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Head & Neck > Lecture 6.2: Common Disorders of the Ear > Flashcards

Lecture 6.2: Common Disorders of the Ear Flashcards

1
Q

What is done during external inspection and
palpation of the Ear?

A
  • Pinna is inspected for size,
    position, shape, lesions and
    discharge. * Pinna palpated for tenderness,
    swelling or nodules. * Examiner should apply pressure
    on mastoid tip, which should be
    painless; tenderness may
    indicate mastoiditis
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2
Q

What is done at the start of an Ear Examination? (3)

A
  • WIPER
  • Ear least likely to have pathology is examined first
  • Examiner sits to the side of the patient
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3
Q

What us done during an Otoscopic Examination of the Ear? (3)

A
  • External auditory canal is straightened by pulling
    pinna up, out and back using the other hand
  • In a child, the ear canal is instead straightened by
    pulling the pinna down and back
  • Any wax should be left undisturbed unless
    interfering with visualisation
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4
Q

How should the Ear appear in a normal Otoscopic Examination? (3)

A
  • Tympanic membrane should appear intact,
    translucent, and pearly grey in colour
  • Blood vessels should be visible around the
    perimeter
  • The handle of the malleus should be seen near the
    centre
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5
Q

How are disorders and pathologies of the ear classified?

A

They are categorised according to location

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6
Q

What are the 3 catagerisations of locations of ear pathologies?

A
  • External Ear
  • Middle Ear
  • Inner Ear
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7
Q

What structures can be found in the External Ear? (4)

A
  • Pinna
  • External Ear Canal (EAC)
  • Helix
  • Lobule
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8
Q

What structures can be found in the Middle Ear? (5)

A
  • Tympanic Membrane
  • Ossicles (malleus, incus, stapes)
  • Oval Window
  • Round Window
  • Eustachian tube
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9
Q

What structures can be found in the Inner Ear? (4)

A
  • Cochlea
  • Semi-Circular Canals (Labyrinth)
  • Vestibule
  • Nerves
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10
Q

Symptoms of Ear Disease (3)

A
  • Otalgia
  • Pruritis
  • Otorrhoea
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11
Q

What is Otalgia? What does it indicate?

A
  • Ear Pain
  • May be related to inflammatory conditions in or
    around the ear
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12
Q

What is Pruritis? What does it indicate?

A
  • Itching
  • May result from a primary disorder of the external
    ear or as a result of discharge from middle ear
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13
Q

What is Otorrhoea? What does it indicate?

A
  • Discharge from Ear
  • Indicates Infection
  • Bloody discharge may be associated with leakage of
    cerebrospinal fluid secondary to skull fracture
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14
Q

What is Referred Otalgia?

A

Pain felt in the ear but originating from a nonotologic source

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15
Q

What is Anotia?

A

Congenital absence of pinna with narrowing or
absence of ear canal, can be uni/bilateral

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16
Q

What type of hearing loss do Anotia and Microtia cause?

A

Conductive Hearing Loss

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17
Q

How is Anotia and Microtia treated?

A
  • Treated surgically (repair of ear canal +/- cosmetic
    reconstruction/prosthetics)
  • May require bone-anchored hearing aid
    implantation
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18
Q

What is Microtia?

A

Underdeveloped auricle, can be unilateral or
bilateral, varies in severity

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19
Q

What is Pinna Haematoma?

A
  • Usually caused by blunt trauma to the ear
  • Perichondrial blood vessels tear, resulting in
    haematoma forming between the auricular cartilage
    and the overlying perichondrium
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20
Q

How is Pinna Haematoma treated?

A

Requires drainage of fluid

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21
Q

What happens if Pinna Haematoma is left untreated?

A
  • Fluid collects under perichondrium, separating it
    from the underlying cartilage,
  • This results in cartilage death and the formation of
    fibrous tissue (cauliflower ear)
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22
Q

How does BCC present on the Ear?

A

Often painless, raised, shiny, and vascular, with ulceration

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23
Q

What is the most common skin cancer? What is it associated with?

A
  • Basal Skin Carcinoma (BCC)
  • Associated with sun exposure and lighter skin
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24
Q

What is the second most common skin cancer? What is it associated with?

A
  • Squamous Skin Carcinoma (SSC)
  • Associated with sun exposure and lighter skin
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25
Q

How does SCC present?

A

Typically presents as hard lump with scaly top layer, but may instead form an ulcer

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26
Q

Is SCC or BCC more likely to metastasise?

A

SCC

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27
Q

How are BCC and SCC treated?

A

Surgical excision

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28
Q

What is another name for Ear Wax?

A

Cerumen

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29
Q

What is the role of ear wax normally?

A

Provide protection against particulate matter and microbes, carrying them to the entrance of the ear
canal through epithelial migration and jaw movement

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30
Q

What can happen if there is excess ear wax?

A

Can lead to conductive hearing loss

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31
Q

How is excess ear wax treated? (3)

A
  • Softeners
  • Syringing
  • Curette Method
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32
Q

How may a foreign body in the auditory canal present? (3)

A
  • Pain
  • Deafness
  • Discharge
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33
Q

How is a foreign body in the auditory canal treated?

A

Removal with forceps or hook, irrigation, or suction with catheter

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34
Q

What is Otitis Externa?

A

Inflammation of the external ear (auricle, external auditory canal, and outer surface of eardrum), may be localised, diffuse, acute, or chronic

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35
Q

How does Otitis Externa present? (5)

A
  • Pain
  • Itching
  • May be associated with discharge
  • Possible hearing loss
  • Pain on movement of the tragus or auricle
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36
Q

What does Otoscopy of Otitis Externa reveal? (3)

A
  • Erythema
  • Oedema
  • Exudate
37
Q

How is Otitis Externa treated? (2)

A
  • Topical Drops
  • Preventative measures (e.g. earplugs during
    swimming)
38
Q

Malignant Otitis Externa

A
  • Life threatening extension into mastoid and
    temporal bones
  • Often caused by pseudomonas
  • Usually affects early diabetics/immunocompromised
    patients
  • Extremely painful beyond what is normally expected
  • Can lead to cranial nerve palsies and death
39
Q

What is Otitis Media?

A

Umbrella term for infective and inflammatory conditions affecting middle ear, may be acute or chronic

40
Q

Who does Otitis Media more commonly affect?

A

More common in children due to shorter and more horizontal Eustachian tubes

41
Q

How does Otitis Media present? (3)

A
  • Hearing Loss
  • Otalgia
  • Fever
42
Q

What does Otoscopy of Otitis Media reveal? (2)

A
  • Tympanic membrane will be erythematous and may
    be bulging
  • If fluid pressure perforates TM, there may be
    purulent discharge visible
43
Q

How is Otitis Media treated? (3)

A
  • Analgesics
  • Antipyretics
  • Antibiotics if required
44
Q

How is Perforation of the Tympanic Membrane treated?

A
  • Often heals spontaneously
  • Treatment involves ear drops and surgery if
    necessary
45
Q

What is Purulent Ottorhoea?

A
  • Pus draining from the ear canal
  • Seen in TM perforation
46
Q

What is Mastoiditis?

A

Inflammation of mucosal lining of mastoid antrum and mastoid air cell system inside the mastoid
process due to infection causing acute suppuration with back pressure into the mastoid cavity

47
Q

What is Mastoiditis often a complication of?

A

Serious complication of otitis media, can lead to death

48
Q

Signs and Symptoms of Mastoiditis (7)

A
  • Earache
  • Fever
  • Malaise
  • Tender Mastoid
  • Swollen Mastoid
  • Erythematous Mastoid
  • Prominent pinna
49
Q

How is Mastoiditis treated? (2)

A
  • Antibiotics
  • May require surgery
50
Q

What is Otitis Media with Effusion (OME)?

A

Chronic inflammatory condition without acute inflammation caused by eustachian tube disfunction, there is an effusion of glue-like fluid behind an intact tympanic membrane

51
Q

Signs and Symptoms of OME

A
  • Usually Painless
  • Conductive Hearing Loss
  • Speech and Language Delay
  • Educational Problems
  • Dull and Retracted TM with visible effusion and/or
    bubbles
52
Q

What condition does OME often follow?

A

Often follows a slowly resolving acute otitis media

53
Q

How to manage OME? (3)

A
  • Otovent
  • Grommets
  • Hearing Aids
54
Q

What can prolongued negative middle ear
pressure lead to?

A

Retraction of the tympanic membrane and cholesteatoma

55
Q

What is Otovent?

A
  • Involves regularly inflating a specialised balloon
    with the nostril
  • Increases middle ear pressure, thereby equalising
    pressure either side of the tympanic membrane
  • In cases of middle ear effusions, this can enable
    clearance down the Eustachian tube
56
Q

What is a Grommet?

A
  • Small tube inserted into ear drum in order to
    equalise middle ear pressure and prevent
    accumulation of fluid there
  • A temporary measure, falling out after 12-24
    months as the TM heals
57
Q

What is a Cholesteatoma?

A

Expanding growth consisting of keratinising squamous epithelium in the middle ear and/or mastoid process

58
Q

What happens if a Cholesteatoma gets too big?

A

Can result in destruction of the bones of the middle ear, as well as growth through the base of the
skull into the brain

59
Q

Signs and Symptoms of Cholesteatoma

A
  • Hearing Loss
  • Odorous Discharge
  • Recurrent Infections
  • Conductive Hearing Loss
  • Discharge
  • Keratin Debris
  • Attic Crusts
  • Polyps
60
Q

Complications of a Cholesteatoma

A

Brain infections and abscesses

61
Q

How is a Cholesteatoma treated?

A

Treatment is usually surgical

62
Q

When can Facial Nerve Dysfunction occur?

A

The facial nerve runs through the middle ear and is
vulnerable to damage from middle ear disease

63
Q

Signs and Symptoms of Facial Nerve Dysfunction (8)

A
  • Ipsilateral Facial Weakness
  • Loss of Taste
  • Hyperacusis
  • Decreased Salivation
  • Tear Aecretion
  • Smoothing out of Forehead
  • Eyebrow Drooping
  • Drooping of Corner of Mouth
64
Q

What is Otosclerosis?

A

Remodelling of the bony labyrinth, restricting movement of the stapes, fixation of the stapes footplate to the oval window of the cochlea

65
Q

Complications of Otosclerosis (3)

A
  • Conductive Hearing Loss
  • Tinnitus
  • Vertigo
66
Q

What can cause Otosclerosis? (2)

A
  • Genetic
  • Environmental Factors/Infections (Measles)
67
Q

How is Otosclerosis treated? (3)

A
  • Sodium Fluoride (slows progression of
    disease)
  • Stapedectomy
  • Amplification with Hearing Aids
68
Q

Deafness will arise if…? (2)

A
69
Q

What is Audiometry?

A

Diagnostic hearing test, measuring ability to hear
pitch (Hz) and loudness (dB)

70
Q

What is normal hearing range in Hz?

A

Between 20-20,000 Hz

71
Q

What is Benign Positional Vertigo?

A
  • Repeated, brief periods of a spinning sensation
    upon head movement
  • Typically lasts less than one minute
72
Q

What can cause Benign Positional Vertigo?

A

Can be caused by a small otolith moving around loose in inner ear OR an unidentified cause

73
Q

How is Benign Positional Vertigo diagnosed?

A

Dix-Halpike manouvre causing nystagmus

74
Q

How is Benign Positional Vertigo treated?

A

May be treated with the Epley manouvre

75
Q

What is Menieres Disease?

A

An ear condition that can cause sudden attacks of vertigo lasting minutes/hours, due to endolymphatic
hydrops (excess fluid/pressure in endolymph)

76
Q

How does Menieres Disease present? (4)

A
  • Vertigo
  • Tinnitus
  • Hearing Loss
  • Inner Ear Fullness
77
Q

How is Menieres Disease treated?

A

Attacks are often treated with medications to help with nausea and anxiety, no treatment for actual condition

78
Q

What is Labyrinthitis?

A

Inflammation of the labyrinth

79
Q

Signs and Symptoms of Labyrinthitis (7)

A
  • Spinning Sensation
  • Hearing Loss
  • Tinnitus
  • Nausea
  • Vomiting
  • Nystagmus
  • Can cause permanent hearing loss in extreme cases
80
Q

What can cause Labyrinthitis? (2)

A
  • Infection
  • Head Injury
81
Q

How is Labyrinthitis treated?

A

Depends on cause

82
Q

What are Vestibular Migraines?

A
  • A feeling of rotation or illusory sensations of motion
    or both associated with headache
  • Treated as migraine
83
Q

What is Rinne’s Test?

A
  • Performed by placing a vibrating 512Hz tuning fork
    against patient’s mastoid bone, then asking patient
    to tell you when sound no longer heard
  • The fork is then placed near the auditory canal, and
    the patient is asked whether they can now hear the
    sound
84
Q

Rinnes Test: What does it mean if Bone > Air Conduction?

A

Conductive Hearing Loss

85
Q

Rinnes Test: What does it mean if Air > Bone Conduction?

A

Normal or Sensorineural Hearing Loss

86
Q

What is Weber’s Test?

A
  • A vibrating tuning fork is placed in the middle of the
    forehead
  • The patient is asked whether the sound is louder on
    one side or equal in both
  • In a normal test, the sound is heard loudest in the
    middle of the head
87
Q

Weber’s Test: Normal Hearing

A

Midline Localisation

88
Q

Weber’s Test: Sensorineural Hearing Loss

A

Localises to normal ear/Localises opposite to affected ear

89
Q

Weber’s Test: Conductive Hearing Loss

A

Localises to affected ear

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