Lecture 8 Otology Flashcards by Jessica Eze

What symptoms would suggest an otology problem

Hearing loss
Tinnitus
Vertigo
Otalgia- ear pain
Otorrhoea- discharge from the ear and may originate from the ear canal or the middle ear.
Facial weakness

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Positive Rinne’s Test

Air>bone conduction- normal ear

air>bone conduction- sensorineural hearing loss

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Negative Rinnes test

Bone>air- conductive hearing loss

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What would you find in a normal ear through Weber’s Test

Left=Right hearing (central)

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What would you find in sensorineural hearing loss of the right ear through the Weber’s test

Left>Right. Tests lateralise to left

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What would you find in conductive hearing loss of the right ear through the Weber’s test

Right>left (test literalists to the right) lateralise to affected ear

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What does a Tympanogram do

Measures movement of eardrum and pressure

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What are the 3 types of results a Tympanogram looks for

Type A -normal middle ear pressure and compliance
Type B-low middle ear compliance- fluid under eardrum
Type C-low middle ear pressure- blockage of eustachian tube

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What is the management of Auricular Haematoma

Incision and drainage
Pressure dressing
Antibiotics

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What are the complications of auricular haematoma

• “Cauliflower ear”- blood becomes infected and erodes cartilage of pinna

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What is the management of a foreign body in the ear

Removal
Urgency
Button battery>organic>inorganic

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What is Otitis Externa

Inflammation of the skin of the external auditory meatus

• Build of debris

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What are the symptoms of Otitis Externa

Hearing loss
Pain
Discharge

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What is the management of Otitis externa

Antibiotic/Steroid ear drops
+/-suction under microscope to remove debris and make eardrops work better

Prevention- no cotton buds or water

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What is malignant Otitis externa

osteomyelitis of temporal bone

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What is the presentation of malignant Otitis externa

Severe pain in elderly diabetic
Granulations in external auditory meatus
+/- cranial nerve palsies

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What is the management for malignant Otitis Externa

• Antibiotics for weeks or months

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What is Otitis Media with Effusion (Glue ear)

Sterile fluid in middle ear

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What is the presentation of Otitis media with effusion

Hearing loss

Speech delay

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What is the management of otitis media with effusion

Observation for 3 months

Otovent or Grommet if it still persists

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What is Acute Suppurative Otitis Media

Pus in middle ear

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What is the presentation of Acute suppurative otitis media

Otalgia +/- Otorrhoea
Mostly seen in children
Discharge if tympanic membrane ruptures

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What is the management of Acute suppurative otitis media

Observation

Amoxicillin

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What is Tympanosclerosis

Calcification in tympanic membrane/middle ear

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What are the symptoms of Tymapnosclerosis

• Bleeding between layers of eardrums Usually asymptomatic No management

What is the pathology of Chronic suppurative otitis media

Chronic infection in middle ear Perforated tympanic membrane Cholestaetoma

What are the complications of chronic suppurative otitis media

* Dead ear * Facial palsy * Meningitis * Brain abscess

What are the causes of perforation of tympanic membrane

* Infection * Trauma * Grommet

What are the presentations of. perforated tympanic membrane

Hearing loss | Recurrent infections

Management of perforated tympanic membrane

Water precautions | Myringoplasty

What is Cholesteatoma

Eustachian tube dysfunction • Impaired skin migration- eardrum gets sucked in (retraction pocket) due to drop in pressure • Skin builds up in retraction pocket and expand into mastoid bone

Presentation of Cholestaetoma

Persistent offensive ottorrhoea

Management of Cholesteatoma

Mastoidectomy

What is Ostosclerosis

Extra bone forming around stapes

Presentation of Osteosclerosis

Conductive hearing loss | Normal tympanic membrane

Management of Osteosclerosis

Hearing aid | Stapedectomy

What are the causes of sensorineural hearing loss

* Presbycusis- natural aging of the auditory system * Head injury * Viral infection * Noise Exposure * Ototoxic medications * Acoustic Neuroma- benign tumour of inner ear (sensorineural hearing loss in one ear)

How is sensorineural hearing loss managed

Hearing aids

What type of tinnitus can you have

Unilateral | Pulsatile

What is the management of tinnitus

* Treat underlying condition * Sound enrichment- background sound * Stress management

What is Vertigo

Any perception of movement

Whats the differential diagnosis for vertigo

BPV and Menieres disease

What is the cause of BPV

* Otoconia in semi-circular canals- tiny crystals of calcium carbonate in one part of your inner ear become dislodged and float into another part * Moves to lower semi-circle of the canals

Clinical features of BPV

Vertigo Nystagmus Lasts seconds

What investigations are carried out for suspected BPV

Dix-halpike test

What is the management for BPV

Epley manoeuvre

What is vestibular neuritis/Labyrinthitis

Reaction of latent HSV infection of vestibular ganglion | Affects CN VIII- Vestibulocochlear

What are the clinical features of Vestibular neuritis/Labyrinthitis

* Spontaneous vertigo * Associated unilateral hearing loss with vertigo (labyrinthitis) * Duration- days * Nystagmus- horizontal, toward affected ear: eyes make repetitive, uncontrolled movements * Just vertigo- vestibular neuritis

Wha is the acute and chronic management of Vestibular neuritis/labyrinthitis

* Acute: Vestibula sedatives | * Chronic: Vestibular rehabilitation

What is Meniere's Disease

Pressure in endolymph on cochlear is raised causing endolymph hydrops

Clinical features of Meniere's disease

* Spontaneous vertigo * Associated unilateral hearing loss/tinnitus/aural fullness * Duration: hours

Management of Meniere's disease

* Bendroflumethazide- diuretics | * Intratympanic dexamethasone- steroids

What is the pathology of migraines

Vascular or neural

Clinical features of migraines

* Spontaneous vertigo * Duration: variable * headache, sensory sensitivity * ± precipitated by migraine triggers * ± past history of migraine

Clinical features of facial palsy

LMN facial palsy (forehead included) | Affects CN VII (facial nerve)

Differential diagnosis of facial nerve palsy

* Intratemporal eg cholesteatoma * Extratemporal eg parotid tumour * Idiopathic = Bell’s palsy

Management of Facial nerve palsy

* Treat underlying cause * Steroids- Bell’s palsy- inflammatory basis * Eye care

• A 25 year old woman presents with a two week history of pain and discharge from her ear

* Otitis externa | * Treatment- Topical antibiotics

• A 30 year old man presents with a 3 year history of offensive discharge from the right ear

• Mastoidectomy ? cholesteatoma

• A 5 year old girl is brought to clinic by her parents who are concerned abouther hearing. An audiogram shows a conductive hearing loss around 25dB bilaterally

* Review in 3 months | * Oitis media- Glue ear

• A 60 year old man presents with a 5 year history of bilateral tinnitus

* Age related hearing loss * Sound enrichment can help with bilateral tinnitus and drowning out the noise * Treatment- hearing aids

• A 60 year old man presents with a 5 year history of episodes of vertigo associated with hearing loss, tinnitus and pressure in the right ear.

* Ménière’s disease | * Diuretics, steroids