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The One Deck To Rule Them All > ENT: Ears > Flashcards

ENT: Ears Flashcards

1
Q

Red flags for ENT ear presentations

A 
Hearing loss
Otalgia
Discharge
Tinnitus
Vertigo
  • Occupation = loud noise exposure?
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2
Q

512hz fork placed on mastoid bone

Positive: Air conduction > Bone conduction
Negative: Bone conduction > Air conduction

A

Rinne’s tests

Positive: Normal/sensorineural hearing loss
Negative: Conduction hearing loss

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3
Q

512hz fork placed on forehead

A

Weber’s test

no localisation: Normal /equal bilateral loss
localises to affected: conduction hearing loss
localises to non-affected: sensorineural hearing loss

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4
Q

Hearing tests in newborn

A

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

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5
Q

Hearing damage happens at

A

3000-6000hz

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6
Q

On audiogram, normal level is

A

> 20dB

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7
Q

Causes of sensorineural hearing loss

A 
Congenital hearing loss
Rubella
CMV
Drugs: 
  - Platinum chemo drugs (cisplatin)
  - Aspirin toxicity
  - Gentamicin 
  - Furosemide (reversible)
  - Quinines (reversible)
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8
Q

Haematuria
Progressive renal failure
Sensorineural hearing loss

A

Alport syndrome

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9
Q

Conductive hearing loss due to bone growth in external ear due to repeated exposure to cold

A

Exostasis

“Swimmer’s/ Surfer’s ear”

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10
Q 
Fixation of stapes footplate
Conductive hearing loss
Tinnitus
"Flamingo tinge" to tympanic membrane
Dip at 2-4hz on audiogram (Cahart's notch)
A

Otosclerosis

Age 20-40 years old
Autosomal dominant
Worse in pregnancy

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11
Q

Sensorineural hearing loss
Bilateral
Worse at high frequency
Speech is difficult to understand

A

Presbycusis

Male>Female
Found in 30% of >65s
Found in 50% of >75s

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12
Q

Management of otosclerosis

A

Hearing aid

Stapedectomy

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13
Q

Causes of tinnitus

A 
Meniere's disease
Otosclerosis
SSNHL
Hearing loss
Drugs
  - NSAIDs
  - Aminoglycosides
  - Loop diuretics
  - Quinine
Ear wax
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14
Q

Causes of sudden onset sensorineural hearing loss (SSNHL)

A 
Acoustic neuroma (80%) 
Idiopathic
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15
Q

Management of sudden onset sensorineural hearing loss (SSNHL)

A

Urgent referral

Prednisolone

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16
Q

Management of perforated tympanic membrane

A

Self resolves in 6-8 weeks
Keep dry + review in 4 weeks
Myringoplasty

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17
Q

Excessive endolymph

A

Meniere’s disease

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18
Q 
Sensorineural hearing loss (low frequency)
Vertigo
Tinnitus 
Sensation of aural fullness
Nystagmus
Epiisoles last mins-hours
A

Meniere’s disease

Positive romberg test

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19
Q

Acute management of Meniere’s disease

A

Buccal/IM Prochlorperazine

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20
Q

Prophylactic management of Meniere’s disease

A

Betahistamine

Vestibula rehab

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21
Q

Sudden onset vertigo
Triggered by changes in head position
Episodes last 20 seconds

A

Benign paroxysmal positional vertigo (BPPV)

22
Q

Dix-hallpike test = positive

A

BPPV

23
Q

Management of BPPV

A

Epley manœuvre
Brandt-Daroff exercises (vestibular rehab)

Recurrence is common 3-5 years later

Prevention: Betahistamine

24
Q

Dizziness on neck extension in elderly

A

Vertebrobasilar ischaemia

25
Q 
Recent viral infection 
Recurrent vertigo (worse on wakening)
No hearing loss
No tinnitus
Lasts hours-days
Nausea + vomiting 
Horizontal nystagmus
A

Vestibular neuronitis

  • affects on vestibular nerve (not cochlear)
26
Q

Management of Vestibular neuronitis

A

Acute: Buccal/IM Prochlorperazine

Vestibular rehab exercises
Antihistamines:
  - cinnarizine
  - cyclizine
  - promethazine
27
Q 
Recent viral infection 
Sudden onset vertigo
Hearing loss
Horizontal nystagmus
Gait disturbance  
Nausea + vomiting
A

Labyrinthitis

  • affects both vestibular and cochlear nerves
  • common in 40-70 years old
28
Q

Management of Labyrinthitis

A

Self limiting
Prochlorperazine
Antihistamines

29
Q

Management for auricular haematoma “Cauliflowe ear”

A

Same day assessment

Incision + drainage

30
Q 
Otalgia 
Pain behind ear
Fever
External ear protruding anteriorly
Swelling + erythema over mastoid
Hx of recurrent otitis media
A

Mastoiditis

  • caused by otitis media spreading outwards
  • can lead to meningitis
31
Q

Management of mastoiditis

A

Admit

Amoxicillin

32
Q

2 years old
Conduction hearing loss (> 3 months)
Speech + language delay
Behaviour + balance problems

Flat tympanogram

A

Otitis media with effusion (glue ear)

33
Q

Management of Otitis media with effusion (glue ear)

A

Grommets

34
Q

Foul smelling ear discharge

A

Pre-auricular sinus

35
Q 
< 3 years old
Acute onset otalgia
"Ear tugging"
Presence of middle ear effusion
        - bulging membrane
        - otorrhea
        - decreased mobility on otoscopy
Erythema of membrane
A

Acute otitis media

36
Q

Causes of Acute otitis media

A

Viral URTI disturbs normal nasopharyngeal microbiome, allowing bacteria to infect middle ear via eustachian tube

  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
37
Q

Management of Acute otitis media

A

Self-limiting
Analgesia

Severe: Amoxicillin (Erythromycin in PA)

Recurrent: Grommets

38
Q

Acute otitis media can lead to

A

Chronic Suppurative Otitis media (CSOM)

39
Q

Perforation of tympanic membrane
Otorrhoea > 6 weeks
Cholesteatoma

A

Chronic Suppurative Otitis media (CSOM)

40
Q

Growth of squamous epithelium that is trapped within skull causing local destruction

A

Cholesteatoma

Ages: 10-20 years
Increased risk ( x 100) if cleft palate
41
Q 
Foul smelling, non-resolving discharge
Hearing loss
Vertigo 
Facial palsy 
Cerebellopontine angle syndrome
A

Cholesteatoma

can lead to meningitis
facial nerve infection

42
Q

Investigation findings for Cholesteatoma

A

Crust seen in the upper eardrum (attic)

43
Q

Management of Cholesteatoma

A

Surgical removal

44
Q

Otalgia
Discharge
Erythema
Eczematous canal

A

Otitis externa

  • common in diabetes + elderly
45
Q

Causes of Otitis externa

A 
Staph aureus 
Pseudomonas aeruginosa 
Fungal
Seborrheic dermatitis 
Contact dermatitis
46
Q

Management of otitis externa

A
  1. Topical Gentamicin + hydrocortisone (drops)
  2. Flucloxacillin (Erythromycin if PA)

Fungal: Cotrimazole drops
Diabetes: Ciprofloxacin (to cover pseudomonas)

47
Q

Non-resolving otitis externa
- Severe otalgia
- Purulent otorrhea
Temporal headaches

A

Malignant otitis externa

  • infection has spread to bone
  • found in immunocompromised patients + diabetics
48
Q

Causes of Malignant otitis externa

A

Pseudomonas aeruginosa

49
Q

Investigations for Malignant otitis externa

A

CT

50
Q

Management for Malignant otitis externa

A

Ciprofloxacin

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