ENT Flashcards
interpreting audiograms
X = left ear
O = right ear
] = left ear bone conduction
[ = right ear bone conduction
1st test normal conduction, if reduced test bone conduction (sensorineural)
further down the graph = deafer you are
0-20dB normal

what does the audiogram show

left ear conductive hearing loss
- decreased air conduction
- normal bone conduction
- therefore air not getting through inner eat - obstruction
e. g. glue ear (otitis media)
what does the audiogram show

sensorineural hearing loss
all the ] on all the X’s declining = sensorineural hearing loss
common in old people - lose high freq first = presbycusis
congenital and acquired causes of sensorineural hearing loss
congenital: born deaf
- genetic
- disease exposure as a foetus - CMV (cytomegalovirus), rubella
- congenital absence of CN/cochlear
generally flat on audigram
- cookie bite hearing loss - in congenital hearing loss -loss of mid range freq sounds e.g. conversation
acquired:
- presbycusis (old age)
- noise induced
- drugs - IV gentamycin/ chemo
- trauma - loud sounds, fractured skull base
old people + noise induced - lose higher frequencies first
causs of conductive hearing loss
obstruction to inner ear
- ear wax
- otitis externa - inflamed outer ear passage
- otitis media (glue ear)
- sclerotic TM
- perforated eardrum
- otosclerosis - ossicle joint calcification –> decreased movement –> decr sound transmission
- cholesteatoma - low middle ear pressure
how do you treat otosclerosis
operate to cure - stapedectomy (remove stapes, replace with prosthetic one)
foul smelling green discharge
headache
pain in ear
vertigo, deafness, facial palsy
diagnosis + management
cholesteatoma
management: surgery
may only see small hole in TM, behind skin sebris and pus can collect - damage ossicles - hearing loss, vertigo, tinnitus
can erode to brain (meningitis, temporal nerve abscess, pus against facial nerve - facial palsy)
what can cause a sclerotic tympanic membrane
can be 2ndry to:
chronic OM
grommets (used to treat OM - tube through TM)
only notice if decreased hearing
causes ossification of edge of footplate of stapes which stops it moving
child
deep ear pain (child may pull on ear)
mucuous from ear
hearing loss, poor speech development if chronic
TM red, bulging, may perforate.
fever if acute
diagnosis and management
otitis media
management:
OME (otitis media with effusion) - usually resolves after 3 months
conservative management - watch and wait
acute otitis media:
majority self limiting
if not settling - oral abx & ear drops
risk factors and causes of otitis media
risk factors:
- passive smoking
- downs
- cleft lip/palate
causes:
- acute: viral URTI (pneumococcus, h. influenza, viral)
- eustation tube dysfunction
adult
superficial ear pain - itchy, tragal tenderness
watery discharge
erythema of external auditory meatus
regularly swims
diagnosis and management
otitis externa
management:
- aural toilet - clean the external auditory meatus of wax, discharge, debris
- topical abx & steroid (7 days gentamicin + hydrocortisone)
causes and risk factors of otitis externa
risk factors:
- swimming
- cotton buds
- eczema
causes:
- moisture (swimming)
- trauma (finger nails)
- wax absence
- hearing aid
organisms:
staph aureus
pseudomonas
what is tinnitus + causes
sensation of sound without external sound stimulation (e.g. ringing in ears)
causes:
- meniere’s - with vertigo/ deafness
acoustic neuroma - unilateral, with vertigo/ deafness
otosclerosis - family hx
noise-induced, head injury, presbyacusis
- decreased Hb, increased BP
- drugs: aspirin, loop diuretics, ETOH, aminoglycosides (gentamicin)
investigations and management of tinnitus
investigations:
- otoscopy
- tympanogram - tests middle ear and TM function using different air pressures in ear canal
- audiometry
- if pulsatile/unilateral - MRI to excluse intracranial abnormality (arterio-venus abnormalities or neuroma)
pulsatile - listen in neck - can be transmitted from carotic artery stenosis bruit
management:
- treat cause
- counselling support:
- hearing aids
- CBT - prevent it becoming all consuming
- use of masking devices
when is disequilibrium seen in people
vague feeling of imbalance
seen in diabetic people with peripheral neuropathy - loss of proprioception and complain of disequilibrium
what is Brandt Daroff exercise
for BPPV
fling yourself from side to side on bed x15
will flood nerve with so much movement it can cause desensitisation
must do it for weeks to keep desensitisation
turned over in bed
sudden vertigo for <30s
nausea + vomiting
audiometry normal
diagnosis and managment
BPPV
displaced Ca crystals in semicircular canals –> false movement
- sudden rotational vertigo <30s provoked by head turning, nystagum
diagnostic test: Dix-Hallpike (sitting -> lying, head off bed. turn face to side- illicit vertigo (can see nystagmus)) (do on both sides of head)
treatment: Epley manouver (park loose crystals where it wont cause issues)
causes of BPPV
recent URTI
recent head injury - dislodge of crystals
central causes of vertigo
acoustic neuroma
MS
head injury
inner ear syphilis
drugs: gentamicin, loop diuretics, metronidazole, co-trimoxazole
tinnitus
vertigo - unprovoked, recurrent, disabling (+- nause, vomiting)- lasts for hrs
fluctuating hearing loss (lower frequencies) (full sensation in ear)
audiometry fluctuant
diagnosis + management
Meniere’s diease
triad of: tinnitus, vertigo (lasts hrs), hearing loss
audiometry (PTA) fluctuant
fullness sensation in ear
two or more episodes
management:
- beta-hystine to sedate labrynith
following febrile illness
vertigo lasting for days/weeks
PTA normal
diagnosis and management
Labyrinthitis (vestibular neuritis)
- inner ear inflammation
causes:
- febrile illness
- head injury
- stress
- allergies or reaction
management:
- symptomatic relief (nausea, vomiting)
if persists - physio for vestibular rehab exercises
management for auricular haematomas
same day ENT assessment (prevent formation of cauliflower ear)
- incision and drainage
cough, tooth pain, purulent nasal discharge 2 wks
pressure in head increased
facial pain worse on bending forward
diagnosis + management
uncomplicated acute sinusitis
intranasal corticosteroids and discharge if symptoms >10 days



















