H&N 3 Flashcards
What is the conduction of sound in a normal ear during the rinnies test?
Air conducts more than bone
I.E Positive test
What is the conduction of sound in conductive hearing loss during the rinnies test?
Bone conducts more than air
I.E test is negative
Due to blockage of some sort preventing sound being conducted through air
What is the conduction of sound in sensorineural hearing loss during the rinnies test?
Air conducts better than bone
I.E positive test
Both air and bone equally reduced, so air still louder than bone
What is the conduction of sound in a normal ear during the webers test?
Left and right sides hear equally
(Or neither heard)
“Central test”
What is the conduction of sound in sensorineural hearing loss (of right ear) during the webers test?
Left is louder than right
Therefore test lateralises to left
What is the conduction of sound in conductive hearing loss (of the right ear) during the webers test?
Right is louder than left
Test lateralises to right
(louder in blocked ear, as less ambient sound to distract)
What investigations can be done into hearing loss?
Pure tone audiogram
Tympanogram
What are the common conditions of the outer ear?
Auricular haematoma
Foreign body
Otitis externa
Malignant ottis externa
What is auricular haematoma?
Large blood accumulation in ear
If untreated underlying cartilage may become damaged and lead to cauilfour ear
Drain asap
What is ottis externa?
Inflammation of the skin of the outer ear drop
“Swimmers ear”
Treated with antibacterial ear drops
What is malignant ottis externa?
(NOT neoplastic)
Infection of temporal bone
Presents with SEVERE pain in ear
Treated with antibiotics
Who often gets malignant ottis externa?
Elderly
Diabetics
What conditions often affect the middle ear?
Otitis media with effusion - glue ear Acute otitis media Chronic suppurative media Tympanosclerosis Otosclerosis
What is ottis media with effusion?
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
What is acute ottis media?
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
What is chronic suppurative media?
Perforated tympanic membrane
What is cholesteatoma?
Collection of skin underneath eardrum (not a benign tumour)
Tympanic membrane goes inwards with low pressure
Presistent discharge from ear
How do you treat cholesteatoma?
Mastoidectomy
Drill into mastoid bone to remove dead skin
What are the complications of cholestatoma?
Facial nerve weakness
Brain damage
What is tympanosclerosis?
Calcified deposits on tympanic membrane
Bleeding and grommet are possible causes
What is otosclerosis?
Overgrowth of bone in middle ear
Will not see anything
What conditions can affect the inner ear?
Presbyacusis Noise induced hearing loss Ototoxic medications Menierers disease Head injury Infections Vestibular schwannoma Tinnitus Vertigo
What four conditions have characteristic changes in audiogram?
Presbyacusis
Noise induced hearing loss
Ototoxic medications
Menieres disease
What is presbyacusis?
Presbyacusis
>Hearing loss with old age
>High frequency sensiorneural loss
What is noise induced hearing loss?
Noise induced hearing loss
>Damage to hair cells via noise
>Notch in hearing chart, down then back up
What is ototoxic induced hearing loss?
Ototoxic medications
>Measure gentamaicin!!
>High frequency sensoreural
What is meniere’s disease?
Menieres disease
>Raised pressure in endolymph
>Causes dizziness
>Low frequency hearing loss
What is vestibular schwannoma?
Benign tumour
Hearing loss on one side
Diagnosed with MRI
What is tinnitus?
Any perception of sound
>Not just ringing
What is the pathology of tinnitus?
no directly treatable pathology in vast majority
hearing loss and stress important contributing factors
How do you investigte tinnitus?
unilateral or pulsatile
>Vast majority no need to investigate
>Vascular ? Pulsitle?
>MRI if one sided
How do you treat tinnitus?
sound enrichment
stress management
What are the differentials for vertigo?
benign positional vertigo
Ménières disease
vestibular neuritis / labyrinthitis
migraine
What are the key questions for vertigo?
features of episodes >duration >frequency >associated symptoms >precipitating factors
What is the pathology of benign postural vertigo?
Otocania in semilunar canals
What are the clinical features of benign postural vertigo?
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
What is the treatment for benign postural vertigo?
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
What is the pathology of vestibular neuritis/labyrunthitis?
Viral in origin
reactivation of latent HSV infection of vestibular ganglion
What are the clinical features of vestibular neuritis/labyrunthitis?
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
What is the treatment of acute vestibular neuritis/labyrunthitis?
vestibular sedatives
First few days
What is the treatment of chronic vestibular neuritis/labyrunthitis?
vestibular rehabilitation
>Promote resolution of motion
>Give exercises to promote the vertigo
>So brain can try to compensate
What is the pathology of menieres disease?
endolymphatic hydrops
Pressure in canal raised
Wht are the clinical features of menieres disease?
spontaneous vertigo
> + unilateral hearing loss / tinnitus / aural fullness
duration: hours
frequency: every few days / weeks / months
> + fluctuating, progressive unilateral hearing loss
How do you treat menieres disease?
Betahistine - ?blood flow bendrofluazide intratympanic dexamethasone intratympanic gentamicin others
What are the clinical features of migranes (vertigo)?
spontaneous vertigo duration: variable frequency: variable ± headache, sensory sensitivity, auras ± precipitated by migraine triggers ± past history of migraine
How do you treat migraine vertigo?
avoid migraine triggers
prophylactic medication
What is facial palsy?
For otology - lower motor neuron facial weakness
Intratemportal pathology - cholesteatoma
Extratemporal - parotid gland tumour
What is bell’s palsy?
No pathology
Long term good - 95% with prednisolone
80% without
How do you treat rhinositus?
Steroids
Saline nasal douche
Surgery
What can cause epistaxis?
Infection
Trauma (Accidental/iatrogenic)
Blood dyscracsias
What infections can cause epistaxis?
Rhitis
Sinusitis
What blood dyscraisis can cause epistaxis?
Iatrogenic
Disease
Alocholism
How do you treat epistaxis?
Anterior/posterior nasal pacs
How do you treat chronic/serious epistaxis?
Artery ligation/embolisation >Sphenopalatine >Inferior maxillary >Anterior/posterior ethmoidal ligation >External carotid ligation
What are the common symptoms of head/neck cancer?
Swelling Ulcer Red/white patch Bleeding Pain Dysphonia Dysphagia
