ENT Flashcards
What 4 hearing tests are done to a child?
ages?
Newborn (within 4/5 weeks of birth)
Newborns with abnormal otoacoustic emission
6-9 months
3y 4 months
what hearing test is done to a newborn?
Newborn hearing screening programme
Computer clicks
Echo detection = healthy cochlea
what hearing test is done for Newborns with abnormal otoacoustic emission?
auditory brainstem response test
what hearing test is done at 6-9 months?
distraction test
what hearing test is done at 3y 4 months?
pure tone audiometry
what does an audiogram measure?
the bigger = ?
measures hearing in dB
Bigger = worse hearing
what dB is normal hearing?
what dB is deafness/HI?
normal = 20dB
deafness/HI = >20 dB
What are the 2 types of hearing loss?
Sensorineural
Conductive
What is webers test?
how to do it?
-Strike the tuning fork to make it vibrate and hum (use the palm of your hand or your knee – not the patient!)
-Place it in the centre of the patient’s forehead
-Ask the patient if they can hear the sound and which ear it is loudest in
what is rinnes test?
How to do it?
-Strike the tuning fork to make it vibrate and hum
-Place the flat end on the mastoid process (the boney lump behind the ear) – this tests bone conduction
-Ask the patient to tell you when they can no longer hear the humming noise
-When they can no longer hear the noise, remove the tuning fork (still vibrating) and hover it 1cm from the same ear
-Ask the patient if they can hear the sound now – this tests air conduction
-Repeat the process on the other side
what is sensorineural HL caused by?
problem caused by sensory system or vestibulocochlear nerve in inner ear
Sensorineural HL
Webers?
Rinnes?
Louder in normal ear, quieter in affected ear
Air>bone +ve
Contralateral HL
what is conductive HL caused by?
Problem with sound travelling into the inner ear, sensory system is fine
Conductive HL
Webers?
Rinnes?
Louder in affected ear (affected ear turns up volume, more sensitive to vibration, straight to cochlea)
-ve, abnormal - Air<bone, sound through air is quieter, bone conduction intact
Ipsilateral hearing loss
Causes of sensorineural HL?
Presbycusis
Noise exposure
Menieres disease
labyrinthitis
acoustic neuroma
infection
Medications causing sensorineural HL?
loop diuretics (furesomide)
Gentamicin
Chemo (cisplatin)
Causes of conductive HL?
ear wax
infection
fluid in middle ear
perforated tympanic membrane
cleft lip/palate
downs
otitis media
wax impaction
osteogenesis imperfecta
what are 2 other causes of Hearing loss?
Cholesteatoma (growth behind ear drum)
Otosclerosis
what are 3 congenital causes of hearing loss?
Rubella
syphillis
CMV
What are some complications of hearing loss?
developmental delay (speech and language)
social/behavioural
education
friendships
psychological
Tx of conductive HL?
self limiting
Grommets (tube to drain fluid from ear)
fluid drainage
hearing aids
Tx for sensorineural HL?
Hearing aids
cochlear implants
What is the MC paeds conductive Hearing loss cause?
otitis media with effusion (glue ear)
What is otitis media?
what ages affected?
Middle ear infection due to immature eustachian tube
6m - 5y (75% incidence)
what is the cause of otitis media?
S.pneumo MC
RSV
recurrent otitis media could be caused by which organism?
P.auerg
RF for otitis media?
Daycare
Cleft lip!
downs
absent breast feeding
low birth weight
Sx of otitis media?
Tugs/rubs ear (ear pain)
Fever
Hearing loss
Poor feed
Vertigo
Vomiting
Dx of otitis media?
what is seen?
otoscopy
Air fluid level + bulging erythematous tympanic membrane + loss of light reflection
Tx of otitis media?
Most = self resolve within 7 days
Recurrent, systemically unwell, >3 days Sx = PO amoxicillin TDS 125-250mg for 7 days
Complications of otitis media?
Mastoiditis
meningitis
CN7 palsy
abscess
what is otitis media with effusion (glue ear)?
blockage of eustachian tube, accumulation of fluid in middle ear, hearing loss
Rf of otitis media with effusion (glue ear)?
Male
daycare
parental smoking
winter
Dx of otitis media with effusion (glue ear)?
what would you see?
Dull tympanic membrane with air bubbles/visible fluid level
Tx of otitis media with effusion (glue ear)?
Audiometry (extent of HL)
May resolve in 3m
then Myringectomy (hole in TM) + Grommets (<10m last) as functional Eustachian tube +/- adenoidectomy
what would audiometry show in otitis media with effusion (glue ear)?
> 25-30 dB HL on 2+ occasions 3m apart
What is otitis externa?
Infection and inflammation of the ear canal (outer ear)
Cause of otitis externa?
S.aureus
RF for otitis externa?
swimming
daycare
itchy + thick DC
Dx of otitis externa?
what would you see?
Otoscopy
Eczematous erythematous ear canal with normal TM
Tx of otitis externa?
Topical flucoxacillin / Amoxicillin drops + steroid drops
complications of otitis externa?
Malignant otitis externa (immunocompromised, DM) - infection spreads to surrounding masto-temporal bone
what is mastoiditis?
Infected mastoid bone usually 2* to otitis media untreated (mastoid air cells)
Sx of mastoiditis?
Otalgia (ear pain)
protruding anterior displaced pinna
post auricular swelling
Dx of mastoiditis?
Clinical +/- otoscope (OM/normal), CT head (r/o IC abscess)
Tx of mastoiditis?
Admission
IV Abx - Piperacillin tazobactam (Pip tazo)
Complications of mastoiditis?
abscess
meningitis
