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Head and Neck > Lecture 8 Otology > Flashcards

Lecture 8 Otology Flashcards

1
Q

What symptoms would suggest an otology problem

A
  • 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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2
Q

Positive Rinne’s Test

A

Air>bone conduction- normal ear

air>bone conduction- sensorineural hearing loss

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3
Q

Negative Rinnes test

A

Bone>air- conductive hearing loss

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4
Q

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

A

Left=Right hearing (central)

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5
Q

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

A

Left>Right. Tests lateralise to left

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6
Q

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

A

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

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7
Q

What does a Tympanogram do

A

Measures movement of eardrum and pressure

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8
Q

What are the 3 types of results a Tympanogram looks for

A
  • 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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9
Q

What is the management of Auricular Haematoma

A
  • Incision and drainage
  • Pressure dressing
  • Antibiotics
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10
Q

What are the complications of auricular haematoma

A

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

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11
Q

What is the management of a foreign body in the ear

A
  • Removal
  • Urgency
  • Button battery>organic>inorganic
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12
Q

What is Otitis Externa

A

Inflammation of the skin of the external auditory meatus

• Build of debris

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13
Q

What are the symptoms of Otitis Externa

A
  • Hearing loss
  • Pain
  • Discharge
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14
Q

What is the management of Otitis externa

A
  • 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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15
Q

What is malignant Otitis externa

A

osteomyelitis of temporal bone

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16
Q

What is the presentation of malignant Otitis externa

A
  • Severe pain in elderly diabetic
  • Granulations in external auditory meatus
  • +/- cranial nerve palsies
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17
Q

What is the management for malignant Otitis Externa

A

• Antibiotics for weeks or months

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18
Q

What is Otitis Media with Effusion (Glue ear)

A

Sterile fluid in middle ear

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19
Q

What is the presentation of Otitis media with effusion

A

Hearing loss

Speech delay

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20
Q

What is the management of otitis media with effusion

A

Observation for 3 months

Otovent or Grommet if it still persists

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21
Q

What is Acute Suppurative Otitis Media

A

Pus in middle ear

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22
Q

What is the presentation of Acute suppurative otitis media

A
  • Otalgia +/- Otorrhoea
  • Mostly seen in children
  • Discharge if tympanic membrane ruptures
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23
Q

What is the management of Acute suppurative otitis media

A

Observation

Amoxicillin

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24
Q

What is Tympanosclerosis

A

Calcification in tympanic membrane/middle ear

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25
Q

What are the symptoms of Tymapnosclerosis

A

• Bleeding between layers of eardrums
Usually asymptomatic
No management

26
Q

What is the pathology of Chronic suppurative otitis media

A

Chronic infection in middle ear
Perforated tympanic membrane
Cholestaetoma

27
Q

What are the complications of chronic suppurative otitis media

A
  • Dead ear
  • Facial palsy
  • Meningitis
  • Brain abscess
28
Q

What are the causes of perforation of tympanic membrane

A
  • Infection
  • Trauma
  • Grommet
29
Q

What are the presentations of. perforated tympanic membrane

A

Hearing loss

Recurrent infections

30
Q

Management of perforated tympanic membrane

A

Water precautions

Myringoplasty

31
Q

What is Cholesteatoma

A

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

32
Q

Presentation of Cholestaetoma

A

Persistent offensive ottorrhoea

33
Q

Management of Cholesteatoma

A

Mastoidectomy

34
Q

What is Ostosclerosis

A

Extra bone forming around stapes

35
Q

Presentation of Osteosclerosis

A

Conductive hearing loss

Normal tympanic membrane

36
Q

Management of Osteosclerosis

A

Hearing aid

Stapedectomy

37
Q

What are the causes of sensorineural hearing loss

A
  • 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)
38
Q

How is sensorineural hearing loss managed

A

Hearing aids

39
Q

What type of tinnitus can you have

A

Unilateral

Pulsatile

40
Q

What is the management of tinnitus

A
  • Treat underlying condition
  • Sound enrichment- background sound
  • Stress management
41
Q

What is Vertigo

A

Any perception of movement

42
Q

Whats the differential diagnosis for vertigo

A

BPV and Menieres disease

43
Q

What is the cause of BPV

A
  • 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
44
Q

Clinical features of BPV

A

Vertigo
Nystagmus
Lasts seconds

45
Q

What investigations are carried out for suspected BPV

A

Dix-halpike test

46
Q

What is the management for BPV

A

Epley manoeuvre

47
Q

What is vestibular neuritis/Labyrinthitis

A

Reaction of latent HSV infection of vestibular ganglion

Affects CN VIII- Vestibulocochlear

48
Q

What are the clinical features of Vestibular neuritis/Labyrinthitis

A
  • 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
49
Q

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

A
  • Acute: Vestibula sedatives

* Chronic: Vestibular rehabilitation

50
Q

What is Meniere’s Disease

A

Pressure in endolymph on cochlear is raised causing endolymph hydrops

51
Q

Clinical features of Meniere’s disease

A
  • Spontaneous vertigo
  • Associated unilateral hearing loss/tinnitus/aural fullness
  • Duration: hours
52
Q

Management of Meniere’s disease

A
  • Bendroflumethazide- diuretics

* Intratympanic dexamethasone- steroids

53
Q

What is the pathology of migraines

A

Vascular or neural

54
Q

Clinical features of migraines

A
  • Spontaneous vertigo
  • Duration: variable
  • headache, sensory sensitivity
  • ± precipitated by migraine triggers
  • ± past history of migraine
55
Q

Clinical features of facial palsy

A

LMN facial palsy (forehead included)

Affects CN VII (facial nerve)

56
Q

Differential diagnosis of facial nerve palsy

A
  • Intratemporal eg cholesteatoma
  • Extratemporal eg parotid tumour
  • Idiopathic = Bell’s palsy
57
Q

Management of Facial nerve palsy

A
  • Treat underlying cause
  • Steroids- Bell’s palsy- inflammatory basis
  • Eye care
58
Q

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

A
  • Otitis externa

* Treatment- Topical antibiotics

59
Q

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

A

• Mastoidectomy ? cholesteatoma

60
Q

• 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

A
  • Review in 3 months

* Oitis media- Glue ear

61
Q

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

A
  • Age related hearing loss
  • Sound enrichment can help with bilateral tinnitus and drowning out the noise
  • Treatment- hearing aids
62
Q

• 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.

A
  • Ménière’s disease

* Diuretics, steroids

Head and Neck (16 decks)

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