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ENT > Inner ear > Flashcards

Inner ear Flashcards

1
Q

What are acquired degenerative diseases of the inner ear?

A
  • Presbycusis
  • Meniere’s disease
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2
Q

What are infective causes of inner ear disease?

A
  • Labrynthitis
  • Spread from otitis media/cholesteatoma
  • Other infections - e.g. mumps
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3
Q

What are vascular causes of inner ear disease?

A
  • Occlusion
  • Vasculitis
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4
Q

What are traumatic causes of inner ear disease?

A
  • Acoustic - acute/chronic
  • Direct/labyrinthine concussion
  • Temporal bone fracture
  • Round/oval window rupture
  • Drug toxicity
  • Surgical
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5
Q

What are metabolic causes of inner ear disease?

A
  • Diabetes mellitus
  • Thyroid disease
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6
Q

What is presbycusis?

A

A degenerative disorder - used to be described as old age hearing loss in both ears. It is characterised by gradual hearing loss, with or without tinnitus

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7
Q

What is the pathophysiological process behind presbycusis?

A

It can be due to the loss of outer hair cells (sensory), loss of the ganglion cells (neural), strial atrophy (metabolic) or it can be a mixed picture

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8
Q

How would you treat presbycusis?

A

Hearing aid

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9
Q

What is the typical characteristic of hearing loss caused by presbycusis?

A

Struggling to hear in places where there is increased background noise

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10
Q

What is labrynthitis?

A

Acute vestibular failure/Vestibular Neuronitis

Acute inflammation of the inner ear that usually follows a simple URTI

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11
Q

Wht can cause labrynthitis?

A
  • URTI
  • Middle ear infection
  • Intracranial sepsis
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12
Q

What are features of labyrinthitis?

A

Sudden attck of unilateral vertigo, accompanied by vomiting

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13
Q

What signs can present in labrynthitis?

A
  • Nystagmus away from affected side
  • Hearing loss
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14
Q

Which way will nystagmus go in someone with labrythitis?

A

Away from affected side - https://www.youtube.com/watch?v=yo-zA1CuKUI

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15
Q

How would you manage someone with suspected labrynthitis?

A
  • Bed Rest
  • Vestiular sedatives - Bucastem, cyclizine
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16
Q

How long does it take labrynthitis to resolve?

A

1-2 days, can take several weeks to fully resolve - residual imbalance with rapid movements for following months

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17
Q

What is a severe complication of labrynthitis?

A

Total vestibular destruction

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18
Q

What are examples of medications that are ototoxic?

A
  • Gentamicin
  • Diuretics
  • Malarial drugs
  • Co-trimoxazole
  • Metranidazole
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19
Q

What is Miniere’s Disease?

A

A disorder of the inner ear that is characterized by episodes of feeling like the world is spinning (vertigo), ringing in the ears (tinnitus), hearing loss, and a fullness in the ear

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20
Q

What is thought to be the cause of miniere’s disease?

A

Distention of the membranous labyrinth/endolymphatic space. This is thought to cause small tears in Reissner’s membrane, leading to mixture of endo and periplymph

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21
Q

What are the features of miniere’s disease?

A

Attacks of the following triad triad of symptoms:

  • Tinitus
  • Hearling loss
  • Vertigo

Also includes:

  • Nausea and vomiting
  • Feeling of fullness in the ear
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22
Q

How long can miniere’s attacks last?

A

Acute spinning vertigo for 30 minutes to 4 hours

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23
Q

What type of hearing loss occurs in miniere’s disease?

A

Sensorineural hearing loss

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24
Q

What features may precede attacks in Miniere’s disease?

A
  • Tinnitus
  • Feeling of fullness in the ear
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25
Q

What happens over time in menieres disease?

A

Attacks of vertigo and tinnitus become permanent

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26
Q

How would you investigate someone with suspected meniere’s disease?

A
  • Clinical history
  • Electrocochleography
  • Endolymphatic space MRI
  • Exclude other causes of vertigo
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27
Q

What are peripheral causes of vertigo?

A
  • Meniere’s disease
  • BPPV
  • Labyrinthitis/Vestibular Failure
  • Cholesteatoma
  • Middle ear disease
  • Drugs
  • Vascular insufficiency
  • Post ear-surgery/trauma
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28
Q

What are central causes of vertigo?

A
  • Acoustic neuroma
  • Vestibular neuronitis
  • MS
  • Head Injury
  • Inner ear syphillis
  • Migraine
  • Vascular occlusion
  • Epilepsy
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29
Q

How would you manage meniere’s disease acutely?

A

Vestibular sedatives - bucastem, chlortalidone

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30
Q

How would you manage meniere’s disease in the long-term?

A
  • Betahistine
  • Diuretics
  • Avoid caffeine and salt
  • Consider destructive interventions
    • Intratympanic gentamicin
    • Vestibular nerve section
    • Labrynthectomy
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31
Q

What is benign paroxysmal positional vertigo?

A

A disease which is characterised by episodic veritgo that occurs when the head is moved in certain directions

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32
Q

What is thought to be the cause of BPPV?

A

Dislodged otoliths settling in the posterior semi-circular canal, and with certain movements this causes irritation of the sensory epithelium

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33
Q

How would you approach assessing vertigo?

A
  • Is it true vertigo?
  • Is there middle ear pathology?
  • Is it acute?
  • Is it episodic?
34
Q

What are features of BPPV?

A

Attacks of sudden rotational vertigo lasting >30 seconds

35
Q

What are causes of BPPV?

A
  • Idiopathic
  • Middle ear disease
  • Head injury
  • Otosclerosis
  • Post viral illness
  • Stapes surgery
36
Q

What is important to exclude before making the diagnosis of BPPV?

A
  • No persistent vertigo
  • No speech, visual, sensory or motor problems
  • No Tinnitus, Headache, Ataxia, facial numbness, dysphagia
  • No vertical nystagmus
37
Q

How would you investigate suspected BPPV?

A

Dix-Hallpike maneuvre

38
Q

What is involved in the Dix-Hallpike maneuvre?

A

https://www.youtube.com/watch?v=kEM9p4EX1jk

Patient sits on couch facing examiner. They are then quickly laid flat , the examiner supports patients head and rotates through 30 deg and inclines the head downwards

39
Q

What is classed as a positive Dix-Hallpike test?

40
Q

How would you manage someone with BPPV?

A

Usually self limiting

  • Vestibular habituation exercises
  • Epley Maneuvre

Rarely

  • Surgery - posterior semicircular canal denervation/obliteration
41
Q

What is an acoustic neuroma?

A

Indolent, histolologically benign subarachnoid tumours that cause problems due to local pressure - Behave like SOLs

They are basically schwannomas of the vestibular part of the VIII cranial nerve

42
Q

What are classic features of an acoustic neuroma?

A

Progressive ipsilateral

  • Tinnitus
  • Sensorineural deafness
43
Q

What are features of a large acoustic neuroma?

A
  • Ipsilateral cerebellar signs
  • Increased ICP
44
Q

Think steps song…

What cranial nerves are at risk in the development of an acoustic neuroma?

A

V, VI, VII, VIII

45
Q

When would you supect an acoustic neuroma?

A

Any patient with unilateral senosorynerual hearing loss or tinnitus that cannot be explained by another cause

46
Q

What investigations would you do if you suspected acoustic neuroma?

A

MRI - all those with unilateral hearing loss/tinnitus

47
Q

What might be a differential diagnosis in someone presenting with features of an acoustic neuroma?

A

Meningioma

48
Q

How would you manage an acoustic neuroma?

A
  • Can watch and wait - repeat MRI scan every 4-6 months
  • Surgery - remove neuroma
  • Sterotactic radiotherapy
49
Q

What are the three branches that are given of from the facial nerve as it travels through the temporal bone the stylomastoid foramen?

A
  • Greater petrosal nerve
  • Nerve to stapedius
  • Chorda tympani
50
Q

What does the greater petrosal nerve supply?

A

Lacrimal gland

51
Q

What does the nerve to stapedius supply?

A

Stapedius muscle - dampens loud sounds through stapedial reflex - tenses stapedius muscle which reduces the amount the stapes vibrates

52
Q

What does the chorda tympani supply?

A

Taste sensation to the anterior 2/3rds of the tongue

53
Q

If someone was experiencing vertigo, what examinations would you want to perform?

A

Test cranial nerves

  • Nystagmus
  • Gait
  • Romberg’s
  • Unterberger’s
  • Dix hallpike
54
Q

What is important to distinguish in an apparent facial nerve palsy?

A

Whether it is UMN or LMN

55
Q

What are intracranial causes of facial nerve palsy?

A
  • Brainstem tumour
  • Stroke
  • Polio
  • MS
  • Cerebellopontine angle lesions - acoustic neuroma, meningitis
56
Q

What are intratemporal causes of facial nerve palsy?

A
  • Otitis media
  • Ramsay hunt syndrome
  • Cholesteatoma
57
Q

What are infratemporal causes of facial nerve palsy?

A
  • Parotid tumours
  • Trauma
58
Q

What are causes of facial nerve palsy’s besides infra/intratemporal and intracranial causes?

A
  • Lyme disease
  • Sarcoidosis
  • Guillain-Barre
  • Herpes
  • Diabetes
  • Bell’s Palsy
59
Q

How would you distinguish an UMN facial nerve palsy from a LMN facial nerve palsy?

A

UMN lesion spares the eyebrows/forehead region, as the UMN for the facial nerve is bilaterally represented in the brain. Therefore, if a lesion occurs in one of the hemispheres, the other still supplies the eyebrows

60
Q

What is characteristic about a LMN facial nerve palsy?

A

Ipsilateral total facial muscle paralysis

61
Q

What are signs of facial nerve palsy?

A
  • Facial muscle paralysis
  • Hyperacusis - loss of stapedius reflex
  • Loss of lacrimation
  • Decreased saliva production
  • Cause - cholesteatoma, herpes zoster signs, trauma
62
Q

What is thought to be the process behind the developent of bell’s palsy?

A

Inflammatory oedema from entrapment of VII nerve in the narrow facial bony canal, for exampe in viral polyneuropathy

63
Q

How does Bell’s palsy usually present?

A

Sudden onset

  • Sagging mouth
  • Dribbling from affected side
  • Watering/dry eyes
  • Impaired brow wrinkling, blowing, whistling, lid closure, taste, speech
64
Q

What can often preceed a Bell’s palsy?

A

URTI

65
Q

How would you manage a Bell’s Palsy?

A
  • Tape eye closed
  • Artificial tears
  • Prednisolone
  • Consider high dose aciclovir - if zoster cause
66
Q

What features would you ask about to screen for Ramsay Hunt Syndrome (herpes zoster infection)?

A
  • Preceding ear pain
  • Stiff neck
  • Reddish auricle
  • Zoster vesicles around the ear
  • Vertigo
  • Sensorinerual deafness
  • Severe VII nerve paralysis
67
Q

What are the different groups of causes of facial nerve palsy?

A
  • Intracranial
  • Intratemporal
  • Infratemporal
  • Others
68
Q

What are extrinsic causes of tinnitus?

A
  • Insect in external acoustic meatus
  • AV malformations
69
Q

What are intrinsic causes of tinnitus?

A
  • Idiopathic central tinnitus
  • VIII nerve tumours
  • Temporal lobe epilepsy
70
Q

What are peripheral causes of tinnitus?

A
  • Drugs
  • Labyrinthitis
  • Trauma
  • Vascular
  • Presbycusis
  • Meniere’s
  • Noise
  • Otosclerosis
71
Q

How would you assess hearing loss?

A

Use following

  1. Is there external ear pathology?
  2. Is the tympanic membrane normal?
  3. Tuning fork test
  4. Is the hearing normal?
  5. Is there conductive/snesory loss?
72
Q

If you were presented with someone who was complaining of dizziness, what are the two main things you you want to establish to narrow down your differencial diagnosis?

A
  1. Is this true vertigo? - illusion of movement rather than lightheadedness
  2. IF TRUE VERTIGO - What is the duration of the feeling of vertigo?
    • Seconds - Minutes - BPPV
    • Minutes - Hours - Meniere’s or Vestibular Migraine
    • Weeks - Labyrinthitis
73
Q

What is the house brackmann scale?

A

A score to grade the degree of nerve damage in a facial nerve palsy. The measurement is determined by measuring the upwards (superior) movement of the mid-portion of the top of the eyebrow, and the outwards (lateral) movement of the angle of the mouth

74
Q

What is grade one of the house brackmann scale?

A

Normal facial function in all areas

75
Q

What is grade two of the house brackmann scale of facial nerve palsy?

A

Mild dyfunction - Slight weakness noticeable on close inspection

76
Q

What is grade three of the house brackmann scale of facial nerve palsy?

A

Moderate dyfunction - Obvious weakness but not disfiguring at rest

77
Q

What is grade four of the house brackmann sclae?

A

Moderate-to-severe dysfunction - incomplete eye closure, obvious asymmetry

78
Q

What is grade five on the house brackmann scale for facial nerve palsy?

A

Severe dysfunction - Incomplete eye closure, only tewitch to gross motor movement

79
Q

What is grade six of the house brackmann scale of facial nerve palsy?

A

Total paralysis

80
Q

What is the house brackmann sclae used for in facial nerve palsy?

A

Determine prognosis in terms of potential for recovery

ENT (11 decks)

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