ENT Flashcards
Summarise Presbycusis
Pathophysiology: Sensironeural HL that occurs with age.
RF: age, male, fhx, loud noise exposure, DM, htn, ototoxic meds, smoking
Presentation: Loss high pitched noises first, gradual, insidious, tinnitus potentially
Ix: Audiometry
Mx: Can’t reverse -
1. optomise environment, 2. hearing aids, 3. cochlear implant
Summarise Sudden Sensorineural HL
Definition: Loss hearing <72 hrs.
Cause: Idiopathic (90%), infection, menieres, meds, MS, migraines, stroke, acoustic neuroma
Presentation: Unilateral hearing loss on audiometry
Mx: IMMEDIATE referral ENT, if idiopathic steroids
Summarise Eustachian Tube Dysfunction
Pathophysiology: Eustachian tube equalises pressures and drains fluid in middle ear - dysfunction may be caused by sinusitis/ rhinitis/ URTI/ smoking
Presentation: Feeling full, hearing loss, popping noises in ear, pain/ discomfort, tinnitus, worse with changing pressures and altitiudes
Ix: Usually clinical, but can do tympanogram and look at tube with nasopharyngoscope
Mx: Watch and wait, valsalva manouvers (otovents OTC), steroids sprays for sinusitis, antihistamines for rhinitis, grommets, Balloon dilatation Eustachian tuboplasty
Summarise Otosclerosis
Pathophysiology: AD condition where stapes is hardened and abnormally remodelled
Presentation: Conductive hearing loss, tinnitus, Can hear higher frequencies better than lower. As is conductive loss and sensory intact they may talk quietly as own voice sounds loud to them.
Ix: Audiometry shows conductive and low frequency HL, tympanograph shows reduced admittance
Mx: Conservative (hearing aids), surgery to replace
Summarise Otitis Media
Pathophysiology: Infection of middle ear, usually secondary to URTI that comes via eustachian tube. Commonly s.penumonia, h.influenzae and s.areus
Glue ear = OM + effusion - assiated with T21
Presentation: Ear pain, hearing loss, systemic sx, URTI sx.
Otoscope shows, red, inflammed and bulging tympanic membrane. If perforation can see hole + effusion. |f retracted and not inflammed = effusion post AOM
Mx:
Most resolve within 3 days without abx.
1. Amoxicillin 5-7d (delay if systemically well, no co-morbidities)
2. clarithromycin/ erythromycin in pregnancy
Grommets for effusion
Complications: Effusion (occurs later, no pain, HL, retracted ear drug, not inflammed), perforation, Mastoiditis, facial nerve palsy, labrynthitis, abscess
Summarise Otitis Externa
Pathophysiology: Infection of outer ear. Commonly due to Pseudomonas Auerangesia or S.aureus, eczema, fungus, dermatitis
RF: Swimming, trauma e.g. cotton buds, multiple abx in fungal infection
Presentation: Pain, conductive hearing loss, itching, discharge. Otoscope shows inflammation ear canal.
Mx:
If mild - acetic acid used
Moderate - Topical Aminoglycosides/ quinolones + steroids e.g. otomize spray .
Severe - PO/ IV
Ear wick if canal too swollen for treatment to reach.
Clotrimazole drops for fungal infection
Summarise Ear Wax
Presentation: Fullness, itchy, pain, tinnitus, conductive HL see on otoscopy.
Mx:
- Olive oil
- Ear irrigation
- Microsuction
Summarise Tinnitus
Causes:
Primary - Sensironeural HL
Secondary -Drugs, noise exposure, meieres, infection, earwax, acoustic neuroma, MS, trauma, DM, high cholestrol
Objective: Eustachian tube dysfunction, carotid stenosis
Assessment: Sudden unilateral HL? unilateral? Pulsatile? Neuro sx?
Ix: FBC, glucose, TSH, lipids, audiology, imaging
Mx: Sound therapy, hearing aids, CBT
Summarise Vertigo
Pathophysiology: Issue with vestibular system, proprioception or eyes causing room to spin
Types:
Central- Tumour, posterior circulation stroke, MS, Vestibular migraine
Peripheral - BPPV, menieres, labrynthirits, vestibularitis, acoustic neuroma, otosclerosis, ramsay hunt
Assessment:
Central - Less nausea, no hearing changes, more perisistent, impaired coordination
DANISH
Rombergs
Dix-Hallpike manouevre
Nystagmus - unilateral horizontal suggests peripheral, bilateral/ vertical suggests central
Mx: For peripheral short-term give prochlorpeazine/ cyclizine Betahistine for Menieres Epley manoevere for BPPV Scan in central DVLA informed
Summarise Benign Paroxysmal Positional Vertigo
Pathophysiology: Calcium carbonate crystals become lodges in the endolymph in the semicircular canals.
Presentation: Positional vertigo attacks e.g. when turning over in bed, which last 20-60s. NO HL or tinnitus.
Ix:
Dix-Hallpike manouevre - will trigger nystagmus + sx
Mx:
Epley manouevre
Summarise Vestibular Neuronitis
Pathophysiology: Inflammation of CN 8 after RTI
Presentation: Acute vertigo, N+V, RTI, NO HL or tinnitus
Ix: Head impulse test - fix gaze on nose whilst jerk head 10-20 degrees. Eees sacchade in peripheral cause.
Mx: Can give prochlorperazine/ antihistamines eg cyclizine for 3 days
Summarise Labryrinthitis
Pathophysiology: Usually URTI, Otitis media or meningitis can cause inflammation bony labryinth inner ear
Presentation: Acute vertigo with HL and tinnitus. URTI. Positive Head impulse test.
Mx: Same as vetibular neuronitis - 3 days prochlorperazine/ antihistamine
Summarise Menieres Disease
Pathophysiology: Too much endolymph in semicircular canals, disupting signal to brain
Presentation: middle aged with sx occuring in clusters. Unilateral sensorineural HL, tinnitus, vertigo, drop attacks, ear feels full, imbalance, nystagmus
Mx: Treat attacks with prochlorperazine/ antihistamines
Prevent with betahistine
Summarise Acoustic Neuromas
Pathophysiology: Tumour of schwann cells in the vestibulocochlear nerve. In bilateral think NF-2
Presentation: Middle aged, usually unilateral, gradual onset of tinnitus, dizzy, sensoroneural HL, fullness ear, facial nerve palsy
Ix: Audiometry, Brain imaging
Mx: Surgery, radiotherapy
Summarise Cholesteatoma
Pathophysiology: squamous epithelial cells in middle ear
Presentation: Foul smelling discharge, unilateral conductive hearing loss, may lead to: infection, pain, vertigo, white crust may be seen on otoscope in upper tympanic membrane
Mx: CT head confirms, surgery
