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Movement > ENT week > Flashcards

ENT week Flashcards

1
Q

disease of which part of the ear causes conductive deafness

A

outer and middle

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2
Q

disease of which part of the ear causes sensorineural deafness?

A

inner ear

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3
Q

atresia of the pinna and/or auditory canal is also known as what and is associated with which conditions

A

microtia - anotia (no ear)
hemifacial microsomeia, goldenhar syndrome, Treacher-Collins syndrome

also traumatic injury, infection, neoplastic changes

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4
Q

what does the outer ear comprise

A

pinna, external auditory meatus,

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5
Q

what is in the middle ear

A

drum to oval window

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6
Q

what is the primary function of the middle ear

A

to amplify sound
this is achieved by mechanical leverage of the ossicles (matches the impedence of air and water) and the drum to oval window ratio (drum 20x bigger than oval window)

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7
Q

what is surfer’s ear

A

exostoses of the auditory cannal - bony out growths following irritation from cold winds and water

Can lead to conductive deafness and increased incidence of infection as can “plug” the ear canal, causing pain

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8
Q

which part of the ear drum is more prone to retraction and cholesteatoma

A

the pars flaccid a

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9
Q

which is the weakest part of the ear drum

A

pars flaccida

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10
Q

how do perforations of the ear drum cause loss of hearing

A

Perforations cause a loss of vibrating area and hence amplification
Larger perforations expose the round window to incident sound waves which can cancel out true sound waves and contribute further to hearing loss

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11
Q

which type of perforation is associated with cholesteatoma

A

attic perforations

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12
Q

antero-inferior perforations are often remnants of what

A

grommets

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13
Q

where do most marginal perforations occur

A

in the postero-superior quadrant

marginal perforations are prone to cholesteatoma formation by squamous ingrowth

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14
Q

what is myringosclerosis

A 
chalky patches (calcification)in the eardrum
it is probably the result of abnormal healing following acute otitis media, middle ear effusion or grommet insertion
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15
Q

what is cholesteatoma

A

destructive keratinsing epithelium growth

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16
Q

how does cholesteatoma present

A

painless
smelly green ear discharge
conductive hearing loss
facial nerve palsy if bad

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17
Q

what is otosclerosis

A

thickening of bone near the stapes footplate (the fissula ante finestram) which fixes the stapes causing conductive hearing loss

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18
Q

in which populations is otosclerosis more common

A

females (M:F 2:1)
Caucasians
inherited in autosomal dominant pattern with incomplete penetrance

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19
Q

what methods of management are available for otosclerosis

A

hearing aids can be useful

surgery: piston placed through stapedotomy

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20
Q

what is otitis media with effusion more commonly known as and who is it more common in

A

glue ear
in children

  • boys
  • winter
  • cleft palate
  • Down’s
  • Bottle fed babies
  • Children of smokers
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21
Q

what often causes eusachian dysfunction in children

A

URTIs involving the adenoids

infective rhinitis

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22
Q

what percentage of glue ear will resolve without treatment

A

90%

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23
Q

what percentage of glue ear will resolve within 3 months

A

50%

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24
Q

which age group would be offered grommets with adenectomy

A

3.5 years - 7 years

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25
Q

why is it so important to treat glue ear

A

due to the developmental delays hearing loss can cause in children

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26
Q

what is presbyacusis

A

age associated hearing loss

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27
Q

list some iatrogenic causes of sensorineural hearing loss

A 
aminoglycosides
loop diuretics (reversible)
chemotherapeutics (cisplatin)
aspirin (reversible)
erythromycin
surgical trauma
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28
Q

which compartment of the cochlea is filled with endolymph

A

the scala media
where the neurepithelium is situated
endolymph has a high concentration of potassium

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29
Q

which compartment of the cochlea is filled with perilymph

A

the scala vestibuli and tympani
perilymph has a low concentration of potassium

these are supportive/protective

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30
Q

what causes presbyacusis

A

deterioration of hair cells and spiral ganglion cells

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31
Q

which frequency is lost first in presbyacusis

A

high frequency

32
Q

where is endolymph produced

A

by the dark cells in the endolymphatic sac

probably regulates volume and composition

33
Q

what might cause a change in the composition of endolymph

A

menieres syndrome or alcohol consumption

34
Q

what splits the internal acoustic meatus horizontally

A

the crista falciformis

35
Q

which nerves travel in the internal acoustic meatus

A

the facial nerve

the vestibulocochlear nerves

36
Q

how does the cochlea achieve amplification

A

the outer hair cells increase the amplitude of soundwaves using electromechanical feedback

37
Q

what is acoustic neuroma

A

vestibular schwannoma
benign cancer which grows on the CnVIII

mostly idiopathic
5% caused by neurofibromatosis type 2

38
Q

how would a small Acoustic Neuroma present

A

hearing loss/tinnitus

vertigo

39
Q

how would a large Acoustic Neuroma present

A

headaches with blurred vision
numbness/pain on one side of face
problems with limb co-ordination on one side of the body

40
Q

how is tonic discharge created in the hair cells of the vestibular apparatus

A

they have membranes which are inherently leaky to potassium

41
Q

when cilia are displaced towards the kinocilium

A

firing rate is increased

42
Q

how is nystagmus defined

A

fast phase away from diseased ear

43
Q

what is the most likely origin of isolated vertigo

A

inner ear

if accompanied with facial weakness, slurring, weakness in a limb or cerebellar signs otehr than nystagmus –> not caused by ear disease

44
Q

what is significant about the blood supply to the ear

A

it is from the labyrinthine artery (from basilar artery)

it is an end-artery system therefore if there is occlusion it dies!

45
Q

what is the most common cause of isolated vertigo

A

BPPV

46
Q

what is vertigo

A

hallucination of movement

47
Q

what is BPPV

A

isolated vertigo which lasts for seconds

caused by the migration of the otoconia into the semicircular canals (94% into posterior canal)

48
Q

which movements trigger BPPV

A 
vertical movements (sitting up in bed)
rolling over in bed
49
Q

what triggers BPPV

A

commonly idiopathic

can follow head trauma

can also follow menieres or vetibular neuritis

50
Q

which clinical test is sensitive and specific for BPPV

A

Dix-Hallpike

look for nystagmus (rotational)

51
Q

which procedure treats BPPV and in what percentage is it successful

A

Epley

85%

52
Q

what is menieres

A

vertigo with cochlear symptoms (tinnitus and hearing loss)
lasts hours to days
from excess endolymph distorting neuroepithelia

53
Q

what is the presentation of a typical attack of menieres

A 
aural pressure:
tinnitis
hearing loss (low frequency)
vertigo
nausea, vomiting and sweating
54
Q

which supportive tests can be used to diagnose menieres

A

mostly on history
pure tone audiogram
vestibular function tests
MRI done to exclude acoustic/brainstem/posterior fossa diseases

55
Q

what treatments are available for menieres

A

salt restriction
betahistine
antiemetics for attacks
surgery

56
Q

which surgical options are available for the treatmnet of menieres

A

grommets - ? how works
gentamicin instillation - destroys balance function while sparing hearing
saccus decompression - drain endolymph
vestibular nerve section

57
Q

what are the symptoms of fossa disease

A 
dysarthria
diplopia
facial weakness
dysphagia
loss of vision
facial or limb parasthesia
limb weakness

posterior fossa symptoms point to circulatory disturbance

58
Q

why is it mandatory to examine the ear drum if a patient presents with vertigo

A

to exclude cholesteatoma which can cause labyrinthitis and needs immediate removal as can cause septic meningitis

59
Q

what is vestibular neuritis

A

sudden onset of vertigo (NO COCHLEAR SYMTOMS) which lasts for 1-2 days
patient will have nystagmus in all directions

60
Q

what is labyrinthitis

A

sudden onset of vestibular AND cochlear symptoms which lasts for 1-2 days
its is a disease of the whole labyrinth and can result in permanent hearing loss

61
Q

what might cause vestibular neuritis

A

likely to be viral in origin
herpes virus
can also be due to vascular occlusion

62
Q

what can cause labyrinthitis

A

mostly viral

can be bacterial if cholesteatoma erodes into bone allowing the passage of acute otitis media

63
Q

what are the red flags for acute vertigo

A 
signs of cranial nerve disease
limb involvement
gaze evoked nystagmus
acute deafness
vertical nystagmus
64
Q

sudden onset of vertigo upon sitting up in bed, resolves after a few seconds

A

BPPV

65
Q

onset of vertigo accompanied by tinnitus and unilateral hearing loss lasting for half a day

A

menieres

66
Q

sudden onset of vertigo with tinnitis and hearing loss, nystagmus is present in all direction, lasts for 2 days until patient can stand up and start to move slowly

A

labrynthitis

67
Q

sudden onset of vertigo nausea and vomiting
no hearing loss or tinnitus
lasts 2 days
head thrust test shows failure of vestibular ocular reflex

A

vestibular neuritis

68
Q

causes of hearing loss

A 
presbyacusis
drug related
traumatic
congenital
acoustic neuroma
meniere's disease
noise induced hearing loss
69
Q

causes of otalgia

A

ear disease
sensory supply to the skin and mucosa of the ear (Cn V,VII,IX,X C2/3)
referred (the Ts)

70
Q

causes of facial palsy

A
  1. Bell’s palsy
  2. ramsay hunt syndrome: Herpes Zoster Oticus -> herpatic rash on pinna and soft palate
  3. trauma: post parotidectomy or middle ear surgery
  4. tumour: schwannomas, parotid malignancy
  5. infection: acute suppurative otitis media, cholesteatoma, malignant otitis externa

other: sarcoid, MS, CVA, GBS, HIV

71
Q

what is acute otitis externa also known as

A

swimmer’s ear

72
Q

the frontal sinus relies on what for its drainage

A

gravity

73
Q

which sinuses are present at birthq

A

maxillary and ethmoid sinuses

74
Q

at what age do the frontal sinuses develop

A

7 years

75
Q

what is the Agger Nasi

A

the most anterior ethmoid air cell

76
Q

what is the ethmoid bullae

A

the biggest ethmoid air cell

Movement (8 decks)

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