - paracetamol/ibuprofen
Delayed amoxicillin prescription
- usually self-resolving
Grommets
- inserted to allow ventilation
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21
Q

Complications of acute otitis media

A 
Bullous myringitis 
- visible on otoscopy
- resolves with abx
Tympanic membrane perforation
- purulent otorrhoea
- abx
- usually heals rapidly
Mastoiditis
- infection extends into mastoid air cells
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22
Q

DDx of acute otitis media

A

Otitis media with effusion
- typically asymptomatic
- dull and retracted membrane
Myringitis - no symptoms associated with middle ear
Mastoiditis
- oedema, erythema and tenderness over mastoid process
Cholestaetoma
- normally presents with painless otorrhoea and hearing loss

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23
Q

Define chronic otitis media

A

Classified as active or inactive depending on whether discharge present
- active associated with chronic ear discharge and conductive hearing loss
Divided into squamous or mucosal
- squamous develops when keratinised squamous cells introduced into middle ear from retraction pocket or perforation
- mucosal develops when failure of tympanic membrane to heal after rupture

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24
Q

Presentation of chronic otitis media

A

Conductive hearing loss
Crusting in retraction pocket
Resistant to abx therapy

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25
Q

Mx of chronic otitis media

A

Squamous disease
- surgical clearance of cholesteatoma +/- mastoidectomy
- risk of recurrence if not totally cleared
Mucosal disease
- topical abx
- surgical repair of perforation

26
Q

Risks of mastoid surgery

A 
Facial nerve palsy
Altered taste from damage to chorda typani
CSF leak
Tinnitus
Vertigo
Complete loss of hearing
27
Q

Define otitis media with effusion

A

Fluid presence in middle ear with intact tympanic membrane

28
Q

Epidemiology of otitis media with effusion

A

More common in children - shorter, more horizontal poorly functioning eustachian tube
Assess post-nasal space as tumour may cause eustachian tube dysfunction

29
Q

Presentation of otitis media with effusion

A

No pain
Conductive hearing loss
Middle ear effusion - bulging tympanic membrane

30
Q

Ix for otitis media with effusion

A 
Otoscopy
- bulging tympanic membrane
- air under drum
Pure tone audiogram
- conductive hearing loss
Tympanometry
- type B flat compliance curve - no tympanic membrane movement
31
Q

Mx of otitis media with effusion

A

Conservative
- settle in 3 months
Consider hearing aid
Grommet insertion +/- adenoidectomy in prolonged cases

32
Q

Define oteosclerosis

A

Disease affecting ossicles in middle ear

33
Q

Epidemiology of oteosclerosis

A

1-2% of population
F:M 2:1
Genetic and environmental components

34
Q

Pathophysiology of oteosclerosis

A

Mature bone gradually replaces with woven bone

Symptoms develop as stapes footplate becomes fixed to oval window

35
Q

Presentation of oteosclerosis

A

Progressive hearing loss
Tinnitus
Improved hearing in noisy surroundings
Pink hue on tympanic membrane

36
Q

Ix for oteosclerosis

A

Tympanogram
- normal A trace
Pure tone audiogram
- conductive hearing loss

37
Q

Mx of oteosclerosis

A

Hearing aid

Stapedectomy

38
Q

Define vertigo

A

Hallucinations of movement

Associated with problems with vestibular system

39
Q

Causes of vertigo

A 
Central
- stroke
- migraine
- neoplasms
- demyelination - MS
- drugs
Peripheral
- BPPV
- Meniere's
- vestibular neuronitis
40
Q

Define benign paroxysmal positional vertigo

A

Vertigo occurring with particular head movements

  • primary = idiopathic
  • secondary = a/w head trauma, migraines, ischaemic processes
41
Q

Epidemiology of BPPV

A

Peak incidence 50-70

More common in females

42
Q

Risk factors for BPPV

A

Head trauma
Migraines
Inner ear surgery

43
Q

Pathophysiology of BPPV

A

Crystals in semi-circular canals cause abnormal stimulation of hair cells

44
Q

Presentation of BPPV

A 
Episodic vertigo 
- provoked by specific positions 
- last less than 30 seconds
Sudden onset intense vertigo
Nausea
Imbalance
Lightheadedness
45
Q

Ix for BPPV

A 
Neuro and otological exam normal
Dix-Hallpike test
- patient sitting
- turn head 45º 
- continue to support head
- lower patient to 30º below horizontal 
- hold head for 30 secs and observe for nystagmus
- return patient to seated position
- positive if vertigo and nystagmus present
46
Q

Mx of BPPV

A 
Reassurance - most resolve spontaneously in 6 months
Epley manoeuvre
- patient sitting
- rotate head to 45º to affected ear
- lower patient to 30º below horizontal
- maintain for 1-2 mins
- observe for primary nystagmus
- rotate head 180º to opposite ear
- observe for secondary nystagmus - primary and secondary nystagmus in same direction indicates good response
- maintain position for 30-60 seconds
- sit patient up
- should be no nystagmus or vertigo
47
Q

Define Meniere’s disease

A

Auditory disease characterised by sudden, episodic onset of vertigo, low frequency hearing loss, low-frequency roaring tinnitus and sensation of fullness

48
Q

Types of Meniere’s’ disease

A 
Primary
- idiopathic
Secondary
- head trauma
- migraines
- ischaemic processes
49
Q

Epidemiology of Meniere’s disease

A

Disease of adulthood
- onset in 4th decade
Slightly higher female incidence
Evidence of genetic link

50
Q

Risk factors for Meniere’s disease

A

Recurrent viral infection

Autoimmune disease

51
Q

Presentation of Meniere’s disease

A 
Recurrent episodes of vertigo
- spinning sensation
- lasts minutes to hours
- a/w N+V
Hearing loss
- fluctuates
- worsening during vertigo periods
- chronic during later stages
- unilateral
Tinnitus
- unilateral
Aural fullness
Drop attacks
- sudden loss of balance without loss of consciousness
Positive Romberg's test
- sway when standing with feet together and eyes closed
Positive fukunda stepping test
- turn towards affected side when marching in place with eyes closed
52
Q

Ix for Meniere’s disease

A

Pure-tone audiometry
- unilateral sensorineural hearing loss
- low frequency in early stages and high frequencies as disease progresses
Speech audiometry
- measures response to simple bisyllabic words
- compared to pure tone hearing to identify non-organic hearing loss
- no discrepancy
Tymapanometry
- normal

53
Q

Mx of Meniere’s disease

A 
Dietary changes
- reduce salt, chocolate, alcohol and caffeine
Thiazide diuretics
Betahistine
- symptomatic treatment of N/V during attaches
Prochlorperazine
- vestibular sedatives in acute attacks
Dexamethasone
- injected into middle ear
Surgery
- grommet insertion
- endolymphatic sac decompression
- surgical labyrinthectomy
54
Q

Define vestibular neurontitis

A

Inflammation in the inner ear causes severe incapacitating vertigo lasting several days

  • a/w N+V
  • horizontal nystagmus during an attack
55
Q

Mx of vestibular neuronitis

A 
Symptomatic relief with vestibular sedatives during the acute attack
IV fluids if recovered
Cawthorne-Cooksey exercises to help with prolonged poor balance
- look up then down
- look left then right
- bending neck forwards and backwards
- turning head left and right
- shrugging and rotating shoulders
- walking up and down stairs
56
Q

Features of hearing tests

A

Differentiate sensorineural hearing loss from conductive hearing loss
- sensorineural hearing loss otological emergency

57
Q

Tuning fork tests

A

256 Hz or 512 Hz tuning fork used
Weber test
- knock tuning fork and place in centre of head
- should be equal in both ears
- if one ear sensioneural loss in other ear
Rinne test
- place tuning fork on mastoid for a few seconds then lateral to external ear meatus
- should be louder when held in air than bone - Rinne positive
- if louder over bone (negative) then conductive hearing loss

58
Q

Uses of pure tone audiogram

A

Assess hearing thresholds at different frequencies
Used from ages 4 up
Tones played at different frequencies and quietest tone at each frequency recorded
Hertz on x axis, decibel on right
- lower decibel = quieter noise
- anything above 20 is normal
Air conduction and bone conduction measured
- air by headphones assess whole auditory pathway
- bone tested with bone conductor over mastoid bone

59
Q

Findings of pure tone audiogram

A

Conductive
- pathology in middle or external ear
- audiogram has normal bone and reduced air conduction
Sensorineural
- pathology between cochlear and auditory of brain
- audiogram has reduced bone and air conduction thresholds - no air bone gap
Mixed
- air conduction worse than bone
- bone conduction worse than normal

60
Q

Uses of tympanogram

A

Measures compliance of tympanic membrane at varying pressures
Probe inserted into external ear canal
Can be done at any age
Compliance measured along y axis and pressure on x axis

61
Q

Findings of Tympanogram

A 
Type A trace - normal
- peak centred at 0 on x axis
Type B
- flat trace
- suggest middle ear effusion or perforation
- effusion has normal canal volume
- perforation has large volume
Type C
- suggests Eustachian tube dysfunction
Peak occurs at negative pressure

Yr4 - Neuro + SS (9 decks)

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