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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
why is it so important to treat glue ear
due to the developmental delays hearing loss can cause in children
26
what is presbyacusis
age associated hearing loss
27
list some iatrogenic causes of sensorineural hearing loss
``` aminoglycosides loop diuretics (reversible) chemotherapeutics (cisplatin) aspirin (reversible) erythromycin surgical trauma ```
28
which compartment of the cochlea is filled with endolymph
the scala media where the neurepithelium is situated endolymph has a high concentration of potassium
29
which compartment of the cochlea is filled with perilymph
the scala vestibuli and tympani perilymph has a low concentration of potassium these are supportive/protective
30
what causes presbyacusis
deterioration of hair cells and spiral ganglion cells
31
which frequency is lost first in presbyacusis
high frequency
32
where is endolymph produced
by the dark cells in the endolymphatic sac | probably regulates volume and composition
33
what might cause a change in the composition of endolymph
menieres syndrome or alcohol consumption
34
what splits the internal acoustic meatus horizontally
the crista falciformis
35
which nerves travel in the internal acoustic meatus
the facial nerve | the vestibulocochlear nerves
36
how does the cochlea achieve amplification
the outer hair cells increase the amplitude of soundwaves using electromechanical feedback
37
what is acoustic neuroma
vestibular schwannoma benign cancer which grows on the CnVIII mostly idiopathic 5% caused by neurofibromatosis type 2
38
how would a small Acoustic Neuroma present
hearing loss/tinnitus | vertigo
39
how would a large Acoustic Neuroma present
headaches with blurred vision numbness/pain on one side of face problems with limb co-ordination on one side of the body
40
how is tonic discharge created in the hair cells of the vestibular apparatus
they have membranes which are inherently leaky to potassium
41
when cilia are displaced towards the kinocilium
firing rate is increased
42
how is nystagmus defined
fast phase away from diseased ear
43
what is the most likely origin of isolated vertigo
inner ear if accompanied with facial weakness, slurring, weakness in a limb or cerebellar signs otehr than nystagmus --> not caused by ear disease
44
what is significant about the blood supply to the ear
it is from the labyrinthine artery (from basilar artery) | it is an end-artery system therefore if there is occlusion it dies!
45
what is the most common cause of isolated vertigo
BPPV
46
what is vertigo
hallucination of movement
47
what is BPPV
isolated vertigo which lasts for seconds caused by the migration of the otoconia into the semicircular canals (94% into posterior canal)
48
which movements trigger BPPV
``` vertical movements (sitting up in bed) rolling over in bed ```
49
what triggers BPPV
commonly idiopathic can follow head trauma can also follow menieres or vetibular neuritis
50
which clinical test is sensitive and specific for BPPV
Dix-Hallpike | look for nystagmus (rotational)
51
which procedure treats BPPV and in what percentage is it successful
Epley | 85%
52
what is menieres
vertigo with cochlear symptoms (tinnitus and hearing loss) lasts hours to days from excess endolymph distorting neuroepithelia
53
what is the presentation of a typical attack of menieres
``` aural pressure: tinnitis hearing loss (low frequency) vertigo nausea, vomiting and sweating ```
54
which supportive tests can be used to diagnose menieres
mostly on history pure tone audiogram vestibular function tests MRI done to exclude acoustic/brainstem/posterior fossa diseases
55
what treatments are available for menieres
salt restriction betahistine antiemetics for attacks surgery
56
which surgical options are available for the treatmnet of menieres
grommets - ? how works gentamicin instillation - destroys balance function while sparing hearing saccus decompression - drain endolymph vestibular nerve section
57
what are the symptoms of fossa disease
``` dysarthria diplopia facial weakness dysphagia loss of vision facial or limb parasthesia limb weakness ``` posterior fossa symptoms point to circulatory disturbance
58
why is it mandatory to examine the ear drum if a patient presents with vertigo
to exclude cholesteatoma which can cause labyrinthitis and needs immediate removal as can cause septic meningitis
59
what is vestibular neuritis
sudden onset of vertigo (NO COCHLEAR SYMTOMS) which lasts for 1-2 days patient will have nystagmus in all directions
60
what is labyrinthitis
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
what might cause vestibular neuritis
likely to be viral in origin herpes virus can also be due to vascular occlusion
62
what can cause labyrinthitis
mostly viral | can be bacterial if cholesteatoma erodes into bone allowing the passage of acute otitis media
63
what are the red flags for acute vertigo
``` signs of cranial nerve disease limb involvement gaze evoked nystagmus acute deafness vertical nystagmus ```
64
sudden onset of vertigo upon sitting up in bed, resolves after a few seconds
BPPV
65
onset of vertigo accompanied by tinnitus and unilateral hearing loss lasting for half a day
menieres
66
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
labrynthitis
67
sudden onset of vertigo nausea and vomiting no hearing loss or tinnitus lasts 2 days head thrust test shows failure of vestibular ocular reflex
vestibular neuritis
68
causes of hearing loss
``` presbyacusis drug related traumatic congenital acoustic neuroma meniere's disease noise induced hearing loss ```
69
causes of otalgia
ear disease sensory supply to the skin and mucosa of the ear (Cn V,VII,IX,X C2/3) referred (the Ts)
70
causes of facial palsy
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
what is acute otitis externa also known as
swimmer's ear
72
the frontal sinus relies on what for its drainage
gravity
73
which sinuses are present at birthq
maxillary and ethmoid sinuses
74
at what age do the frontal sinuses develop
7 years
75
what is the Agger Nasi
the most anterior ethmoid air cell
76
what is the ethmoid bullae
the biggest ethmoid air cell

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