ENT Flashcards
What is Ramsay hunt syndrome
Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
Facial nerve palsy differentials
Bells palsy
Ramsay hunt syndrome
Stroke (UMN)
Management of Ramsay hunt syndrome
Oral aciclovir and corticosteroids
features of ramsay hunt syndrome
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Features of vestibular neuronitis
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
preceding viral infection
Differentials for vertigo
Peripheral (vestibular)
BPPV
Meniers disease
vestibular neuronitis
Trauma to vestibular nerve
otosclerosis
hyperviscosity syndromes
Acoustic neuroma
Herpes zoster (Ramsay hunt syndrome)
Central
Cerebellar or brainstem lesion affecting vestibulaar nerve function
Posterior circulation stroke
tumour
multiple sclerosis
vestibular migraine
sensory inputs for maintaining balance
Vision
Proprioception
and vestibular system
Pathophysiology of BPPV
Calcium crystals in semicercular canals (otoconia) are dislodged and disrupt the flow of fluid
can be triggered by a viral infection, head trauma, aging or idiopathic
Symptoms wore after changing position as movement is required to dislodge crystals
features of vertigo in BPPV
triggered on movement
last up to 1 min
over several weeks then resolves
diagnostic test for BPPV
Hallpike maneuver
Pathophysiology of Menieres disease
excessive build up of endolymph in the semicircular canals causing a higher pressure than usual, disrupting flow
Associated features of Menieres disease
Tinnitus
Hearing loss
feeling of fullness in the ear
nystagmus
Features of vertigo in Menieres disease
NOT associated with movement- random attacks
last up to hours
deterioration of hearing between attacks
Pathophysiology of vestibular neuronitis
Inflammation of the vestibular nerve following a viral infection leading to missmatch of signalling
features of vertigo in vestibular neuronitis
lasts several weeks
acute onset
Features of vertigo in central pathologies
sustained, non positional vertigo
disruption in the interpretation of signals
Management of BPPV
Epley maneuver
Important questions to ask with ear problems
Pain
Itch
discharge
Hearing loss
Vertigo
Tinnitus
Recent illnesses
Neurological symptoms eg. facial nerve palsy
Causes of sensorineural hearing loss
age related
Noise exposure
Menieres disease
Acoustic neuroma
Labyrinthitis
neurological; stoke, MS, brain tumour
Meningitis
Drugs
Drugs that cause sensorineural hearing loss
Aminoglycosides (gentamicin)
Loop diuretics (eg. furosemide)
chemotherapy (eg. cisplatin)
Causes of conductive hearing loss
Earwax
foreign body
Infection eg. otitis media/externa
GLue ear
effusion in middle ear
eustation tube dysfunction
perforated tympanic membrane
otosclerosis
cholesteotoma
benign bone growth (exosteotosis)
tumours
Mananagement of vertigo in vestibular neuronitis
- Buccal/ IM prochlorperazine (acute vertigo relief)
- vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
What is otosclerosis?
Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults
features of otosclerosis
conductive deafness
tinnitus
tympanic membrane
the majority of patients will have a normal tympanic membrane
10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
positive family history
Positive Hallpike test for BPPV
delayed onset (few seconds) torsional nystagmus on descent facing one side only
First line antibiotic for acute otitis media
amoxicillin
clarythromycin if pen allergy
common bacterial causative organisms of otitis media
Streptococcus Pneumoniae, Haemophilus Influenzae and Moraxella Catarrhalis
