ENT Flashcards
What is the most common cause of deafness?
Age related damage to the cochlear
What is conductive hearing loss?
Problem in the transmission of waves from external ear to middle ear
Causes of conductive hearing loss
Occlusion, infection, perforations, cholesteatoma, adenoids
What is sensorineural hearing loss?
Problems in the cochlear (most common), cochlear nerve or brain stem.
Causes of sensorineural hearing loss
Noise induced, ototoxic hearing loss, immune conditions, acoustic neuroma and Meniere’s disease
Define tinnitus
The perception of sound in the ears or head where no external source exists
What is subjective tinnitus?
Common - no acoustic stimulus exists
Causes of subjective tinnitus
Otological, neurological, infections, drug related
What is objective tinnitus?
Rare - actual noise to be heard is generated within the head
Causes of objective tinnitus
Pulsatile, muscular or anatomical
Treatment of tinnitus
No cure - reassure that condition will not progress.
Association between tinnitus and stress so relaxation techniques effective
3 symptoms of Meniere’s disease?
Unilateral vertigo + hearing loss + tinnitus
What is vertigo
Sensation of spinning in the head - symptom not a diagnosis
What are the 3 types of vertigo?
Vestibular Neuronitis - most common
Benign Paroxysmal Positional Vertigo
Meniere’s disease
What is the pathology in vestibular neuronitis
Inflammation of the middle ear
Symptoms of vestibular neuronitis
Nausea + vomiting, rapid onset rotary vertigo
Very debilitating - symptoms settle over a few weeks
Treatment of vestibular neuronitis
Prochlorperazine - vestibular sedative
Exercise encourages compensation, drugs prevent it
What is the pathology in benign paroxysmal positional vertigo
Cellular debris in the SCC’s - head movement sets them in motion which gives the spinning sensation
BPPV symptoms
Head spinning on movement - esp when looking up or turning in bed
May follow URTI, head injury or vestibular neuronitis
Treatment of BPPV
Epley manouvre
Cause of Meniere’s disease
Unknown
Time course of Meniere’s disease
Pt well between attacks but gradually lose hearing in affected ear
Treatment of Meneire’s
Cure - surgical removal of affected vestibular apparatus
Vestibular sedatives for acute attacks
Gentamicin injections to inner ear
What is the basilar membrane?
Contains the nerve endings within the cochlear to transfer sound waves into neurlogical impulse
How is the frequency of the basilar membrane arranges?
High pitch noises stimulate the base
Low pitch noises stimulate the tip
Presentation of otitis externa
Acute, itchy and painful with discharge
Painful pinna
Common causative agents of OE
Pseudomonas Aeruginosa/ Staph A
Treatment of OE
Antibiotic eardrops
Presentation of Otitis Media
Earache, cold symptoms, general malaise
Hearing loss
Treatment of OM
Analgesics + NSAIDS first
Avoid Abx till day 5 - then oral amoxicillin if symptoms still present
Presentation of perforated tympanic membrane
May follow OM infection - pain disappears as pressure released
Blood and pus coming out of ear
Hearing loss
Treatment of perforated membrane
Analgesics and Abx
Slowly heals over 2 months
Presentation of mastoiditis
Earache, fever, general malaise
Become more unwell with pain and swelling behind ear
Treatment of mastoiditis
Admit to hospital
IV abx
Myringotomy - surgical incision into eardrum to relieve pressure
Surgery if develop abscess
Complications of mastoiditis
Meningitis, abscess, venous thrombosis
What is a cholesteatoma
Benign skin growth in the middle ear behind the ear drum
Symptoms of cholesteatoma
Intermittent smelly ottorhoea and hearing loss
No pain
What is the pathology in necrotising otitis externa
Osteomyelitis of the temporal bone and skull base
Presentation of Necrotising otitis externa
Diabetes, pain that keeps awake at night, ipsilateral facial palsy
NOE treatment
Admit to hospital
Swab for culture
Oral abx for weeks
Control diabetes
What is Bells Palsy
Ipsilateral facial paralysis where not other cause can be identified
How does an UMN lesion (Stroke) differ from a LMN lesion (Bell’s Palsy)
Upper 1/4 facial sparing
UMN = Contraleteral
LMN = Ipsilateral
What is Ramsey Hunt Syndome?
Reactivation of Herpez Zoster in the geniculate ganglion
Symptoms of Ramsey Hunt Syndrome
Triad of ipsilateral facial paralysis, ear pain and vesicles of the face, ear or tongue
