ENT Flashcards
Where does the pinna develop from?
The 1st and 2nd branchial arches, from the 6 hillocks
Name some methods in which to test for hearing loss?
Tuning fork test - Rinne’s + Weber’s
Audiometry - most commonly used as it quantifies hearing loss
Tympanometry - objective way of establishing cause of conductive hearing loss
Audiological brainstem responses
Otoacoustic emissions
What are the symtoms of Otitis Externa? (inflammation of outer ear)
Discharge, itch, pain, tragal tenderness
What is the main organism causing Otitis Externa?
Pseudomonas followed by Staph Aureus
How do you treat OE?
Mild = hydrocortisone cream
Moderate = swab, topical abx, steroid drops (c/i if grommets or perforated TM) - Clotrimazole
Severe = occluded EAC so requires careful cleansing
What is malignant otitis externa?
Aggressive , life-threatening infection, 90% of pts have underlying diabetes, resistant to normal treatment
Usually caused by Pseudomonas Aeuriginosa (also Proteus and Klebsiella)
Treat with surgical debridement, systemic abx and Ig’s
What is Furunculosis?
Painful staphylococcal abscess in the hair follical of the ear canal, treat with flucloxacillin.
Diabetes predisposes you to this.
What methods can be used to clean the External auditory canal?
Syringing/ irrigation
Dry mopping - Jobson Horne probe
Micro-suction - used in ENT not primary care
How do you treat TMJ dysfunction?
Splinting, physiotherapy, CBT
Which nerves result in referred pain to the ear?
V = auriculotemporal branch of trigeminal nerve
VII = sensory branch of facial nerve (ramsey hunt)
IX = tympanic branch of glossopharyngeal nerve
X = auricular branch from the vagus
C2 + 3 = great auricular nerve that supplies lower 1/2 of pinna
What defines the outer ear, middle ear and inner ear?
Outer ear = up to the tympanic membrane
Middle ear = tympanic membrane to cochlea
Inner ear = cochlea and eustachian tube
What is acute otitis media (AOM)?
Middle ear inflammation
Rapid onset pain, fever, irritability, vomiting
Often after a viral URTI
What common organisms cause otitis media?
Pneumococcus, Haemophilus
Same as what causes RTIs
How do you treat AOM?
Analgesia - usually resolves in 48h days
Consider abx if systemically unwell, no improvement after 4 days or are immuno compromised
Amoxicillin for 5 days (Erythromycin if allergic)
Rare complication of AOM is mastoiditis
What is Chronic Otitis Media (COM) ?
Ear with a tympanic perforation in the setting of a chronic infection
Symptoms include hearing loss, otorrheoa, otalgia
Treat with abx, cleaning and potentially surgery
What are the complications of COM?
Development of a cholesteatoma
What is a cholesteatoma?
Rare, not made of cholesterol and not a tumour
Foul discharge, deafness, headache, pain, vertigo
Complications are meningitis, cerebral abscess, mastoiditis, facial nerve dysfunction
Treat with mastoid surgery (mastoidectomy)
What is mastoiditis?
Middle ear infection can lead to destruction of air in mastoid bone causing abscess formation
Fever, tenderness, redness behind the pinna
Prevent by giving abx for AOM
If still occurs, admit for IV abx + myringotomy +/- mastoidectomy
What are the RFs for otitis media?
URTI (winter) Bottle feeding Passive smoking Asthma Malformations (cleft palate) Dummys GORD / raised BMI in adults
What is a myringoplasty vs tympanoplasty?
Repair of the tympanic membrane alone = Myringoplasty
Repair of tympanic + ossicles = Tympanoplasty
What is glue ear?
It is Otitis Media with Effusion (OME)
Hearing impairment due to dysfunction of eustachian tube
No known cause, higher in males, winter, RTIs, smokers, cleft palate, Down’s
What findings on history/examination of OME?
Poor listening, poor speech, poor attention, language delay
Tympanic membrane can be bulging or retracted
How do you treat OME?
Usually conservative, resolves spontaneously, give advice re reducing background noise, speak in short sentences. Repeat hearing test after 3 months
Autoinflation of eustachian tube
Surgery if no improvement over 3 months (grommets)
Hearing aids if surgery not accepted
What test would you order for OME?
Formal assessment of hearing via:
Audiogram - shows conductive hearing loss
Tympanometry - will be flat
What would you see on an audiogram of someone with genetic deafness?
Cookie bite appearance
Name some causes of genetic hearing losses
Conductive -
Congenital abnormalities of the pinna/ EEC/ drum/ osicles
Pierre-Robin
Sensorineural -
Waardenburg Syndrome, Alport syndrome
Usher’s
Turners
Name some non-genetic childhood hearing loss
TORCH infection (Toxoplasmosis, Other (PVB19, syphillus), Rubella, CMV, Herpes )
Prematurity, Hypoxia, Kernicterus
Birth trauma
What is in the universal newborn hearing screening?
Otoacoustic emissions +/- Audiological brainstem responses (if they fail OAE)
What is the next line of treatment if hearing aids are not beneficial?
Cochlear implants - however, a normal cochlear is necessary
When would you use BAHA (Bone Anchored Hearing Aid) ?
Sound is transmitted via bone conduction
Used when normal HA are intolerated
Children - as it is not felt by the child
C/I is poor hygiene and non-compliance
Name some causes of conductive hearing loss in adults
Ear wax//debris/pus
Perforated ear drum
Otosclerosis
Name some causes of sensorineural hearing loss in adults
Drugs - Strepto/Vanco/Gentamycin, Chloroquine
Post-infective - measles, mumps, herpes
Meniere’s
Acoustic Neuroma
What is otosclerosis?
A new bone forming around the stapes leading to conductive hearing loss
Autosomal Dominant - 50% have +ve FH and 80% are bilateral
What are the symptoms of otosclerosis?
Usually start in adult life, made worse by pregnancy
Tinnitus
Mild vertigo
Hearing is better with background noise (typical of conductive hearing loss)
10% have Shwartz sign - pink tinge to the ear drum
Cahart’s notch on audiogram
How do you treat otosclerosis?
Hearing aid
Surgery - stepedectomy or stepedotomy
What is presbyacusis?
Age related, bilateral high-frequency SNHL
Deafness is gradual and is only noticed when speech is affected
What is the treatment for presbyacusis?
Hearing aids
