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Yr3: GP > ENT > Flashcards

ENT Flashcards

1
Q

Go and revise Sem 3: Head & Neck- Anatomy of the Ear

A
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2
Q

Remind yourself of where the following are on the pinna of the ear:

  • Helix
  • Antihelix
  • Tragus
  • Antitragus
  • Lobule
  • External auditory meatus
  • Concha
A
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3
Q

Label the following diagram of ear, include:

  • Ear canal
  • Tympanic membrane
  • Each of the ossicles
  • Auditory (Eustachain) tube
  • Round window
  • Oval window
  • Cochlea
  • Semi-circular canals
  • Vestibulocochlear nerve
A
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4
Q

Label the following diagram of the tympanic membrane, include:

  • Cone of light
  • Handle of malleus
  • Umbo (tip of malleus)
  • Pars tensa
  • Pars flaccida
  • Incus
  • Annulus
  • Short process of malleus
  • Anterior fold
  • Posterior fold
A
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5
Q

Remind yourself of the difference between conductive and sensorineural hearing loss

A
  • conductive: cause related to outer or middle ear
  • sensorineural: causes related to inner ear
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6
Q

What frequency tuning fork should you use for Weber’s & Rinne’s?

A

512Hz tuning fork

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7
Q

Remind yourself of how to do Weber’s and Rinne’s test

Remind yourself of what the results of each mean

A
  • Webers: pinch tuning fork and place on patients forehead or in midline. Ask pt if same loudness both sides or one side louder than other
    • Louder on right: conductive on R or sensorineural on L
    • Louder on left: conductive on L or sensorineural on R
  • Rinne’s: pinch tuning fork and place against mastoid. Pinch tuning fork again and hold ~1cm away from ear. Ask pt which is louder.
    • Louder on mastoid: suggests conductive hearing loss
    • Louder by the ear: either normal or must be sensorineural (if had abnormal Weber’s)
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8
Q

State some of the common hearing tests for adults and briefly describe what is involved in each

A

Pure tone audiometry= most common

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9
Q

Briefly describe how pure tone audiometry is done

A
  • Sound proof room
  • Before test, examine ears for infection, foreign body or occluding wax
  • Patient wears headphones to test air conduction, followed by a bone vibrator places on mastoid process to test bone conduction.
  • Audiometer machine makes pure tone sounds at varying frequencies
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10
Q

What is the pure tone threshold?

A

Lowest decibel hearing level (i.e. quietest sound) at which the patient detects the pure tone at least 50% of the time

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11
Q

How is air conduction measured in audiometry?

A

Wear headphones and audiometer produces sounds of varying frequnecies at different decibels

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12
Q

How is bone conduction measured in audiometry?

A

Vibrator placed on mastoid process

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13
Q

What is masking?

A

Masking is when you present a sound to the non-test ear (masking noise) to prevent it from detecting the sound being presented to the test ear.

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14
Q

Remind yourself of the function of the Eustachain tube

A

Eustachain tube closed but opens very regularlyy e.g. when swallow and chew. When opens, opportunity for any mucus in middle ear to drain and also allows equilibrium of ear.

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15
Q

State some key questions to ask when taking an ear pain history

A
  • When did it start
  • Which ear
  • Painful? Or discomfort?
  • Any discharge? If so what colour? How much? Does it smell?
  • What does ear look like?
  • Fullness?
  • Tender when move ear/press tragus down?
  • Tender when press on mastoid?
  • Any tinnitus
  • Impaired hearing
  • Any balance issues
  • Any sore throat, nose issues ongoing or in past few weeks?
  • Anything make it better
  • Anything made it worse
  • Any ear problems in past?
  • Any history of eczema or psoriasis?
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16
Q

Explain why Eustachain tube blokage is more common in childdren (4)

A

Certain conditions can cause Eustachain tube to block completeley; common in children as they have smaller diameter of their E.T, their tube is also shorter and more horizontal, large adenoids which obstruct, increased frequency of colds. Prevents drainage of mucus and equilibrium of

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17
Q

Describe how the position of the malleus, in regards to how it appears on tympanic membrane, appears as the tympanic membrane becomes more convex

A

Malleus is more horizontal when tympanic membrane is more convex

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18
Q

Remind yourself of how to hold both the otosope and ear when viewing tympanic membrane during otoscopy

A
  • If examining right ear hold otoscope in right hand and vice versa…
  • Examine ‘better ear’ first
  • Pull pinna upwards & backwards (in adults)
  • Hold otoscope like a pencil and rest hand against patients cheek for stability
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19
Q

Remind yourself how to tell difference between left and right tympanic membrane

A
  • Malleus points posterior
  • Cone of light anterior
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20
Q

State some potential ear condtions in the:

  • External ear
  • Middle ear
  • Inner ear
A

External Ear

  • Wax causing obstruction
  • Foreign body
  • Otitis externa
  • Malignant otitis externa

Middle Ear

  • Acute otitis media (subtypes: without perforation, with perforation)
  • Chronic supparative otitis media
  • Mastoiditis
  • Cholesteatoma
  • Otits media with effusion
  • Typanosclerosis

Inner Ear

  • Acute labrynthitis
  • Meniere’s disease
  • BPPV (benign paroxysmal positional vertigo)
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21
Q

Explain what is meant by dry perforation and wet perforation

A
  • Dry= no discharge
  • Wet= discharge
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22
Q

State the types of ear perforation

A

***Main idea is to know:

  • Central (pars tensa region)
  • Peripheral (periphery of pars tensa)
  • Attic (pars flaccida region)
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23
Q

For otitis externa, state:

  • What it is
  • Common causes
  • Peak incidence (age)
  • Risk factors
A
  • Inflammation of external ear canal
  • Can be infective or non infective (due to allergy or irritation); most commonly infective and most common causative organism is Pseudomonas Aeruginosa (40%). Others include: S.Epidermis, S.Aureus & anaearobes
  • 7-12 years
  • Risk factors:
    • Ear trauma
    • Excess moisture e.g. swimming
    • Psoriasis or eczema
    • Humid environments
    • Immunocompromised (& have increased irsk complications)
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24
Q

State signs & symptoms of otitis externa

A

Common Signs & Symptoms

  • Itching
  • Discomfort or otalgia (often otalgia disproportionate to otoscopic findings)
  • Tenderness on moving jaw
  • Ottorrhoea
  • Aural fullness
  • Decreased hearing
  • Swollen, erythematous ear canal
  • Dry hypertrophic skin
  • Otalgia worsened by tragus or pinna movement/insertion of otoscope
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25
Q

Describe the appearance of otitis externa on otoscopy

A

Ear canal appears erythematous and swollen- may be so much so that you cannot see tympanic membrane and may also see discharge

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26
Q

Discuss what investigations may be considered for otitis externa

A
  • Mainly a clinical diagnosis
  • If persists/doesn’t respond to treatment consider a swab of external ear canal for MC&S
  • Consider diabetes screening if suspect immunosupression
  • Urgent CT head required if necrotising/malignant otitis externa suspected to assess extent of infection
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27
Q

Discuss the management of otitis externa

A
  • Aural toileting
  • Analgesia
  • Topical antbiotics +/- steroid (7-14 days) e.g. ciprofloxacin & dexamethasone
  • Manage aggravating & precipitating factors e.g. keep ear dry, avoid cotton buds
  • Can give oral antibiotics (alongside topical) if refractory to initial treatment or immunocompromised e.g. ciprofloxacin
  • Insertion of ear wick to keep ear canal open and help topical preparations take effect
  • ENT referral
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28
Q

What gradiing system can be used to classify severity of otitis externa?

A
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29
Q

When would you consider immediate ENT referral in someone with otitis externa

A
  • Considerable swelling & discharge
  • Sufficient ear wax or debris to obsruct application of topical medication
  • Extreme pain or discomfort
  • Signs of malignant otitis externa
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30
Q

State two potential complications of otitis externa

A
  • Peri-auricular cellulitis
  • Malignant/necrotising otitis externa
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31
Q

For malignant otitis externa, describe:

  • What it is
  • Populations at increased risk
  • Symptoms
  • Management
A
  • Otitis externa infection has spread to temporal bone and caused osteomyelitis
  • Common in immunocompromised, particularly diabetics
  • Symptoms:
    • Severe pain
    • Headaches
    • Yellow or green foul smelling ottorhea
    • Fever
    • Itchign in ear canal
    • Swollen, erythematous skin aroud ear
    • Pain when press mastoid
    • Otalgia with radiation to TMJ
    • Facial palsy
  • Management:
    • Urgent Ct scan
    • Urgent debridement
    • IV antibiotics (abx against pseudomonas e.g. ciprofloxacin and anaerobes e.g. metronidazole)
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32
Q

For noise related hearing loss, discuss:

  • What it is
  • Risk factors
  • Diagnoses to exclude
  • Symptoms/how it presents
  • Investigations
  • Management
A
  • Hearing loss due to damage to stereocilia due to excessive noise; can be a single loud event or damage over a period of time (generally sounds >85dB)
  • Risk factors:
    • Occupational e.g. construction worker
    • Recreational e.g. loud music
    • Accidental e.g. blast injury, gunfire
    • Not wearing appropriate ear defenders
  • Diagnoses to exclude/other reasons for hearing loss:
    • Impacted wax
    • Acute ear infection
    • Otitis media with effusion
  • Symptoms/presentation:
    • Bilateral hearing loss
    • No features suggestive of infection, impaction, effusion etc…
    • Muffled speech
    • Sensorineural hearing loss
    • Often accompanied by high pitched tinnitus
    • Hyperacusis
    • Risk factors present
  • Investigations:
    • Otoscopy: rule out other causes
    • Weber’s & Rinne’s
    • Audiometry
  • Management:
    • Irreversible therefore about trying to improve hearing and preventing further damage:
      • Hearing aids
      • Nosie protection e.g. foam ear plugs
      • Education about how to protect ears
      • Early detection
33
Q

What would you see on the audiogram of someone with noise-induced hearing loss?

A

Boiler’s notch

34
Q

For Meniere’s disease remind yourself:

  • Pathophysiology
  • Risk factors
  • Symptoms
A
  • Too much endolymph in inner ear which causes an increase in pressure and results in hearing loss/dullness. As pressure eases, hearing comes back; however, if increased pressure has damaged the ear hearing won’t come back. Consequenlty hearing may deteriorate over time and then may get acute worsening of hearing during episodes. May also get persistent tinnitus as disease progresses.
  • Risk factors:
    • Autoimmunity
    • FH
    • Head trauma
    • Viral infection
    • Association with migraines (vascular factors)
  • Symptoms, may last from 30 mins up to 24 hours, triad of:
    • Vertigo
    • Tinnitus
    • Hearing loss (sensorineural)
    • …. with associated aural fullness
35
Q

For Meniere’s disease, discuss:

  • Investigations
  • Mangement
A
  • Investigations (refer to ENT for investigations):
    • Pure tone audiometry (with air & bone conduction & masking)
    • Others may be done to exclude other issues e.g. CT or MRI to rule out issues with brain, MS etc..
  • Managment:
    • Limiting caffeine, alcohol, stress and smoking cessation as these can trigger an attack
    • Low salt diet & diuretics to decrease endolymphatic pressure
    • Antihistamines (help with vertigo)
    • Tinnitus masksers (help with tinnitus)
    • Vestibular & balance rehabilitation therapy
    • Hearing aids
    • Intratympanic therpay e.g. steroids, gentamycin
    • Meniett device
36
Q

State the proper term for age related hearing loss

A

Presbyacusis

37
Q

For presbyacusis, discuss:

  • Pathophysiology
  • Risk factors
A
  • Pathophysiology thought to be multifactorial e.g. neuronal loss, damage to sterocilia, metabolic & systemic disease e.g. diabetes
  • Risk factors:
    • Age
    • Ototoxic medications e.g. aminoglycosides, loop diuretics etc…
    • Hypertension
    • Diabetes
    • Smoking
    • Family history
38
Q

Discuss the typical presentation of someone with presbyacusis

A
  • Bilateral, gradual hearing loss (however, be aware that someone might think it has come on quite suddenly if their hearing has just crossed threshold of what is impacting their life)
  • Sensorineural
  • Struggle to conversate with people with background noise
  • High pitch sounds are muffled
  • Struggle to understand what words people are saying- can hear them talking but can’t distinguish between certain words
  • Some sounds appear overly loud “annoying sounds”
39
Q

What investigations would you do if you suspect presbyacusis?

A
  • Otoscopy: rule out other causes
  • Gross hearing assessment (whisper word in ear)
  • Weber’s & Rinnes
  • Pure tone audiometry
40
Q

Discuss the management of presbyacusis

A
  • Hearing aids
  • Learning to lip read
  • Use of assistive listening devices e.g. flashing light alarms, loud doorbell, phone with loud ring tone, subtitles on TV etc…
  • Cochlear implants considered in severe cases where pt is young and hearing aids have not been beneficial
  • Reassurance that they will not go completely deaf
41
Q
A
42
Q

For acute otitis media, remind yourself:

  • What it is
  • Common causes
  • Who it commonly affects
  • Symptoms
A
  • Presence of inflammation in the middle ear, associated with an effusion, and accompanied by the rapid onset of symptoms and signs of an ear infection (infection of middle ear)
  • Common causes:
    • Most commonly viral
    • Can be bacterial e.g. S.Pneumoniae, H.Influenza
  • More common in infants & children <4yrs
  • Symptoms:
    • Otalgia
    • Fever
    • Malaise
    • Rhinorrhoea
    • Child may rub or hold ear, cry, poor feeding
    • Decreased hearing
    • Often history of URT
43
Q

What might you find on otoscopy of someone with acute otitis media

A
  • Bulging tympanic membrane with classic “doughnut” or “bagel” appearance
  • Erythematous tympanic membrane
  • May aslo see prurulent discharge in external ear canal
44
Q

Discuss the management of acute otitis media

A
  • First line= analgesia e.g. paracetamol, ibruprofen
  • Second line= delayed antibiotic therapy (wait 2-3 days for any improvement)
    • ​Amoxicillin 5-7 days
    • Clarithromycin or erythromycin if penicillin allergic
45
Q

Which patients, with acute otits media, would you consider immediate admission to hospital for specialist attention?

A
  • People with a severe systemic infection.
  • People with suspected complications of AOM, such as meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis.
  • Children younger than 3 months of age with a temperature of 38°C or more.
46
Q

State some potential complications of acute otits media

A
  • Tympanic membrane perforation (and hence chronic suppartive otitis media)
  • Labyrinthitis
  • Rarely:
    • Mastoiditis
    • Meningitis
    • Sinus thrombosis
    • Intracranial abcess
    • Facial nerve paralysis
47
Q

What is chronic suppartive otits media?

A

Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent otorrhoea through a tympanic perforation.

World Health Organization definition states that AOM is considered to be CSOM after at least 2 weeks of discharge, whereas some experts suggest that more than 6 weeks of discharge is the cut-off point.

48
Q

Discuss the typical presentation of chronic supparitive otitis media (CSOM)

A

Symptoms

  • Otorrhoea >2 weeks without pain or fever
  • Hearing loss
  • History of acute otitis media, trauma, grommet insertion, otitis media with effusion

Examination & Otoscopy

  • Painless ear examination (unlike in AOM)
  • Perforated tympanic membrane
49
Q

How should you approach a case of suspected chronic suppartive otitis media?

A

Assessment should include:

  • Checking for anything that requires admission:
    • postauricular swelling & tenderness
    • facial paralysis
    • vertigo
    • signs or symptoms of intracranial infection
  • Asking about hearing loss and effect on everyday activities (and speech development in child)
  • Excluding alternative causes for persistent ear discharge e.g. otitis externa, a foreign body impacted ear wax, and neoplasm (ear canal swelling that bleeds on contact).
50
Q

Discuss the management of chronic supparative otitis media in primary care

A

If CSOM is suspected, referral to an ear, nose, and throat specialist (for diagnosis, treatment, and follow-up) should be made:

  • Ears should not be swabbed
  • Treatment should not be initiated
  • Reassurance should be given that any hearing loss will usually return when the perforation heals, but that a hearing test may be carried out in secondary care
51
Q

State potential symptoms of tympanic membrane perforations; include the distinguishing features between wet and dry perforations

A
  • Hearing loss
  • Tinnitus
  • Ottorhea (WET ONLY)
  • Sudden sharp otalgia or sudden decrease in otalgia
  • Facial palsy
  • Vertigo
52
Q

State some potential causes of tympanic membrane perforations

A
  • Acute otitis media
  • Barotrauma (imbalance of middle ear pressure and atmospheric pressure e.g. following scuba diving)
  • Foreign objects
  • Severe head trauma
  • Acoustic trauma e.g. explosion or gunshot
53
Q

What investigations are required for a suspected tympanic membrane perforation?

A

No specific investigations required.

  • Otoscopy: should be able to see perforation. Micro-otoscopy may be required but this would require referral
54
Q

Discuss the managment of a perforated tympanic membranes

A
  • Keep ear dry (sue cotton wool smeared with vaseline in bath/shower)
  • Usually repair by themselves in a 6-8 weeks, but sometimes may need patch or surgical repair to heal. If peforation not healing, refer to ENT
  • If infected, may require antibiotic ear drops (only use ones that are safe for perforations e.g.
  • Increased risk of developing acute otitis media, if this does develop treat as normal
55
Q

For mastoiditis, discuss:

  • What it is
  • Risk factors
  • Cause
  • Symptoms & signs
A
  • Mastoiditis= infection of mastoid air cells in the mastoid bone (osteomyelitis of mastoid bone)
  • Risk factors:
    • Immunosupression
    • Acute otitis media
  • Caused by spread of middle ear infection into mastoid air cells (spread through mastoid aditus into mastoid antrum)
  • Symptoms & signs:
    • Erythema behind ear
    • Tenderness on pressing mastoid bone
    • Swelling behind ear
    • Other signs of acute otitis media e.g. hearing loss, otalgia, ottorhea
    • Fever
    • Headache
56
Q

Discuss what investigations are required for mastoiditis

Discuss the management of mastoiditis

A

*emergency admission for all of the following

Investigations

  • Blood test: FBC, ESR, CRP, blood culture
  • Swab of discharge for MC&S
  • CT head to check extent

Management

  • IV antibiotics e.g. IV ceftriaxone & IV metronidazole
  • Can also consider adidng topical antibiotics aswell (avoid topical aminoglycosides in perforation)
  • Analgesia
  • Surgery to drain middle ear and/or remove part of mastoid bone
57
Q

For cholesteatoma, discuss:

  • What it is/pathophysiology
  • Is it common?
  • Risk factors
A
  • Abnormal sac of keratinizing squamous epithelium and accumulation of keratin within the middle ear or mastoid air cell spaces which can become infected and also erode neighbouring structures
  • Pathophysiology: mostly due to Eustachain tube dysfunction this creates -ve pressures in the middle ear cavity and retracts pars flacida which forms the retraction pocket. Risk factors e.g. ototlogial surgery can promote depostion of keratin & epithelial cells in retraction pocket.
  • Not common
  • Risk factors:
    • Middle ear disease e.g. otitis media
    • Chronic Eustachain tube dysfunction
    • Otological surgery
    • Trauma
    • Congential abnormalities associated with Eustachain tube dysfunction e.g. Down syndrome, cleft palate
58
Q

Discuss signs & symptoms of cholesteatoma- include what you find on otoscopy

A

Symptoms

  • Persistent, foul smelling otorrhoea
  • Hearing loss
  • Tinnitus
  • Less commonly: vertigo, otalgia, CNVII involvement e.g. facial palsy, altered taste

Signs/otoscopic findings

  • Discharge
  • Deep retraction pocket in tympanic membrane- with or without skin debris & granulation tissue
  • Crust or keratin in upper part of tympanic membrane
  • Tympanic perforation

*NOTE: congential cholesteatomas may present as white mass behind tympanic membrane

59
Q

Discuss what investigations are required for suspected cholesteatomas (are these done in primary care?)

A

In primary care setting it is a clinical diagnosis however secondary care investigations include:

  • Pure tone audiogram: assess hearing
  • CT scan of petrous temporal bone:asess for mastoid pathology complications e.g. cochlear, semicircular canal or intracranial pathology
60
Q

Discuss the management of cholesteatomas

A
  • Referral to ENT:
    • Semi-urgent referral if suspected cholesteatoma but no serious complications
    • Emergency admission if have vertigo, facial nerve involvement or other neurological symptoms that could be due to intracranial pathology e.g. abscess, meningitis etc…
  • Pre-surgery topical antibiotics e.g. ciprofloxacin/dexamethasone (quinolones are effective)
  • Pre-surgery ear care: e.g. aural cleaning, ear wick if necesary
  • Surgery to remove (followed by second look surgery to check all gone)
61
Q

State some potential complications of cholesteatomas

A
  • Extensive disease casuing facial palsy, veritgo, meningitis, intracranial abscess
  • Conductive hearing loss
  • Labrinthyine fistula
62
Q

State some causes of referred pain to the ear, and for each explain why

A

Remember, ear is innervated by 6 nerves: two branches from cervical plexus derived from nerve roots C2 and C3, and four cranial nerves: trigeminal (CNV), facial (CNVII), glossopharyngeal (CNIX) and vagus (CNX). Hence, stimulation of any branch of these nerves by any of the structures sending sensory information via these nerves can cause ear pain. Examples include:

  • TMJ syndrome
  • Sore throat
  • Malignancy
  • Sinusitis
  • Tonsilitis
  • Laryngitis
  • GORD
63
Q

What investigations would you do if you suspet referred ear pain

A

Investigations are centred around ruling out otalgia caused by ear issues and finding alternative cause; investigations may include:

  • Otoscopy
  • Throat/oropharynx examination
  • Head and neck examination
  • Cranial nerve examination
  • Flexible endoscopy (if indicated)
64
Q

For otitis media with effusion (“glue ear”) remind yourself:

  • What it is/pathophysiology
  • Who it is common in
  • Risk factors
A
  • Collection of fluid within the middle ear space without signs of acute inflammation due to negative pressure in middle ear causing collection of fluid (remember: mucous membranes of middle ear continuously reabsorb air causing negative pressure to develop. Usually, Eustachain tube allows equilibration of pressure)
  • Common in children (2-5yrs)- presents commonly in winter months
  • Risk factors:
    • Acute otitis media (50% OME develop after AOM)
    • Congenital abnormalities associated with Eustachain tube dysfunction e.g. Down’s syndrome, cleft palate etc…
    • Household smoking
    • Frequent URT infections
65
Q

State signs & symptoms of otitis media with effusion- include appearnce of tympanic membrane on otoscopy

A

Symptoms

  • Hearing loss: commonly presents as child having difficulty communicating, asking for things to be repeated, needing TV loud
  • Mild intermittent otalgia
  • Aural fullness with popping
  • Recurrent ear infections, URT infections or nasal obstruction

Signs

  • Tympanic membrane looks abnormal colour e.g. yellow, amber or blue (as effusion can be purulent, mucoid or serous)
  • No signs of inflammation
  • Retracted ear drum (rarely causes bulging- hence learn that is is retracted in OME and bulgin in AOM)

*Ensure to examine nose & throat to assess for factors that may predispose ot OME

66
Q

What investigations would you do for suspected otitis media with effusion?

A
  • Tympanometry (put device in external auditory canal- forming an ear tight seal- uses pressure to try and move the tympanic membrane. If not movement then it must be being ‘braced’ by fluid in middle ear hence flat line supports diagnosis)
  • Audiometry (visual if under 2.5yrs, conventional for >4yrs)
67
Q

Discuss the management of otitis media with effusion

A
  • Active observe for 6-12 weeks as most spontaenously recover (be sure to re-evaluate during this time to check for any complications. Ideally have two hearing tests)
  • If persists after active observation, refer to ENT (NOTE: refer children with Down’s syndrome or cleft palate straight away to ENT)
  • Grommet (tympanostomy tubes) insertion to equilibrate pressures
68
Q

What is on the axis of an audiogram?

A

X axis= frequecy

Y axis= decibels

69
Q

Interpret the following audiometry results:

  • = 20dB
  • 21-40dB
  • 41-70dB
  • 71-90dB
  • >90dB
A

Degree of hearing loss is expressed by the difference between a person’s threshold and the average threshold for people with normal sensitivity (therefore smaller number=better hearing)

  • = 20dB: normal
  • 21-40dB: mild hearing loss
  • 41-70dB: moderate hearing loss
  • 71-90dB: severe hearing loss
  • >90dB: profound hearing loss
70
Q

What do the following signs/key mean on audiogram:

A
71
Q

What is the normal hearing rangee, include:

  • Frequency
  • Decibels
A
  • Frequency: 20 to 20000Hz
  • Decibles: 0 to 180dB
72
Q

What type of hearing loss does this audiogram suggest?

A

Presbyacusis

73
Q

What type of hearing loss is represented by each of the lines on the audiogram?

A
74
Q

Remind youself, for acute labrinthytis:

  • What it is
  • Causes
  • Symptoms & signs
  • Management
A
  • Inflammation of inner ear due to infection
  • Normally viral cause
  • Symptoms (often resolve in few days):
    • Tinnitus
    • Vertigo
    • Hearing loss
    • Nausea & vomitting
    • Otalgia
    • Nystagmus
    • Positive head impulse test
    • Normal otoscopic findings
  • Management:
    • Antiemetic e.g. prochlorperazine
    • Anithistaminies e.g. cyclizine
    • Analgesia
    • Reassurance
    • Regard on safety e.g. driving, working if vertigo
75
Q

Discuss the difference between acute labyrinthitis and vestibular neuronitis

A
  • Acute labyrinthitis is inflammation of inner ear due to infection- usually viral cause. Has both ear and balance related symptoms.
  • Vestibular neuronitis is inflammation of the cochlear component of the vestibular component of the vestibulocochlear nerve (CNVIII) usually following viral infection. ONLY HAS BALANCE related symptoms e.g. vertigo, nausea/vomitting, unsteadiness
76
Q

Discuss the typical presentation of vestibular neuronitis

Discuss the management of vestibular neuronitis

A
  • Spontaneous onset of vertigo, nausea, vomiting, and unsteadiness. Hearing loss and tinnitus are not present, and there are no focal neurological symptoms.
  • Management similar to acute labyrinthitis:
    • Reassurance
    • Advise on alcohol, tiredness in relation to increased impact on balance
    • Advise on safety e.g. driving
    • Anti-emetic e.g. prochlorperazine
    • Antihistamine e.g. cyclizine
    • Consider referral to secondary care if dehydration risk, symptoms persist after 6 weeks or other neurological signs
77
Q

For congenital deafness, discuss:

  • What it means
  • Potential causes
  • Symptoms
A
  • Hearing loss present from birth/at time of birth
  • Potential causes:
    • Syndromic: e.g. Down’s syndrome, Alport syndrome, Treacher Collins syndrome
    • Non-syndromic e.g. infection (rubella, syphillis), teratogenic drugs (thalidomide)
  • Symptoms:
    • No startled by loud sounds
    • Not trying to make babbling noises by 4 months
    • Not turning towards sounds by 6 months
    • Not saying simple words by 1 year
78
Q

Dicuss what investigations may be done for congenital deafness

A
  • Newborn hearing screening (automated otoacoustic emission test): a miniature earphone and microphone are placed in the ear, sounds are played and a response is measured. If a baby hears normally, an echo is reflected back into the ear canal and this is picked up by the microphone
  • when a baby has a hearing loss, no echo can be measured on the OAE test*
  • Auditory brainstem response (sound waves played to baby and electrodes placed on head to detect brain’s response to sounds)
79
Q

Discuss the management of congential deafness

A
  • Hearing aids
  • Cochlear implants
  • Learning special skills such as BSL
  • Speech therapy
  • Surgery
  • Support groups

Yr3: GP (21 decks)

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