Lecture 8 Otology Flashcards
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
Positive Rinne’s Test
Air>bone conduction- normal ear
air>bone conduction- sensorineural hearing loss
Negative Rinnes test
Bone>air- conductive hearing loss
What would you find in a normal ear through Weber’s Test
Left=Right hearing (central)
What would you find in sensorineural hearing loss of the right ear through the Weber’s test
Left>Right. Tests lateralise to left
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
What does a Tympanogram do
Measures movement of eardrum and pressure
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
What is the management of Auricular Haematoma
- Incision and drainage
- Pressure dressing
- Antibiotics
What are the complications of auricular haematoma
• “Cauliflower ear”- blood becomes infected and erodes cartilage of pinna
What is the management of a foreign body in the ear
- Removal
- Urgency
- Button battery>organic>inorganic
What is Otitis Externa
Inflammation of the skin of the external auditory meatus
• Build of debris
What are the symptoms of Otitis Externa
- Hearing loss
- Pain
- Discharge
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
What is malignant Otitis externa
osteomyelitis of temporal bone
What is the presentation of malignant Otitis externa
- Severe pain in elderly diabetic
- Granulations in external auditory meatus
- +/- cranial nerve palsies
What is the management for malignant Otitis Externa
• Antibiotics for weeks or months
What is Otitis Media with Effusion (Glue ear)
Sterile fluid in middle ear
What is the presentation of Otitis media with effusion
Hearing loss
Speech delay
What is the management of otitis media with effusion
Observation for 3 months
Otovent or Grommet if it still persists
What is Acute Suppurative Otitis Media
Pus in middle ear
What is the presentation of Acute suppurative otitis media
- Otalgia +/- Otorrhoea
- Mostly seen in children
- Discharge if tympanic membrane ruptures
What is the management of Acute suppurative otitis media
Observation
Amoxicillin
What is Tympanosclerosis
Calcification in tympanic membrane/middle ear
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
