ENT & Opthalmology Flashcards
Name 5 symptoms which should be asked about for any hearing changes history?
Same in both ears? Tinnitus? Discharge? Pain? Vertigo/ spinning etc.?
Name 3 non symptom factors which should be asked in a hearing loss history?
Trauma/ water exposure
Occupation (noise exposure)
PMHx and DHx (causative drugs)
How do you distinguish between conductive and sensorineural hearing loss (one Hx question and then examination findings?)
Q: If you are in a crowd of people is it easier to tell what someone is saying to you (conductive) or more difficult (sensorineural)
Webers (lateralises to either conductive deaf on same side or sensorineural on the opposite)
Rinne’s- positive is normal, negative means conductive deafness on that side
If you have a R sided conductive deafness, which side would Webers test lateralise to?
Right side
Conductive deafness is ipsilateral
Name 4 differentials for a bilateral hearing loss?
Wax
Noise induced
Presbycusis (sensorineural hearing loss caused by old age)
Vascular/ chemo/ syphiliis
Name 5 differentials for a conductive hearing loss?
Wax Foreign body Otitis externa/ media Otosclerosis Tympanic membrane perforation Cholesteatoma
Give 4 differentials for a sensorineural hearing loss?
Labrinthitis (acute onset vertigo, nausea and vomitting)
Noise induced
Presbycusis (gradual, slow onset)
Meniere’s disease (recurrent vertigo, mins to hours with ringing or buzzing)
What is the most common cause of, and how do you manage a perforated ear drum?
Cause: Infection (also barotrauma or trauma)
Tx: Usually heals by itself in 6-8 weeks
- Prescribe AB’s if due to infection
- If this fails can do myringoplasty
How do you treat otitis media in a child over 6 months age?
Paracetamol/ ibuprofen for fever (alternate but not together) Antibiotics only if: - Syxlasting over 4 days - Perforation - Discharge - Bilateral + age <2
Name three groups of children who should be admitted with a suspected ear infection?
- Age < 3months
- 3-6 months with temp >39
- Systemically unwell
- Acute complications (mastoiditis/ meningitis)
What antibiotics should be given to children with acute otitis media (for example lasting >4days and needing AB’s)
Amoxicillin (5 day course)
- Macrolide if allergic
How do you diagnose and treat BBPV?
Dix-hallpike to diagnose?
Epley manoeuvre to treat
What is the classic presentation of BPPV?
Age approx 55, uncommon in younger
Vertigo triggered by change in head position, nausea
Episodes last 10-20 seconds
James, 40, has presented to his GP with weakness of the right side of his face, which examination confirms. James also reveals that he has experienced pain in his ear and otoscopy reveals the presence of vesicles on his tympanic membrane. Which of the following is the likely diagnosis?
Ramsay Hunt Syndrome
(Reactivation of Varicella Zoster)
- Pain in ear
- Vesicles on tympanic membrane
- Facial paralysis
- Hearing loss, tinnitus, vertigo, taste loss etc.
How is otitis media treated in adults?
Same as kids (paracetamol)
AB’s only if >4days, discharge or perforation or systemically unwell etc)
What are the main symptoms of otitis externa?
Ear pain
Itching
Possible discharge
Possible hearing loss
When are swabs recommended in otitis externa?
If there has been treatment failure or if atypical situation
How is otitis externa treated if the ear is red, odematous or showing discharge?
Topical antibiotics (neomycin or clioquinol)
+
Topical steroid
(Betamethasone, hydrocortisone)
Treat for at least one week (but continue for a maximum of two weeks if needed)
How long should otitis externa take to settle down?
Approximately one week
What should be used for mild cases of otitis externa (no redness, discharge, hearing loss etc)?
If just pain and itching consider using topical acetic acid
When are oral antibiotics indicated for acute otitis externa?
Fever
Regional lymphaenopathy
Cellulitis spreading beyond the ear
A px presents with vertigo, what is the best way to distinguish between BPPV, labyrinthitis and meniere’s?
BPPV: Episodes <30seconds, triggered by specific postures
Labyrinthitis: Episode can last for days, can be triggered by ANY movement, preceding viral infection common. Can experience hearing loss.
Meniere’s: Episodes last mins-hours. Associated more with aurual fullness, tinnitus and hearing loss
How should labyrinthitis be treated?
Prochlorperazine (for acute phase (days) only)
- General advice is to lie down with eyes closed during acute attack but when begins to reside to get active as soon as possible, this may reduce attack severity
If symptoms of bacterial ear infection (discharge etc.) then also give AB’s
How long does labyrinthitis take to settle down?
Several days to three weeks