Hearing and Ear Disease Flashcards
Conductive hearing loss
-causes
Ear wax Ear drum perforation Glue ear - in children OE, OM Otosclerosis
Sensorineural hearing loss
-causes
Age related (presbyaccusis)
Noise induced
Trauma
Non organic hearing loss
Congenital - cochleaauditory nerve
Meniere
Vestibular schwannoma
Ear history
Duration
Side
Onset - sudden/gradual
Hearing loss
Discharge
Tinnitus
Dizziness
Neurology review
IMPACT ON QOL
Sudden sensorineural loss => hearing may be rescued with CS
Unilateral SNHL or tinnitus => brain imaging to rule out vestibular schwannoma or CPA tumour
Ear examination
Inspection - ear, face, mastoid
Otoscopy
Rinne, Weber examination
Cranial nerve examination
Ear investigations
Pure tone audiogram
Tympanometry - middle ear function
-perforation, glue ear, auditory tube dysfunction
Otoscopy
Glue ear
Common in children - immature auditory tube dysfunction
- hearing loss
- poor balance
- frequent nose and ear infections
- behavioural and speech and language delay
- air bubble visible behind eardrum
Management if symptoms affect development and learning
- majority => watch and wait
- hearing aid
- grommets - bilateral persistent hearing loss
Ear drum perforation
- possible causes
- presentation
- management
Post OM, grommet surgery, trauma
Recurrent ear infections
Hearing loss
Conservative
Surgical => ear drum repair (myringoplasty)
Past medical history
Other medical conditions
-past surgeries, procedures, hoospital visits
Current medications and allergies
Ototoxic medications
- aminoglycosides
- aspirin OD => tinnitus
- furosemide
- chemotherapy
Management of hearing loss
Noise protection advice
-ear protection
Hearing aids
Surgery Eardrum/ossicle repair Surgical implants/hearing aids -bone conduction hearing aids -middle ear implants -cochlear implants
OE
- population often found in
- common causative organism
- presentation
- management
- presentation of complications
More common in adults - pseudomonas
- pain, discharge, itching
- foreign bodies, polyps, malignancy?
Keep ear dry
Topical ABx/SC - external ear has a poor blood supply so PO not suitable
Necrotising OE - infection spreads beyond skin of ear canal => soft tissue, bone (temporal osetomyelitis)
-often in diabetics, IC
Symptoms
- pain out of proportion to clinical features
- ear canal granulations
- possible facial palsy
AOM
- population often found in
- common causative organism
- presentation
- management
More common in children - viral resp, strep
- fever, pain
- hearing loss
- discharge if perforated
Conservative
PO amox
COM
- population often found in
- pathophysiology
- presentation
- management
Children and adults - skin behind ear drum grows and erodes surrounding structures
-associated with poor auditory tube function
Discharge
Hearing loss
Surgery - mastroidectomy if fit
-if not monitor and microsuction
Complications of OM
-presentation
Hearing loss
Dizzy
Facial palsy
Fevers
Mastoiditis
Meningitis
Intracranial abscess
Venous thrombosis
Drain abscess to prevent further spread
Facial palsy in relation to the ear
Facial nerve route - IAM => middle ear => mastoid => stylomastoid foramen => 5 branches (temporal, zygomatic, buccal, mandibular, cervical)
Temporal - raise eyebrows Zygomatic - scrunch eyes Buccal - purse lips Mandibular - smile Cervical - grimace
Hear tear taste face
