ENT: Ears Flashcards
Red flags for ENT ear presentations
Hearing loss Otalgia Discharge Tinnitus Vertigo
- Occupation = loud noise exposure?
512hz fork placed on mastoid bone
Positive: Air conduction > Bone conduction
Negative: Bone conduction > Air conduction
Rinne’s tests
Positive: Normal/sensorineural hearing loss
Negative: Conduction hearing loss
512hz fork placed on forehead
Weber’s test
no localisation: Normal /equal bilateral loss
localises to affected: conduction hearing loss
localises to non-affected: sensorineural hearing loss
Hearing tests in newborn
Otoacoustic emission test at birth
-If abnormal: Auditory brainstem test as newborn
6-9 months: distraction test
18 months -2.5 years: Recognition of familial objects
Hearing damage happens at
3000-6000hz
On audiogram, normal level is
> 20dB
Causes of sensorineural hearing loss
Congenital hearing loss Rubella CMV Drugs: - Platinum chemo drugs (cisplatin) - Aspirin toxicity - Gentamicin - Furosemide (reversible) - Quinines (reversible)
Haematuria
Progressive renal failure
Sensorineural hearing loss
Alport syndrome
Conductive hearing loss due to bone growth in external ear due to repeated exposure to cold
Exostasis
“Swimmer’s/ Surfer’s ear”
Fixation of stapes footplate Conductive hearing loss Tinnitus "Flamingo tinge" to tympanic membrane Dip at 2-4hz on audiogram (Cahart's notch)
Otosclerosis
Age 20-40 years old
Autosomal dominant
Worse in pregnancy
Sensorineural hearing loss
Bilateral
Worse at high frequency
Speech is difficult to understand
Presbycusis
Male>Female
Found in 30% of >65s
Found in 50% of >75s
Management of otosclerosis
Hearing aid
Stapedectomy
Causes of tinnitus
Meniere's disease Otosclerosis SSNHL Hearing loss Drugs - NSAIDs - Aminoglycosides - Loop diuretics - Quinine Ear wax
Causes of sudden onset sensorineural hearing loss (SSNHL)
Acoustic neuroma (80%) Idiopathic
Management of sudden onset sensorineural hearing loss (SSNHL)
Urgent referral
Prednisolone
Management of perforated tympanic membrane
Self resolves in 6-8 weeks
Keep dry + review in 4 weeks
Myringoplasty
Excessive endolymph
Meniere’s disease
Sensorineural hearing loss (low frequency) Vertigo Tinnitus Sensation of aural fullness Nystagmus Epiisoles last mins-hours
Meniere’s disease
Positive romberg test
Acute management of Meniere’s disease
Buccal/IM Prochlorperazine
Prophylactic management of Meniere’s disease
Betahistamine
Vestibula rehab
Sudden onset vertigo
Triggered by changes in head position
Episodes last 20 seconds
Benign paroxysmal positional vertigo (BPPV)
Dix-hallpike test = positive
BPPV
Management of BPPV
Epley manœuvre
Brandt-Daroff exercises (vestibular rehab)
Recurrence is common 3-5 years later
Prevention: Betahistamine
Dizziness on neck extension in elderly
Vertebrobasilar ischaemia
Recent viral infection Recurrent vertigo (worse on wakening) No hearing loss No tinnitus Lasts hours-days Nausea + vomiting Horizontal nystagmus
Vestibular neuronitis
- affects on vestibular nerve (not cochlear)
Management of Vestibular neuronitis
Acute: Buccal/IM Prochlorperazine
Vestibular rehab exercises Antihistamines: - cinnarizine - cyclizine - promethazine
Recent viral infection Sudden onset vertigo Hearing loss Horizontal nystagmus Gait disturbance Nausea + vomiting
Labyrinthitis
- affects both vestibular and cochlear nerves
- common in 40-70 years old
Management of Labyrinthitis
Self limiting
Prochlorperazine
Antihistamines
Management for auricular haematoma “Cauliflowe ear”
Same day assessment
Incision + drainage
Otalgia Pain behind ear Fever External ear protruding anteriorly Swelling + erythema over mastoid Hx of recurrent otitis media
Mastoiditis
- caused by otitis media spreading outwards
- can lead to meningitis
Management of mastoiditis
Admit
Amoxicillin
2 years old
Conduction hearing loss (> 3 months)
Speech + language delay
Behaviour + balance problems
Flat tympanogram
Otitis media with effusion (glue ear)
Management of Otitis media with effusion (glue ear)
Grommets
Foul smelling ear discharge
Pre-auricular sinus
< 3 years old
Acute onset otalgia
"Ear tugging"
Presence of middle ear effusion
- bulging membrane
- otorrhea
- decreased mobility on otoscopy
Erythema of membraneAcute otitis media
Causes of Acute otitis media
Viral URTI disturbs normal nasopharyngeal microbiome, allowing bacteria to infect middle ear via eustachian tube
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Management of Acute otitis media
Self-limiting
Analgesia
Severe: Amoxicillin (Erythromycin in PA)
Recurrent: Grommets
Acute otitis media can lead to
Chronic Suppurative Otitis media (CSOM)
Perforation of tympanic membrane
Otorrhoea > 6 weeks
Cholesteatoma
Chronic Suppurative Otitis media (CSOM)
Growth of squamous epithelium that is trapped within skull causing local destruction
Cholesteatoma
Ages: 10-20 years Increased risk ( x 100) if cleft palate
Foul smelling, non-resolving discharge Hearing loss Vertigo Facial palsy Cerebellopontine angle syndrome
Cholesteatoma
can lead to meningitis
facial nerve infection
Investigation findings for Cholesteatoma
Crust seen in the upper eardrum (attic)
Management of Cholesteatoma
Surgical removal
Otalgia
Discharge
Erythema
Eczematous canal
Otitis externa
- common in diabetes + elderly
Causes of Otitis externa
Staph aureus Pseudomonas aeruginosa Fungal Seborrheic dermatitis Contact dermatitis
Management of otitis externa
- Topical Gentamicin + hydrocortisone (drops)
- Flucloxacillin (Erythromycin if PA)
Fungal: Cotrimazole drops
Diabetes: Ciprofloxacin (to cover pseudomonas)
Non-resolving otitis externa
- Severe otalgia
- Purulent otorrhea
Temporal headaches
Malignant otitis externa
- infection has spread to bone
- found in immunocompromised patients + diabetics
Causes of Malignant otitis externa
Pseudomonas aeruginosa
Investigations for Malignant otitis externa
CT
Management for Malignant otitis externa
Ciprofloxacin
