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Conditions + definitions > H&N 3 > Flashcards

H&N 3 Flashcards

1
Q

What is the conduction of sound in a normal ear during the rinnies test?

A

Air conducts more than bone

I.E Positive test

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2
Q

What is the conduction of sound in conductive hearing loss during the rinnies test?

A

Bone conducts more than air
I.E test is negative
Due to blockage of some sort preventing sound being conducted through air

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3
Q

What is the conduction of sound in sensorineural hearing loss during the rinnies test?

A

Air conducts better than bone
I.E positive test
Both air and bone equally reduced, so air still louder than bone

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4
Q

What is the conduction of sound in a normal ear during the webers test?

A

Left and right sides hear equally
(Or neither heard)
“Central test”

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5
Q

What is the conduction of sound in sensorineural hearing loss (of right ear) during the webers test?

A

Left is louder than right

Therefore test lateralises to left

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6
Q

What is the conduction of sound in conductive hearing loss (of the right ear) during the webers test?

A

Right is louder than left
Test lateralises to right
(louder in blocked ear, as less ambient sound to distract)

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7
Q

What investigations can be done into hearing loss?

A

Pure tone audiogram

Tympanogram

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8
Q

What are the common conditions of the outer ear?

A

Auricular haematoma
Foreign body
Otitis externa
Malignant ottis externa

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9
Q

What is auricular haematoma?

A

Large blood accumulation in ear
If untreated underlying cartilage may become damaged and lead to cauilfour ear
Drain asap

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10
Q

What is ottis externa?

A

Inflammation of the skin of the outer ear drop
“Swimmers ear”
Treated with antibacterial ear drops

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11
Q

What is malignant ottis externa?

A

(NOT neoplastic)
Infection of temporal bone
Presents with SEVERE pain in ear
Treated with antibiotics

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12
Q

Who often gets malignant ottis externa?

A

Elderly

Diabetics

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13
Q

What conditions often affect the middle ear?

A 
Otitis media with effusion - glue ear
	Acute otitis media
	Chronic suppurative media
	Tympanosclerosis
Otosclerosis
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14
Q

What is ottis media with effusion?

A

Due to fluid beind ear (sometimes excreted)
Leads to low pressure, and thus hearing difficulties
Often affects young children
Worry if in adult
Consider grommet

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15
Q

What is acute ottis media?

A

Bacterial infection beneath eardrum
Severe pain until eardrum bursts (very painful) and then subides
Do not treat with antibiotics straight away as often self limiting

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16
Q

What is chronic suppurative media?

A

Perforated tympanic membrane

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17
Q

What is cholesteatoma?

A

Collection of skin underneath eardrum (not a benign tumour)
Tympanic membrane goes inwards with low pressure
Presistent discharge from ear

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18
Q

How do you treat cholesteatoma?

A

Mastoidectomy

Drill into mastoid bone to remove dead skin

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19
Q

What are the complications of cholestatoma?

A

Facial nerve weakness

Brain damage

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20
Q

What is tympanosclerosis?

A

Calcified deposits on tympanic membrane

Bleeding and grommet are possible causes

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21
Q

What is otosclerosis?

A

Overgrowth of bone in middle ear

Will not see anything

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22
Q

What conditions can affect the inner ear?

A 
Presbyacusis
	Noise induced hearing loss
	Ototoxic medications
	Menierers disease
	Head injury
	Infections
	Vestibular schwannoma
	Tinnitus
Vertigo
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23
Q

What four conditions have characteristic changes in audiogram?

A

Presbyacusis
Noise induced hearing loss
Ototoxic medications
Menieres disease

24
Q

What is presbyacusis?

A

Presbyacusis
>Hearing loss with old age
>High frequency sensiorneural loss

25
Q

What is noise induced hearing loss?

A

Noise induced hearing loss
>Damage to hair cells via noise
>Notch in hearing chart, down then back up

26
Q

What is ototoxic induced hearing loss?

A

Ototoxic medications
>Measure gentamaicin!!
>High frequency sensoreural

27
Q

What is meniere’s disease?

A

Menieres disease
>Raised pressure in endolymph
>Causes dizziness
>Low frequency hearing loss

28
Q

What is vestibular schwannoma?

A

Benign tumour
Hearing loss on one side
Diagnosed with MRI

29
Q

What is tinnitus?

A

Any perception of sound

>Not just ringing

30
Q

What is the pathology of tinnitus?

A

no directly treatable pathology in vast majority

hearing loss and stress important contributing factors

31
Q

How do you investigte tinnitus?

A

unilateral or pulsatile
>Vast majority no need to investigate
>Vascular ? Pulsitle?
>MRI if one sided

32
Q

How do you treat tinnitus?

A

sound enrichment

stress management

33
Q

What are the differentials for vertigo?

A

benign positional vertigo
Ménières disease
vestibular neuritis / labyrinthitis
migraine

34
Q

What are the key questions for vertigo?

A 
features of episodes
>duration
>frequency
>associated symptoms
>precipitating factors
35
Q

What is the pathology of benign postural vertigo?

A

Otocania in semilunar canals

36
Q

What are the clinical features of benign postural vertigo?

A 
vertigo precipitated by specific changes in head position
duration: seconds
frequency: several times per day
Often turning in bed
no associated symptoms
positive Dix-Hallpike test
37
Q

What is the treatment for benign postural vertigo?

A 
Epley manoeuvre
>Sit
>Dipax test
>Lie on oppsite side
>Look all the way round to the ground on other side
>Sit up and look down
38
Q

What is the pathology of vestibular neuritis/labyrunthitis?

A

Viral in origin

reactivation of latent HSV infection of vestibular ganglion

39
Q

What are the clinical features of vestibular neuritis/labyrunthitis?

A

spontaneous vertigo
no associated symptoms (vestibular neuritis)
associated unilateral hearing loss (labyrinthitis)
duration: days
frequency: few episodes
>More than 2-3 unlikely
residual motion-provoked vertigo

40
Q

What is the treatment of acute vestibular neuritis/labyrunthitis?

A

vestibular sedatives

First few days

41
Q

What is the treatment of chronic vestibular neuritis/labyrunthitis?

A

vestibular rehabilitation
>Promote resolution of motion
>Give exercises to promote the vertigo
>So brain can try to compensate

42
Q

What is the pathology of menieres disease?

A

endolymphatic hydrops

Pressure in canal raised

43
Q

Wht are the clinical features of menieres disease?

A

spontaneous vertigo
> + unilateral hearing loss / tinnitus / aural fullness
duration: hours
frequency: every few days / weeks / months
> + fluctuating, progressive unilateral hearing loss

44
Q

How do you treat menieres disease?

A 
Betahistine - ?blood flow
bendrofluazide
intratympanic dexamethasone	
intratympanic gentamicin
others
45
Q

What are the clinical features of migranes (vertigo)?

A 
spontaneous vertigo
duration: variable
frequency: variable
± headache, sensory sensitivity, auras
± precipitated by migraine triggers
± past history of migraine
46
Q

How do you treat migraine vertigo?

A

avoid migraine triggers

prophylactic medication

47
Q

What is facial palsy?

A

For otology - lower motor neuron facial weakness
Intratemportal pathology - cholesteatoma
Extratemporal - parotid gland tumour

48
Q

What is bell’s palsy?

A

No pathology
Long term good - 95% with prednisolone
80% without

49
Q

How do you treat rhinositus?

A

Steroids
Saline nasal douche
Surgery

50
Q

What can cause epistaxis?

A

Infection
Trauma (Accidental/iatrogenic)
Blood dyscracsias

51
Q

What infections can cause epistaxis?

A

Rhitis

Sinusitis

52
Q

What blood dyscraisis can cause epistaxis?

A

Iatrogenic
Disease
Alocholism

53
Q

How do you treat epistaxis?

A

Anterior/posterior nasal pacs

54
Q

How do you treat chronic/serious epistaxis?

A 
Artery ligation/embolisation
>Sphenopalatine
>Inferior maxillary
>Anterior/posterior ethmoidal ligation
>External carotid ligation
55
Q

What are the common symptoms of head/neck cancer?

A 
Swelling
	Ulcer
	Red/white patch
	Bleeding
	Pain
	Dysphonia
Dysphagia

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