Hearing and sight disorders

Question 1

What is sensorineural hearing loss?

Answer 1

Hearing loss caused by malfunction or disease within cochlea or auditory nerve. Occurs with damage to tiny hair cells.
Common type of hearing loss especially in adults

Question 2

What are some of the causes of sensorinerual hearing loss?

Answer 2

Presbycusis (age related)
Noise induced hearing loss,
Congenital infections (rubella or CMV),
Neonatal complications eg meningitis,
Drug induced eg aminoglycosides.
Vascular eg, stoke or TIA

Question 3

What are the investigations for sensorineural hearing loss?

Answer 3

Audogram,
If sudden onset then MRI for vesticular schwannoma

Question 4

What is conductive hearing loss

Answer 4

This is hearing loss when there is any problem in delivering sound energy to your cochlea.

Question 5

Explain Weber’s test?

Answer 5

Do first. Place tuning fork in middle of forehead. In unilateral sensorineural deafness sound is localised to unaffected side.
In conductive hearing loss sound is localised to affected side.

Question 6

Describe features of Rinne’s test

Answer 6

Turning fork placed over mastoid process until no sound is heard, then bring in front of ear.
Positive - air conduction is better than bone conduction (can be normal unless positive Weber’s then sensorineural).
Negative - Bone conduction >air conduction. This suggests conductive deafness

Question 7

What is the first line investigation for hearing loss?

Answer 7

Audiogram

Question 8

What are some causes of conductive hearing loss?

Answer 8

Wax impaction,
Otitis media with effusion (glue ear),
Eustation tube dysfunction,
Ear infections,
Perforation in tympanic membrane,
Chronic suppurative otitis media

Question 9

What is the management of conductive hearing loss?

Answer 9

Removal of wax,
Antibiotics for ear infections,
Surgical interventions for chronic suppurative otitis media or perforations.

Question 10

What is Glaucoma

Answer 10

Optic nerve damage associated with raised intraocular pressure. This is caused by a blockage in the aqueous humour trying to escape the eye.

Question 11

What are the two types of glaucoma?

Answer 11

Open angle,
Closed angle

Question 12

What is the vitreous chamber?

Answer 12

Main bulk of eyeball where vitreous humour is found

Question 13

What is the anterior chamber of the eye?

Answer 13

It is between the cornea and the iris. Filled with aqueous humour which provides nutrients to cornea.

Question 14

What is the posterior chamber of the eye?

Answer 14

It is between the lens and the iris. Filled with aqueous humour which provides nutrients to cornea.

Question 15

Explain the production and movement of aquous humour

Answer 15

Produced by cilliary body. Flows through posterior chamber into anterior chamber where it then drains through trabecular meshwork at the angle between the cornea and the iris. If there is more pressure in the trabecular meshwork then is increases intraocular pressure.

Question 16

Explain the pathophysiology of open angle glaucoma?

Answer 16

Gradual increase in resistance through trabecular meshwork which causes slow rise in intraocular pressure. This causes cupping of the optic disk

Question 17

What are the risk factors for open angle glaucoma?

Answer 17

Increased age, family history, black ethnic origin or near sightedness.

Question 18

What is the pressentaion of open angle glaucoma?

Answer 18

Often asymptomatic .
Tends to affect peripheral vision first
Fluctuating pain, headaches, blurred vision, halos surrounding lights.

Question 19

How do you measure intraocular pressure?

Answer 19

Non contact tonometry - less accurate but good for screening
Goldman applanation tonometry - gold standard

Question 20

What is the management of open angle glaucoma?

Answer 20

Prostaglandin analogue eye drops (latanoprost), can increase pigmentation.
Topical beta blockers,
Carbonic anhydrase inhibitors,
Sympathomometics
Surgery if eye drops in affective - trabeculectomy

Question 21

What is closed angle glaucoma?

Answer 21

Iris bulges forward and seals off trabecular meshwork which prevents aqueous humour from draining. This leads to build up pressure especially in the posterior chamber which further presses iris, further sealing trabecular meshwork. Emergency!!

Question 22

What are the risk factors for closed angle glaucoma?

Answer 22

Increasing age,
Female age,
Family history,
Chinease/east asian ethnic origin,
Shallow anterior chamber,
Meds (noradrenaline, anticholinergic meds, tricyclic antidepressants)

Question 23

What is the presentation of closed angle glaucoma?

Answer 23

Systemically upset,
Severely painful red eye,
Blurred vision,
Halos around lights,
Associated headaches and vomiting,
Hazy cornea,
Reduced visual acuity
Pupillary dilation unresponsive to light

Question 24

What is the GP management of acute closed angle glaucoma?

Answer 24

Same day referral for ophthalmology.
Lie patient on back without pillow, give pilocarpine eye drops (causes pupil constriction), give acetazolamide 500mg orally (carbonic anhydrase inhibitor which reduces production of fluid)

Question 25

What is cataracts?

Answer 25

Where the lens of the eye becomes cloudy

Question 26

What are the causes of cataracts?

Answer 26

Normal aging process,
Smoking,
Increased alcohol,
Trauma,
Diabetes mellitus,
Long term corticosteroids,
Radiation,
Myotonic dystrophy,
HYpocalcaemia

Question 27

What are the signs and symptoms of cataracts?

Answer 27

Reduced vision, faded colour vision, glare, halos around light,
Defect in red reflex.
Definitive treatment - surgical replacement of lens with artificial one.