ENT Flashcards
HEARING LOSS
What are the two types of hearing loss and briefly explain them?
- Conductive = sound is not conducted to the inner ear due to problem of external or middle ear
- Sensorineural = sound is conducted to inner ear but issue at the sensory organ (cochlear) or vestibulocochlear nerve
HEARING LOSS
What are the causes of conductive hearing loss?
- Wax impaction
- Otitis media with effusion
- Perforated tympanic membrane
- Otosclerosis
- Cholesteatoma
HEARING LOSS
What are the causes of sensorineural hearing loss?
- Presbycusis = most common (age-related), gradual + insidious (symmetrical high frequency hearing loss)
- Meniere’s disease
- Congenital infections = rubella, CMV
- Acoustic neuroma
- Drugs = loop diuretics, aminoglycosides
HEARING LOSS Explain the axis of an audiogram What is normal? What indicates sensorineural hearing loss? What indicates conductive hearing loss? What indicates mixed hearing loss?
- X-axis is frequency (Hz) going low to high, Y-axis is volume (dB) with top quiet to bottom loud
- Anything <20dB line
- BOTH air + bone conduction impaired (>20dB)
- ONLY air conduction >20dB, bone is normal
- BOTH air + bone impaired but AIR WORSE by >15dB
HEARING LOSS
What two bedside tests would you do in hearing loss and briefly explain them?
- Rinne’s = place tuning fork on mastoid then external acoustic meatus
- Weber’s = place tuning fork on forehead in midline
HEARING LOSS
What are you looking for in Rinne’s test?
- Normal = louder at EAM
- Conductive = louder at mastoid
- Sensorineural = both decreased
HEARING LOSS
What are you looking for in Weber’s test?
- Normal = vibrations equal in both ears
- Conductive = louder in ABNORMAL ear
- Sensorineural = louder in NORMAL ear
HEARING LOSS
What is the management of hearing loss?
- Conductive = resolve issue (e.g., syringe ears, treat infection)
- Sensorineural = hearing aids, cochlear implants if profound hearing loss >95dB
OTOSCLEROSIS
What is the pathophysiology of otosclerosis?
- Autosomal dominant condition with replacement of normal bone by vascular spongy bone mainly affecting base of stapes where it attaches to oval window causing stiffening preventing it from transmitting sound
OTOSCLEROSIS
What is the clinical presentation of otosclerosis?
- Progressive conductive deafness at 20–40y
- Tinnitus
- Audiometry = Carhart’s notch (false depression of bone conduction at 2000Hz)
OTOSCLEROSIS
What is the management of otosclerosis?
- Hearing aid
- Stapedectomy
SSNHL
What is sudden sensorineural hearing loss (SSNHL)?
What is the most common cause?
What are some other causes?
- Sensorineural hearing loss over <72h
- Idiopathic
- Meniere’s disease, ototoxic meds, MS, stroke, acoustic neuroma
SSNHL
How do you manage SSNHL?
- URGENT ENT referral
- Audiometry to establish Dx
- CT/MRI head if ?stroke/acoustic neuroma
- ALL cases receive high dose PO corticosteroids
OTITIS MEDIA
What is otitis media?
What are some causes?
- Acute infection of middle ear, v common in paeds
- Mostly bacterial = strep pneumoniae #1, H. influenzae, moraxella catarrhalis
OTITIS MEDIA
What is the clinical presentation of otitis media?
What would you find on examination?
- Recent viral URTI Sx
- Otalgia = tugging/rubbing ear in paeds
- Conductive hearing loss
- Otoscopy = bright red + bulging tympanic membrane (loss of light reflex)
OTITIS MEDIA
What are the potential sequelae of otitis media?
- Otitis media with perforation
- Otitis media with effusion
- Labyrinthitis
OTITIS MEDIA
How does otitis media with perforation present?
What can happen if unresolved?
- Purulent otorrhoea clinically + on otoscopy
- Chronic suppurative otitis media = perforation of tympanic membrane with otorrhoea for >6w
OTITIS MEDIA
What are some complications of otitis media?
- Mastoiditis
- Meningitis
- Brain abscess
- Facial nerve paralysis
OTITIS MEDIA
What is the first line management of otitis media?
What might be considered afterwards?
- Supportive management with analgesia, safety net to seek help if no improvement after 3d
- First line Abx = amoxicillin 5–7d (erythromycin if pen allergic/pregnant)
OTITIS MEDIA
When would you consider immediate antibiotic prescription?
- Sx ≥4d + not improving
- Systemically unwell
- Immunocompromised
- <2y and bilateral
- Otitis media with perforation
OME
What is otitis media with effusion (OME)?
What are some risk factors for OME?
- Fluid collection within the middle ear space without signs of acute infection.
- Male, siblings with glue ear, trisomy 21, parental smoking
OME
What is the clinical presentation of OME?
- # 1 cause of conductive hearing loss in paeds
- May have secondary problems such as speech + language delay
- Otoscopy = dull + retracted TM with visible fluid level
- Audiometry = flat tympanogram
OME
What is the management of OME?
- Watchful waiting for 3m
- Grommet insertion to allow fluid to drain
- Adenoidectomy
OTITIS EXTERNA
What is otitis externa?
What are some risk factors?
- Infection of outer ear
- Increased water contact (swimming), cotton buds, hearing aids, DM