Ears

Question 1

History taking for otalgia.Name 8 questions

Answer 1

1- When did it start? (Onset)
2- Associated symptoms? (Vertigo, fever
3- Hx of Trauma?
4- Worse with chewing?
5- Hearing loss?
6-Uni or bilateral?
7- Upper respiratory tract infection?
8- CV risk/heavy smoker?

Question 2

Additional questions if young child with otalgia (3)

Answer 2

1- Daycare/sick contacts?
2- Bottle or breastfed?
3- Immunizations UTD?

Question 3

Describe physical exam for otalgia. (6)

Answer 3

1- Look outside of ear
2- Look inside of ear. (Note ear canal + tympanic membrane)
3- check for cervical adenopathy. (Palpate lymph nodes)
4- Check inside mouth.
5- Palpate for otitis external or temporomandibular joint.
6- Neuro exam PRN.

Question 4

Considerations for serous otitis media…. In child…? (3)

Answer 4

1- could need tubes (tympanostomy)
2- Referral to ORL if recurrent otitis
3- Screen for hearing impairment.

Question 5

1- What would postauricular tenderness, swelling and erythema indicate in a AOM context?
2- What do you do with it?

Answer 5

1- Acute mastoiditis.
2- Urgent referral to ORL. ER!!!

Question 6

Name causes of Otorrhea. (5)

Answer 6

1- Otitis externa
2- Acute otitis media with perforated tympanic membrane
3- Cerebrospinal fluid leak
4- Trauma
5- Osteomyelitis

Question 7

1- Counselling and 2- Follow-up for someone who’s had a perforated tympanic membrane?

Answer 7

1- No swimming/water, plugs in shower.
2- FU in 6 weeks to ensure healed. If not, refer to ENT.

Question 8

External otitis symptoms? (4)

Answer 8

1- Hyperemic ear canal
2- Swollen ear canal (Narrow)
3- Otorrhea (green)
4- Ear is tender (palpate)

Question 9

How to treat external otitis?

Answer 9

Cipro-dex drops x 7 days.

Question 10

1-What to consider for unilateral otalgia and diabetes and immunocompromized patients.
2- What do you do with it?

Answer 10

1- Malignant necrotizing external otitis
2- ER for ENT stat.

Question 11

Name some questions to ask for history taking in tinnitus (7)

Answer 11

1- Description of tinnitus (Episodic vs constant. Pulsatile or not. Quality of sound, high pitch or no?)
2- How it affects quality of life/sleep/depression?
3- Ask about medication (Ototoxic)
4- Uni or bilateral?
5- Associated hearing loss?
6- Vertigo?
7- Change of intensity with motion or body position?

Question 12

What do you include in physical examination in the case of tinnitus? (6)

Answer 12

1- Neuro exam, to rule out neuro cause.
2- Observe tympanic membrane. To rule out cerumen impaction, perforation, infection tumor.
3- Weber, Rinne, Whisper test.
4- Observe balance and gait.
5- Head and neck exam (like all ear issues)
6- If pulsatile, auscultation over neck for carotid bruits.

Question 13

What do you ask if someone complains of hearing loss? (5)

Answer 13

1- Presence of tinnitus or vertigo?
2- unilateral or bilateral Hearing loss?
3- Inciting factor such as trauma, surgery or medication?
4- How it started?
5- Occupation/hobbies? (Loud noises could cause acoustic trauma)

Question 14

Name common causes of
1- Conductive hearing loss. (4)
2- Sensorineural hearing loss (4)

Answer 14

1- Otitis, foreign body, cerumen impaction, TM perforation
2- Noise induced traumatic loss, presbyacusis, Miniere’s disease, acoustic neuroma

Question 15

Name red flags for hearing loss. (2)

Answer 15

1- Sudden unilateral hearing loss (Acoustic neuroma)
2- Abnormal neurological findings (Tumor, brainstem infarction, cerebrovascular accident)

Question 16

(2) Counselling and (2) Pharmacological interventions for idiopathic tinnitus.

Answer 16

1- Background noise
2- Cognitive behavior therapy
3- Antidepressants.
4- Melatonin or trazadone for sleep

Question 17

Rinne test: air>bone
Weber test: equal at midline.
What does it man?

Answer 17

No hearing loss.

Question 18

Rinne test: Air>bone
Weber test: Louder in normal ear or better hearing ear
What does it mean?

Answer 18

Sensorineural hearing loss

Question 19

Rinne test: Bone>air
Weber test: Louder in affected ear
What does it mean?

Answer 19

Conductive hearing loss.

Question 20

Intervention plan for an adult with serous otitis. (4)

Answer 20

1- Nasal hygiene
2- Intermittent auto inflation (chew gum, yawn)
3- No flying/scuba diving (anything that could cause barotrauma)
4- Could use 2nd line decongestants

Question 21

Name 3 tests that can be performed in house for hearing loss. And what do they do?
1 intervention outside of clinic

Answer 21

1- Weber test (symmetric vs asymmetric)
2- Rinne test (condudtive vs sensorineural)
3- Whisper test (high frequency loss)
4- Refer to audiology

Question 22

1- What do you do with serous otitis in a child?
2- When do you refer to ENT?

Answer 22

1- Watchful waiting x 3 months
2- if speech/learning/language is at risk, and if not resolved in 3 months.

Question 23

Ear effusion without hyperemia is what?

Answer 23

Serous Otitis media

Question 24

Why do you inspect head and neck when checking ears?

Answer 24

Checking for masses or lymphadenitis which would indicate cancer or infection.

Question 25

Name 7 Ddx for conductive hearing loss.

Answer 25

1- Cholesteatoma
2- Polyp/cyst/tumor
3- Foreign body
4- Cerumen impaction
5- Otosclerosis
6- Otitis externa
7- Middle ear effusion