Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT > Middle ear > Flashcards

Middle ear Flashcards

1
Q

What epithelium on external ear

A

Stratified squamous keratinised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What epithelium in middle ear

A

Ciliated columnar epithelium with goblet cell

Can produce mucous which can cause glue ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three layers of the tympanic membrane

A

Outer = continuous with EAM
Middle fibrous
Inner layer of respiratory = same as middle ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What structures of the tympanic membrane

A 
Paratensa - tense
Paraflaccid - flaccid 
Cone of light - anterior inferior
Umbo in the middle
Annulus surrounds
Look at photo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If small perforation of TM

A

Small hearing loss

If large = large loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does middle ear do

A

Transforms acoustic energy from air to fluid

Acts as sound amplifier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the bones in the middle ear

A

Malleus
Incus
Stapes which is attached to foot plate in oval window

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does middle ear do its job

A

TM bigger than footplate so gives more energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can disrupt the middle ear

A 
Trauma
Bony sclerosis 
Chronic infection can erode incus
Fibrous tissue between ossicles so don't conduct
Oteosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is otosclerosis

A

AD bony deposition in annular ligament that surrounds oval window where staple plate is so sound doesn’t conduct into cochlea
CONDUCTIVE DEAFNESS
MAY HAVE TINNITUS AND TRANSINT VERTIGO
RX = HEARING AID OR SURGERY - STAPEDECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the role of the Eustachian tube

A

Connects middle ear to nasopharynx

Acts to equalise pressure in ear to that of EAM as middle ear needs to be at atmospheric pressure to work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can cause dysfunction

A

Inflammation
Infection
Genetics
Blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens if dysfunction

A

-ve pressure develops inside ear
Causes transudate to be pulled out of mucosa
Increased pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is otitis media

A

Inflammation / infection of the middle ear
Occurs when Eustachian tube stops working and fluid builds up underneath the ear drum

OME - can be sequels of otitis media but is regarded as a difference non-infective condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If adult what should you suspect

A

Is there a tumour blocking the ear drum causing Eustachian tube dysfunction
Do flexible nasal-endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you Rx

A

Grommet to equalise pressure if recurrent

Children do not require unless persistent and hearing loss is affecting development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why are young children particularly prone / RF

A

Eustachian tube smaller
Adenoids much larger
Cleft palate
Down syndrome

Other RF

  • URTI / scarlet fever
  • Bottle fed / use of dummy
  • Passive smoking
  • Adenoids
  • Asthma
  • Malformations e.g. cleft palate
  • Reflux
  • GORD / obesity in adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What causes acute otitis media

A 
Usually URTI (viral) induced effusion 2 to Eustachian dysfunction
- RSV
- Rhinovirus  
Can be bacteria
H.influenza
S.pneumonia = most common
M.catarrhalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the history

A

Short history
Prodromal URTI
Increasing pain
Bulging red ear drum causing pain which is relieved if perforates
Perforation = discharge
Hearing loss
May have fever but don’t act sick
Ear drum can perforate and discharge released
Can be very non-specific in young children - fever, vomit, irritable, poor feed so always examine if unwell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you Dx

A

Otoscopy showing red infected ear or perforated membrane
Always examine ears and throat of unwell children
Consider MC+S swab if discharge
CT / MRI if complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you Rx

A

Analgesia + anti-pyretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do you give Ax

A 
Symptoms 4+ days
Systemically unwell
Immunocompromsied
<2 + bilateral
Perforation or discharge
Admit if child <3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What Ax

A

Amoxicillin
Erythromycin 2nd line
5-10 days
Co-amox if no improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do you do if recurrent or complicated

A

Grommet insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are extra-cranial complications of AOM

A 
Perforation 
Acute mastoiditis / mastoid abscess
Facial nerve palsy 
Labrynthitis 
Ossicular / cochlear nerve damage = Hearing loss 
Tympanosclerosis due to scarring 
Chronic perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are intracranial complications

A 
Febrile convulsion
Brain abscess
Meningitis
Cavernous sinus thrombosis 
Sub or extradural empyema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes chronic otitis media

A

Cholesteatoma
Perforated TM with persistent or repeated infection
- Psuedomona
- S.aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the symptoms and how do you Rx

A 
Intermittent non-offensive discharge 
Hearing loss
May have pain
May develop 2 otitis externa due to discharge 
Complications = same as otitis media

Rx

  • Ax and steroid ear drop if infection present
  • Myringoplasty to repair drum and prevent infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is cholesteatoma

A

Abnormal collection of skin (keratinising squamous cells) in middle ear causing local destruction
Usually present in childhood due to eustachian dysfunction but can be congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the symptoms

A

Hx repeated smelly watery discharge despite Ax
Doesn’t resolve
Gradual unilateral hearing loss
Headache
Pain
May get vertigo / facial nerve palsy if extends which suggests inmepnding CNS complications
Other complications same as otitis media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you Dx

A

Otoscopy shows crust in upper part of ear drum
May not see if wax so debridement needed before
May see discharge if 2 infection

If complications
PTA
CT temporal bone

32
Q

How do you treat

A

Refer ENT for mastoidectomy to take away dead skin

33
Q

What can cholestatoma lead too

A 
Ear infection
Hearing loss
Mastoiditis 
Labrynthitiis 
Vertigo 
Tinnitius
Damage to facial nerve
Meningitis 
Brain abscess / paralysis
Venous sinus thrombosis
34
Q

What is otitis media with effusion ‘glue ear’

A

Collection of fluid in middle ear
Non-infective
Occurs when an effusion is present after regression of symptoms of acute OM

35
Q

What is most common cause of hearing loss in children

A

Otitis media with effusion

36
Q

How do you Dx

A

Otoscope shows fluid level of bubbles behind the ear drum
PTA = conductive loss
Tympanometry = flat trace

37
Q

What causes it

A

Eustachian tube dysfunction
- More common in Cleft / Syndrome
Adenoidal hypertrophy
Resolving AOM

38
Q

Who is more at risk

A 
Day care
Older siblings 
Parenteral smoking 
URTI 
Oversized adenoid 
Cleft palate
Down syndrome
39
Q

What are symptoms

A 
Hearing loss
Speech delay
Behaviour problems
Poor balance
Can go on to develop otitis media
40
Q

How do you Rx conservatively

A

Most improve by themselves so 3 months of active observation
Autoinflation if >4 - blow balloon using nose to create pressure and open up tube
Valsalva manoeuvre

41
Q

What advise

A

Stop smoking
Likely seasonal variation
Breast feeding reduces risk

42
Q

What are more invasive Rx

What are risk of Grommet

A

Grommet insertion if bilateral >3 months and affecting hearing / Down’s or cleft palate
Adenoidectomy as last resort
Hearing aids / bone implant if other options not effective

Risk

  • Infection
  • Tympanosclerosis
  • TM perforation
43
Q

What do you ask in history / examination of discharging ear

A

When did it start
Associated Sx
Otoscope

44
Q

What further investigation

A

Refer for pure tone audiometry / appropriate hearing test for age
Possible CT if continually discharge
Must exclude a post nasal space tumour as cause of fluid in an adult

45
Q

What causes perforated tympanic membrane

A

Infection = most common (Acute otitis media)
Previous surgery e.g. grommet which doesn’t close
Baro trauma
Blow to the ear

46
Q

What may it cause

A

Ear pain when perforation occurs + discharge
Hearing loss
Recurrent discharge
Increased risk of otitis media

47
Q

How do you Rx

A 
None in most usually heals 6-8 weeks 
Avoid getting water in 
Prescribe Ax if due to an episode of AOM
- Avoid ototoxic
- Ciprofloxacin = 1st line 
Myringoplasty if fails to heal by itself
48
Q

What is tympanosclerois

A

Hyalinzation and calcification of connective tissue in middle ear or TM

49
Q

What can it cause

A

White plaque on ear drum as calcified

Conductive hearing loss if affects the ossicles

50
Q

What are RF

A

Recurrent middle ear infection

Perforated TM

51
Q

How do you Rx

A

Hearing aid

Reconstruction of ear drum

52
Q

What are mastoid air cell

A

Form love middle ear
Air filled spaces in mastoid process of temporal bone
Air released from mastoid Antrum into tympanic cavity when pressure is too low

53
Q

What is mastoiditis

A

Inflammation of mastoid air cells

54
Q

What causes

A

Persistent otitis media

Choleastoma

55
Q

What are symptoms

A 
Red ear
Swelling around ear
Tenderness
External ear may protrude forward 
Discharge if perforates
Fever
Headache
Hearing loss
VERY UNWELL
56
Q

How do you Dx

A

Refer ENT

CT

57
Q

Complications of mastoiditis

A

Menignitis
OM
Hearing loss
CN palsy

58
Q

How do you Rx

A

IV Ax
Myringotomy
+- definitive mastoidectomy

59
Q

Most common cause of otitis media / rhino sinusitis

A

Strep pneumonia

60
Q

Most common cause of tonsillitis

A

Strep A

61
Q

What is recommended to Rx motion sickness

A

Hyoscine (transdermal patch)

Non-sedating antihistamine

62
Q

What are common bacterial pathogens in discharging ear

A 
Psuedomona
S>aureus
S.pneumonia
H.influenza
M.catarrhalis
63
Q

What do you want to know in HX

A 
Duration
Any ear pain
Fever / systemic Sx suggesting infective 
Any hearing loss
Any dizzy
Any FB
Any facial nerve palsy
Any trauma 
Rx tried
64
Q

What does trauma suggest discharge could be

A

CSF from basal skull fracture

65
Q

What are other Dx

A 
Cholesteatoma
FB
Malignant otitis externa 
Otitis externa
Ottis media with effusion
Perforated TM
66
Q

What can middle ear infections cause

A

Facial nerve palsy

67
Q

What is most common cause of this

A

Bell’s but Dx of exclusion so need to actively exclude other causes

68
Q

What are other causes

A

Trauma

  • Iatrogenic
  • Temporla fracture
  • Cholestatoma

Infectious

  • Ramsay hunt - VZV reactivation
  • 2 to acute / chronic otitis media / malignant

Neoplastic

  • Parotid or temporal bone tumour
  • Acoustic neuroma

Congenital
- CHARGE

Inflammatory

  • Sarcoid
  • GBS
  • MS

Other
- CVA

69
Q

How do you investigate

A 
Examine 
- Ear
- Throat 
- Parotid 
- Mass? 
Bloods
Audiogram 
PTA
MRI if suspect central cause
70
Q

How do you manage

A

Eye care - tears / tape shut
Refer ophthalmology
Oral steroid for Bells -1 mg/kg
Oral anti-viral for Ramsay

71
Q

What is Ramsay Hunt

A

HAZ reactivation in ganglion of facial nerve

Intense pain, palsy and vesicles

72
Q

What does facial nerve innervate in the eye

A

Orbicularis oculi
So if palsy not able to close the eye
If only mild some people will still be able to close

73
Q

What nerve innervates eye opening

A

Oculomotor

So if damaged = ptosis as can’t open ear

74
Q

What grades facial nerve

A

House Brackmann

75
Q

If forehead still moves what does this suggest

A

UMN

Scan brain to look for stroke

76
Q

What path does facial nerve take

A

Through ear and parotid

77
Q

If other branches are affected what can you get

A

Taste disturbance
HYperacusis
Lacrimation

ENT (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions