ENT Flashcards
What are the three parts of the ear?
External
Middle
Inner
What are some parts of the outer ear?
Pinna
Lobe
Tragus
Anti-tragus
Helix
Anti-helix
What are the parts of the middle ear?
Tympanic membrane
Ossicles
What are the names of the ossicles?
Malleus
Incus
Stapes
What are the parts of the inner ear?
Semi-circular canals
Cochlea
Vestibulocochlear nerve
Round Window
Oval window
What are the two main features of the ear?
Hearing
Balance
What symptoms can you get from problems in ear?
Ear pain
Otorrhea
Vertigo
Tinnitus
Itching
Fullness
What are some examinations for ear problems?
Otoscopy
Weber’s and Rinne’s
How do you use otoscope?
Pull patients ear up and back
Place in ear - not too far
How do you do Rinne’s Test?
Vibrate tuning fork and place behind ear on mastoid process. Ask them when they stop hearing it.
Then place it in front of ear and ask if they still can, they should be able to as AC>BC ( normal or sensorineural)
How do you perform Weber’s test?
Bang tuning fork and place on centre of forhead
Ask them if its the same on both sides ( normal )
What is the difference between conductive and sensorineural?
Conductive = problem with transfer of waves e.g blockage
Sensorineural - problem with the VC nerve
How do you tell on otoscope with ear you are looking at?
Cone of light will be on the same side as which ear it is
What is audiometry?
First line investigation for hearing loss
Place headphones on patient with muffling sounds on non test ear and see the minimum pure tone sound the patient can hear
What is normal in audiometry?
Above 20dB
What is a Cholesteatoma?
An abnormal collection of skin cells that gets trapped behind the eardrum/ossicles .
How does a Cholesteatoma form?
Either congenital, or due to poor ventilation of the Eustachian Tube ( poor negative pressure leads to ear drum retraction where skin cells and ear wax collect )
What are the symptoms of a Cholesteatoma?
Watery/smelly discharge
Gradual loss of hearing in one ear
Discomfort
What will appear on otoscopy for a Cholesteatoma?
Retracted pocket of pearly white/ keratin material on the upper part of the tympanic membrane
What would a Cholesteatoma result on a Weber’s and Rinne’s test show?
Conductive hearing loss of the affected side
BC > AC , lateralised to unaffected side
What is the treatment for a Cholesteatoma?
Surgical removal
What serious consequences can result from a Cholesteatoma?
It can erode bone to can spread
Brain abcesses
Facial paralysis
Vertigo
What is the causes of referred pain to the ear ( Secondary Otalgia )
Dental issues
TMJ dysfunction
What are the symptoms of dental issues?
Pain
Difficulty chewing
Difficulty swallowing
Bleeding hums
What are symptoms of TMJ dysfunction?
Pain
Jaw stiffness
Popping/ locking or jaw
Pain can spread to face or neck
What is the treatment for Secondary Otalgia?
Treatment of underlying cause
OTC ear medication may be used for symptom relief
What is Otitis Media with Effusion?
Also known as glue ear. It is a collection of fluid within the middle ear space
What are the symptoms of Otitis Media with Effusion?
Earache
Hearing
Ringing
Problems with balance
Retracted, straw coloured tympanic membrane
What are the signs of otitis media with effusion on otoscopy?
Retracted, straw coloured membrane
What would be shown on an Audiogram in Otitis media with effusion?
Mild conductive hearing loss, reduced specifically in middle ear
What is Tympanometry?
A test for fluid in the middle ear. It measures the movement in the eardrum to a change in the air pressure . When there is fluid it does not move so well and sound waves bounce back rather than through to the middle ear
What is the treatment Otitis Media with effusion?
Most resolve spontaneously in 2-3 months.
If it doesn’t, use a nasal balloon treatment , blow it up three times a day to open up ET and drain fluid
Can use grommets
Why are children more prone to OM with Effusion?
They have a shorter, more horizontal ET
What are some complications of OM with Effusuion?
Chronic damage to TM
Hearing loss
Speech and language development
What is the treatment for Acute Otitis Externa?
Acetic Acid Spray
If this is ineffective or there are signs of more severe infection such as discharge or oedema, antibiotic and steroid ear drops can be given.
What is the treatment for Acute Otitis Media?
No systemic upset/fever - Analgesia
Systemic upset/very unwell/ bilateral/ high risk of complications/ More than 4 days - Amoxicillin
What is the treatment for Pinna Haemtoma?
Antibiotics
Aspiration to prevent complications
What is the management for TMJ dysfunction?
Explanation its usually caused by stress
Reassurance it is self-resolving
Simple analgesia
What is the treatment for noise induced hearing loss?
Hearing aids
Whar is the first line treatment for Nasal Polyps?
Nasal Steroid Drops
What are the presenting symptoms of Acute LAbrynthitis?
Sudden onset of unilateral vertigo, with associated hearing loss on the background of a recent viral infction.
Appears normal on otoscopy
What is given for bacterial tonsillitis/laryngitis if the patient is Penicillin allergic?
Clarithromycin or Erythromcyin
What are indications for tonsillectomy?
Recurrent OM, Chronic Rhino-sinusitis, Chronic Tonsillitis
What is Otosclerosis?
Abnormal bone growth in the middle ear, progressive hearing loss in both ears , usually 40s/50s
Treated with Stapedectomy or Hearing aids
What are the three conditions associated with vertigo?
Viral labyrinthitis
BPPV
Meniere’s Disease
How can you distinguish between the causes of vertigo?
Acute/Viral Labyrinthitis - any movement triggers vertigo / constant , recent history of URTI, tinnitus , hearing loss, nsytagmus
BPPV - episodic vertigo when turning head, NO hearing loss, NO tinnitus, nystagmus
Meniere’s Disease - no clear trigger, tinnitus, hearing loss
What makes a central cause of vertigo more likely?
Neurological symptoms
Constant
No tinnitus/hearing loss
Symptoms not altered by position
How do you confirm BPPV? and how is this done?
Dix-Hallpike Maneuver
Sit patient up on bed
Turn patient’s head to 45 degrees on the left or right, then support neck and make patient lean back with head turned and stay there for 1-2 minutes
Check for Nystagmus
Repeat on other side
What are two classes of drugs that can treat chronic vertigo?
Antihistamines ( Promethazine)
Phenothiazines ( Prochlorperazine )
