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Internal Medicine > OHCEPS - Ear, Nose, And Throat > Flashcards

OHCEPS - Ear, Nose, And Throat Flashcards

1
Q

Into what is the auricle divided?

A
  1. Antihelix
  2. Helix
  3. Lobe
  4. Tragus
  5. Concha
    composed of fibrocartilage - the ear lobe is adipose only.
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2
Q

Describe the tympanic membrane.

A
  1. Thin
  2. Grey
  3. Oval
  4. Semitransparent membrane
  5. At the medial end of the external acoustic meatus 1cm in diameter.
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3
Q

Where does the middle ear lie?

A

In the petrous part of the temporal bone and is connected to the nasopharynx via the Eustachian tube.
It connects with the mastoid air cells.

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4
Q

Which are the 2 muscles of the middle ear?

A

Stapedius and tensor tympani.

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5
Q

Which are the paranasal sinuses?

A
  1. Frontal
  2. Ethmoid
  3. Sphenoid
  4. Maxillary
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6
Q

What is the role of the paranasal sinuses?

A
  1. Protection of intracranial structures.
  2. Eyes from trauma
  3. Aid to vocal resonance
  4. Reduction of skull weight.
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7
Q

What does the oral cavity include?

A
  1. Lips
  2. Anterior 2/3 of the tongue
  3. Hard palate
  4. Teeth
  5. Alveoli of the mandible and maxilla
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8
Q

How many sets of teeth develop during lifetime?

A

Two sets of teeth.

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9
Q

What is the first set of teeth that develops?

A

Milk teeth.

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10
Q

What is the timeline for the different teeth types?

A 
Incisors --> 6months.
Rest follow within 3 years.
In the permanent set --> 1st molar or central incisor --> 6yrs.
2nd molar --> 11yrs.
3rd molar --> 18yrs (wisdom teeth).
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11
Q

Where does the larynx lie?

A

At the level of the bodies of C33-C6 vertebrae.

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12
Q

What is the role of the larynx?

A
  1. Prevent food and saliva from entering the respiratory tract.
  2. As a phonating mechanism for voice production.
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13
Q

Where is the epiglottis attached?

A

To the thyroid cartilage + Occludes the laryngeal inlet during shallowing.

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14
Q

Mention the 3 main salivary glands.

A
  1. Parotid
  2. Submandibular
  3. Sublingual
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15
Q

Where do the parotid ducts open?

A

They cross the masseter muscles and open into the oral cavity OPPOSITE the upper 2nd MOLAR TEETH.

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16
Q

What should also be asked when otalgia is the presenting complaint?

A
  1. Discharge
  2. Hearing loss
  3. Previous ear operations
  4. Ear syringing
  5. Use of cotton buds
  6. Trauma
  7. Swimming
  8. Air travel
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17
Q

What is the sensory supply of the ears?

A

V, IX, X and the C2, C3 nerves –> Otalgia may be referred from other areas.

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18
Q

Mention some causes of otological otalgia.

A
  1. Acute otitis externa
  2. Acute otitis media
  3. Perichondritis
  4. Furunculosis
  5. Trauma
  6. Neoplasm
  7. Herpes zoster (Ramsey Hunt syndrome)
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19
Q

Mention some NON-otological causes of otalgia.

A
  1. Cervical spine disease
  2. Tonsillitis
  3. Dental disease
  4. Temporo-mandibular joint disease
  5. Neoplasms of the pharynx or larynx
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20
Q

What is otorrhoea?

A

Discharge from the external auditory meatus.

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21
Q

What should be asked about the nature of the discharge in otorrhea?

A
  1. Watery –> Eczema, CSF.
  2. Purulent –> Acute otitis externa
  3. Mucoid –> Chronic suppurative otitis media with perforation
  4. Mucopurulent/blood stained –> Trauma, acute otitis media, cancer.
  5. Foul-smelling –> Chronic suppurative otitis media, cholesteatoma.
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22
Q

What should be asked during PC, regarding hearing loss?

A
  1. The time and speed of onset.
  2. Is it partial or complete?
  3. Are both ears affected or just one?
  4. Is there associated pain, discharge, or vertigo?
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23
Q

What should be asked during PMH, regarding hearing loss?

A

Especially tuberculosis and septicaemia.

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24
Q

What should be asked during FHx regarding hearing loss?

A

Hearing loss may be inherited (e.g., otosclerosis).

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25
Q

What should be asked during DHx, regarding hearing loss?

A

Certain drugs, particularly those which are toxic to the renal system, affect the ear –>

  1. Aminoglycosides
  2. Some diuretics
  3. Cytotoxic agents
  4. Salicylates + quinine show reversible toxicity.
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26
Q

What should be asked during SHx, regarding hearing loss?

A
  1. Occupation and leisure activities should not be overlooked.
  2. Prolonged exposure to loud noise (heavy industrial machinery)
  3. Levels of 90dB or greater require ear protection.
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27
Q

Mention some causes of CONDUCTIVE hearing loss.

A
  1. Wax
  2. Otitis externa, if ear is full of debris.
  3. Middle ear effusion
  4. Trauma to ossicles
  5. Otosclerosis
  6. Chronic middle ear infection (current or previous)
  7. Tumors of the middle ear
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28
Q

Mention some causes of sensorineural hearing loss.

A
  1. Presbyacusis
  2. Vascular ischemia
  3. Noise exposure
  4. Inflammatory/infectious diseases - measles, mumps, meningitis, syphilis.
  5. Ototoxicity
  6. Acoustic tumors (progressive unilateral hearing loss, but may be bilateral).
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29
Q

What is tinnitus?

A

Perception of abnormal noise in the ear or head and may be caused by almost any pathology in the auditory apparatus.

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30
Q

What should be asked about tinnitus?

A
  1. Character
  2. Associated hearing loss
  3. How the tinnitus bothers them (sleep or daily living affected)
  4. Any previous history of ear disease as well as the full standard history.
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31
Q

What is the MC tinnitus?

A

Rushing, hissing, or buzzing tinnitus - Usually associated with hearing loss.

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32
Q

How is rushing, hissing, or buzzing tinnitus caused?

A

By pathology in the inner ear, brainstem or auditory cortex. Sometimes can appear with conductive hearing loss.

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33
Q

What is pulsatile tinnitus?

A

It is caused by noise transmitted from blood vessels close to the ear.
–> ICA, IJV.
Occasionally, can be heard by an observer by using a stethoscope over the ear or neck.

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34
Q

Cracking and popping noises may be associated with what?

A
  1. Dysfunction of the Eustachian tube.

2. Rhythmic myoclonus of the muscles in the middle ear or attached to the Eustachian tube.

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35
Q

What should be kept in mind about tinnitus?

A

It must be distinguished from complex noises (e.g., voices, music) which may constitute AUDITORY HALLUCINATIONS –> psychiatric diagnosis.

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36
Q

Mention some causes of tinnitus.

A
  1. Presbyacusis
  2. Noise-induced hearing loss
  3. Meniere’s disease
  4. Ototoxic drugs
  5. Trauma
  6. Any cause of conductive hearing loss
  7. Acoustic neuromas
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37
Q

Mention 3 causes of pulsatile tinnitus.

A
  1. Arterial aneurysms
  2. Arteriovenous malformations
  3. Glomus tumors of the middle ear
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38
Q

From what must the term “Dizziness” be distinguished?

A
  1. Light-headedness
  2. Pre-syncope
  3. Pure unsteadiness
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39
Q

Mention 2 features of dizziness that suggest vestibular origin.

A
  1. Vertigo –> An hallucination of movement, MC rotational.

2. Dizziness –> Related to movement or position change.

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40
Q

What should be asked when the patient reports dizziness?

A

It should be established whether or not the dizziness is due to vestibular disease:

  1. Nature + Severity of disease
  2. Whether it is persistent or intermittent.
  3. Duration of attacks (seconds, hours, or days)
  4. Patterns of events since the onset
  5. Relation to movement or position, especially lying down.
  6. Associated symptoms
  7. DHx including ALCOHOL
  8. Other ear problems or previous ear surgery
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41
Q

What is the MC type of vertigo?

A

Rotational - may be tilting or swaying.

Whether it is movement of the person or the surrounding is IRRELEVANT.

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42
Q

Which dizziness is specific to benign paroxysmal positional vertigo?

A

Dizziness provoked by lying down, rolling over, or sitting up.

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43
Q

How do we figure CENTRAL vestibular lesions?

A

These are not always easy to distinguish on the history but vertigo is NOT so marked and GAIT disturbances + other neurological symptoms and signs would suggest this.

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44
Q

Mention some otological causes of dizziness.

A
  1. Benign paroxysmal positional vertigo
  2. Meniere disease
  3. Vestibular neuronitis
  4. Trauma (surgery or temporal bone fracture)
  5. Perilymph fistula
  6. Middle ear infection
  7. Otosclerosis
  8. Syphilis
  9. Ototoxic drugs
  10. Acoustic neuromas
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45
Q

Mention some non-otological causes of dizziness/disequillibrium.

A
  1. These are often more disequilibrium than dizziness.
  2. Aging (poor eyesight and proprioception)
  3. Cerebrovascular disease
  4. Parkinson’s
  5. Migraine
  6. Epilepsy
  7. Demyelinating disorders
  8. Hyperventilation
  9. Drugs –> Cardiovascular, neuroleptic drugs, and alcohol.
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46
Q

In a patient with nasal obstruction, what should be established during history?

A
  1. Nose blocked constantly or intermittently.
  2. Unilateral/bilateral
  3. Associated discharge
  4. Relieving/exacerbating factors
  5. Use of nasal drops or other “per-nasal” substance.
  6. Don’t miss any previous history of nasal surgery.
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47
Q

Constant nasal obstruction may be a sign of what?

A

Long standing structural deformity such as deviated septum, nasal polyps, or enlarged turbinates.

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48
Q

Intermittent nasal obstruction may be a sign of what?

A

Allergic rhinitis and common cold.

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49
Q

What types of nasal discharge are there?

A
  1. Watery or mucoid
  2. Purulent
  3. Blood stained
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50
Q

Watery or mucoid discharge may be a sign of what?

A
  1. Allergic or infective (viral) or Vasomotor rhinitis.

2. A UNILATERAL copious watery discharge may be due to CSF rhinorrhoea.

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51
Q

Purulent discharge may be a sign of what?

A

Infective rhinosinusitis or foreign body (especially if unilateral).

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52
Q

Blood-stained discharge may be a sign of what?

A

With unilateral symptoms - tumors, a bleeding diathesis, or trauma.

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53
Q

What is another name for anterior septum?

A

Little’s area.

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54
Q

What happens in Little’s area?

A

It is the point of convergence of the anterior ethmoidal artery, the septal branches of the sphenopalantine and superior labial arteries, and the greater palantine artery.

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55
Q

What is the MCC of epistaxis?

A

Spontaneous rupture of a blood vessel in the nasal mucous membrane.

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56
Q

Mention some causes of epistaxis.

A
  1. Trauma from nose picking, surgery, or infection.
  2. Prolonged bleeding may be caused by anticoagulants, HTN, alcohol, coagulation defects, and hereditary telangiectasia.
  3. Neoplasia and angiomas of the post-nasal space and nose may present with epistaxis.
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57
Q

With what is sneezing associated?

A

Most commonly due to viral URI and allergic rhinitis.

Commonly associated with rhinorrhoea and itching of eyes and nose.

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58
Q

What causes anosmia most commonly?

A
  1. Nasal polyps - may be caused by head injury disrupting the olfactory fibers emerging through the cribiform plate.
  2. May be also complicate a viral URI - viral neuropathy.
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59
Q

What is termed “cacosmia”?

A

The hallucination of an unpleasant smell and may be caused by infection interfering with the olfactory structures.

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60
Q

Mention 3 conditions with saddle nose.

A
  1. Wegener
  2. Congenital syphilis
  3. Long term snorting of cocaine
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61
Q

What is acne rosacea?

A

Can cause an enlarged, red, and bulbous rhinophyma. Widening of the nose is an early feature of ACROMEGALY.

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62
Q

Facial pain may be related to what?

A 
Not normally to local nasal causes.
More frequently to:
1. Sinuses
2. Trigeminal neuralgia
3. Dental sepsis
4. Migraine
5. Mid-facial tension pain
63
Q

What is the MCC of pain in the oral cavity?

A

Dental caries and peridental infection.

Peridental disease can cause pain on tooth-brushing and is associated with halitosis.

64
Q

What should be established regarding sore throat?

A

WHERE the pain is felt.

65
Q

Most acute sore throats are associated with what?

A
  1. Rhinorrhoea
  2. Productive cough
  3. Infectious mono in teens
    Generally, viral in origin.
66
Q

With what is acute tonsillitis associated?

A

Systemic symtpoms such as:

  1. Malaise
  2. Fever
  3. Anorexia
67
Q

What should be considered in ALL chronically sore throats in adults?

A

Malignancy - Ask about cancer symptoms:

  1. Dysphagia
  2. Dysphonia
  3. Weight loss
  4. History of alcohol/smoking
68
Q

What questions should be asked in chronic pharyngitis?

A
  1. Ask about irritants such as tobacco smoke and alcohol.
  2. Consider chronic tonsillitis, post-nasal drip from chronic sinusitis, acid reflux, and chronic non-infective laryngitis.
69
Q

Throat pain often radiates where?

A

To the ear because the pharynx and external auditory meatus are Innervated by the X nerve.

70
Q

Lumps in the mouth occur where primarily?

A
  1. Lips
  2. Tongue
  3. Oral cavity
71
Q

A lump on the lips is a common site of what?

A

Localized malignancy –> BCC and SCC.

72
Q

Lumps on the tongue are nearly always what?

A

Neoplastic

73
Q

To what may blockage of a minor salivary gland give rise?

A

To a cystic lesion called –> Ranula - usually sites in the floor of the mouth.

74
Q

Most malignant lesions on the floor of the mouth present late or early?

A

Late.

75
Q

Inside the oral cavity what is a common site for cancer?

A

The buccal lining.

76
Q

What is globus pharyngeus?

A

This is a sensation of a lump in the throat (Globus pharyngeus or globus syndrome).

77
Q

What is important to ask in a patient with globus pharyngeus?

A
  1. Symptoms of GERD
  2. Post-nasal drip
  3. Occasionally malignant –> dysphagia, odynophagia, hoarseness, weight loss.
78
Q

Neck lumps are usually secondary to what?

A

To infections - a minority are due to malignant disease.

79
Q

What is the MCC of neck swelling?

A

Lymph node enlargement.

80
Q

What is worth remembering in the adult about lumps in the neck?

A

Metastatic disease may represent spread from structures below the clavicle including:

  1. Lung
  2. Breast
  3. Stomach
  4. Pancreas
  5. Kidney
  6. Prostate
  7. Uterus
81
Q

If a patient presents with a lump in the neck, what should be asked especially?

A
  1. Duration of the swelling
  2. Progression in size
  3. Associated pain or other symptoms in the upper aerodigestive tract - Odynophagia, dysphagia, dysphonia.
  4. Systemic symptoms - Weight loss, night sweats, malaise.
  5. Smoking and alcohol habits.
82
Q

What is dysphonia?

A

An alteration in the quality of the voice.

83
Q

What are the possible categories of causes for dysphonia?

A
  1. Inflammatory
  2. Neurological
  3. Neoplastic
  4. Systemic
  5. Psychogenic
84
Q

Mention some inflammatory causes of dysphonia.

A
  1. Acute laryngitis
  2. Chronic laryngitis
  3. Chronic vocal abuse
  4. Alcohol
  5. Smoking
85
Q

Mention some neurological causes of dysphonia.

A

Central –> Pseudobulbar palsy/ cerebral palsy/ MS/ Stroke/ Guillain-Barré syndrome/ head injury.
Peripheral –> Lesions affecting the X and recurrent laryngeal nerves (e.g. Lung cancer, post-thyroidectomy, cardiothoracic, esophageal surgery), myasthenia gravis, motor neuron disease.

86
Q

Mention a neoplastic cause of dysphonia.

A

Laryngeal Cancer

87
Q

Mention systemic causes of dysphonia.

A
  1. RA
  2. Angiogenic edema
  3. Hypothyroidism
88
Q

Mention some causes of halitosis.

A
  1. Poor dental hygiene or diet.
  2. Tonsillar infection
  3. Gingivitis
  4. Pharyngeal pouch
  5. Chronic sinusitis with Purulent post nasal drip can also cause bad breath.
89
Q

What is Stridor?

A

Noise from the upper airway and is caused by narrowing of the trachea or larynx.

90
Q

Mention the main causes of Stridor in adults.

A
  1. Laryngeal cancer
  2. Laryngeal trauma
  3. Epiglottitis
  4. Cancer of the trachea or main bronchus
91
Q

What should be done during inspection and palpation of the ear?

A
  1. Briefly inspect the external structures of the ear –> particularly Pinna, noting shape, size, and any deformity.
  2. Carefully inspect for any skin changes suggestive of cancer.
  3. Don’t forget to look behind the ears for any scars or a hearing aid.
  4. Pull on the pinna and ask the patient if it is painful. (External auditory meatus infection)
  5. Palpate the area in front of the tragus and ask if there is any pain - temporo-mandibular joint disease.
  6. Look for any discharge.
92
Q

What do we examine with the otoscope?

A
  1. External auditory canal
  2. Eardrum
  3. Few middle ear structures
93
Q

A healthy eardrum should appear as what?

A

Greyish and translucent.

94
Q

What is termed tympanosclerosis?

A

Any white patches or perforation.

95
Q

What is a sign of acute otitis media?

A

A reddened, bulging drum.

96
Q

Dull grey, yellow drum may indicate what?

A

Middle ear infection.

97
Q

What does external inspection of the nose involve?

A
  1. Inspect the external surface and appearance of the nose noting any deformity or disease.
  2. Stand behind the patient and look down - over their head to detect any deviation.
98
Q

What should be done during palpation of the nose?

A
  1. Gently Palpate the nasal bones and ask the patient to alert you to any pain.
  2. If a visible deformity is present, Palpate to determine if it is bony (hard or immobile) or cartilaginous (firm but compressible).
  3. Feel for facial swelling and tenderness - tenderness suggest underlying inflammation.
99
Q

How do we examine the Nasopharynx?

A

Using fine-bore endoscopy - done by trained professionals - student or non specialist should examine anterior portion of the nose only.

100
Q

What should be looked inside the nose?

A
  1. Color of the mucosa
  2. Presence and colour of any discharge
  3. The septum (which should be in the midline)
  4. Any obvious bleeding points, clots, crusting, or perforation.
  5. Middle and inferior turbinates along the lateral wall for evidence of Polypoid growth, foreign bodies, and other soft tissue swelling.
101
Q

Which nasal sinuses can be examined?

A

The frontal and the maxillary, albeit indirectly.

102
Q

How do we examine the nasal sinuses?

A
  1. Palpate and Percuss the skin overlying the frontal and maxillary sinuses.
  2. Tap on the upper teeth (which sit in the floor of the maxillary sinus)
  3. In both of the above, pain suggests inflammation (sinusitis).
103
Q

What should be looked during inspection of the patient’s face?

A
  1. Skin disease
  2. Scars
  3. Lumps
  4. Signs of trauma
  5. Deformity
  6. Facial asymmetry (including parotid enlargement)
104
Q

What should be examined during inspection of lips, teeth, gums?

A
  1. Inspect the lips at rest first.
  2. Ask the patient to open the mouth and take a look at the buccal mucosa, teeth, and gums.
  3. Note signs of dental decay or gingivitis.
  4. Ask the patient to evert the lips and look for any inflammation, discoloration, ulceration, nodules, and telangiectasia.
105
Q

What should be examined during inspection of the tongue and floor of the mouth?

A
  1. Inspect the tongue inside and outside the mouth. Look for any obvious abnormalities.
  2. Including assessment of XII.
  3. Ask the patient to touch the roof of the mouth with their tongue.
  4. This allows you to look at the underside of the tongue and floor of the mouth.
106
Q

What should be done in order to examine the oropharynx?

A
  1. To look to the posterior oropharynx, ask the patient to say “ahh” - elevates soft palate.
  2. Using tongue depressor may provide a better view.
107
Q

Mention 3 causes of deviation of the uvula.

A
  1. IX palsy
  2. Tumor
  3. Infection
108
Q

What should be examined in the soft palate?

A

Look for any cleft, structural abnormality or asymmetry of movements and note any telangiectasia.

109
Q

What should be examined in the tonsils?

A
  1. Size
  2. Color
  3. Any discharge
110
Q

Where do the tonsils lie?

A

In an alcove between the posterior and anterior pillars (arches) on either side of the mouth.

111
Q

How should we Palpate the oral cavity?

A

Put on a pair of gloves and Palpate the area of interest with BOTH hands (one hand outside on the patient’s cheek or jaw and the other inside the mouth).

112
Q

Mention 4 main findings during the examination of the oral cavity?

A
  1. Mucosal inflammation
  2. Oral candidiasis
  3. Gingivitis
  4. Tonsillitis
113
Q

What are the possible causes of mucosal inflammation?

A
  1. Bacterial
  2. Fungal (candidiasis)
  3. Viral (herpes simplex) infections
  4. After radiotherapy treatment
114
Q

Mention some causes of oral candidiasis.

A
  1. Think radiotherapy

2. Use of inhaled steroids and immunodeficiency states (leukemia, lymphoma, HIV).

115
Q

Mention some causes of gingivitis.

A

Inflammation of the gums due to:

  1. Minor trauma (teeth or brushing)
  2. Vitamin and mineral deficiency, or lichen planus.
116
Q

Mention some causes of tonsillitis.

A

Mucopus on the pharyngeal wall implies bacterial infection.

Think of infectious mono if patient is a teen and tonsils are covered with a white pseudomembranous exudate.

117
Q

With what is acute tonsillitis associated?

A

Systemic features of:

  1. Malaise
  2. Fever
  3. Anorexia
  4. Cervical lymphadenopathy
  5. Candidiasis
118
Q

Gum changes in systemic conditions:

A
  1. Chronic lead poisoning: punctuate blue lesions.
  2. Phenytoin treatment: firm and hypertrophied.
  3. Scurvy: soft and hemorrhagic.
  4. Cyanotic congenital heart disease: spongy and hemorrhagic.
119
Q

Mention some causes of midline neck masses.

A
  1. Lesions of the thyroid gland.
  2. Thyroglossal cysts (lump moves when patient sticks out tongue)
  3. Midline dermoids.
  4. Submental lymph nodes
  5. Parathyroid gland enlargement (very rare)
120
Q

Mention some causes of lateral neck masses.

A
  1. Neoplasia (primary Cancer, lymphoma, Schwannoma, metastatic cancer).
  2. Infection (mumps, glandular fever, TB, HIV).
  3. Autoimmune (Sjögren)
  4. Normal variants (transverse process of C2, cervical rib, elongated styloid process)
  5. Sarcoidosis
  6. Branchial cyst
121
Q

What is otitis externa?

A

Inflammation of the external ear.

122
Q

What is the cause of otitis externa?

A
  1. Strep, staph, pseudomonas.

2. Fungi

123
Q

Mention some predisposing factors to otitis externa.

A
  1. Heat
  2. Swimming
  3. Humidity
  4. Any irritants causing Pruritus can all predispose to otitis externa.
  5. May occur in patients with eczema, seborrheic dermatitis, or psoriasis due to scratching.
124
Q

What happens in malignant otitis externa?

A

1 It is a very aggressive form caused by a spreading osteomyelitis of the temporal bone (usually Pseudomonas pyocaneus).

  1. Infection may spread to involve the middle ear ear and lower cranial nerves.
  2. Seen in immunocompromised patients and diabetics.
125
Q

What happens in Furunculosis?

A

Infection of hair follicles in the auditory canal.
It presents with severe throbbing pain - exacerbated by jaw movement - with pyrexia and often precedes rupture of an abscess.

126
Q

Mention some complications of otitis media.

A
  1. Mastoiditis
  2. Labyrinthitis
  3. Facial nerve palsy
  4. Extradural abscess
  5. Meningitis
  6. Lateral sinus thrombosis
  7. Cerebellar and temporal lobe abscess
127
Q

What happens in chronic suppurative otitis media?

A

Associated with central persistent perforation of the pars tensa.
Resulting otorrhea is usually mucoid and profuse in active infection.

128
Q

What is the MCC of acquired conductive hearing loss in children?

A

Glue or otitis media with effusion - peaks between 3-6yrs.

129
Q

In which groups is glue ear /otitis media with effusion highly prevalent?

A

Higher incidence in patients with cleft palate and Down’s syndrome.

130
Q

What is the etiology behind glue ear?

A

Eustachian tube dysfunction with thinning of the drum.

131
Q

What happens in cholesteatoma?

A

This is destructive disease consisting of overgrowth of stratified squamous epithelial tissue in the middle ear and mastoid causing erosion of local structures and the introduction of infection.

132
Q

Mention some complications of cholesteatoma.

A
  1. When infected –> foul-smelling aural discharge.
  2. Bone destruction and marked hearing loss can occur.
  3. It may be complicated by meningitis, cerebral abscesses and facial nerve palsy.
133
Q

What is another name for Ménière’s disease?

A

Endolymphatic hydrops

134
Q

What happens in Ménière’s disease?

A

Distention of the membranous labyrinth spaces but exact cause is not known.

135
Q

What are the symptoms of Ménière’s disease?

A
  1. Attacks of vertigo with prostration
  2. Nausea
  3. Vomiting
  4. Fluctuating sensorineural hearing loss at the low frequencies.
  5. Tinnitus
  6. Aural fullness
  7. Pressure in the ear
136
Q

What is the pattern of the attacks in Ménière’s disease?

A

Occur in clusters with quiescent periods between.
Each attack only lasts a few hours and the patient usually has normal balance between.
Over years, the hearing gradually deteriorates in the affected ear.

137
Q

What happens in vestibular neuronitis?

A

Typically associated with :

  1. Sudden vertigo
  2. Vomiting
  3. Prostration
138
Q

What exacerbates the symptoms in vestibular neuronitis?

A

Head movement.

139
Q

What does often precedes vestibular neuronitis?

A

Often follows a viral illness in the young or a vascular lesion in the elderly. There is no deafness or tinnitus.

140
Q

What happens in otosclerosis?

A

Localized disease of the bone which affects the capsule of the inner ear.
Vascular, spongy bone replaces normal bone around the oval window and may fix the footplate of stapes.

141
Q

What is the otoscopic examination in otosclerosis?

A

Normal.

142
Q

Mention some symptoms of otosclerosis.

A
  1. Progressive conductive deafness
  2. Manifesting after the 2nd decade
  3. Possibly with tinnitus and , rarely, with vertigo.
  4. Pregnancy and lactation aggravate the condition.
  5. There is often a strong FHx
  6. BOTH ears are affected in >50% of patients.
143
Q

What happens in benign positional vertigo?

A

Attacks of sudden-onset rotational vertigo provoked by lying down flat or turning over in bed.

144
Q

What causes benign positional vertigo?

A

Crystalline debris in the posterior semicircular canal.

145
Q

What may precede benign positional vertigo?

A
  1. URI
  2. Head injury
  3. But often there may be no preceding illness.
146
Q

What manoeuvre is diagnostic of benign positional vertigo?

A

The Hallpike manoeuvre.

147
Q

If diagnosed, what manoeuvre should the patient have?

A

The Epley manoeuvre which is often curative –> Repositions the debris in the posterior semicircular canal into the utricle.

148
Q

What happens in Labyrinthitis?

A

Localized infection of the labyrinth apparatus.

149
Q

From what is labyrinthitis difficult to be distinguished?

A

Vestibular neuronitis, unless there is hearing loss due to cochlear involvement.

150
Q

What are the acoustic neuromas?

A

Benign, slowly growing tumors of the vestibular element of VIII.

151
Q

What is the target group of acoustic neuromas?

A

Usually present in middle age and occur more frequently in females.

152
Q

In what percentage of patients with acoustic neuroma do we find BILATERAL acoustic neuromas?

A

5%

153
Q

What are the early symptoms of acoustic neuromas?

A
  1. Unilateral or markedly asymmetric, progressive sensorineural hearing loss and tinnitus.
  2. Vertigo is rare.
  3. Patients with large tumors may have ataxia.
154
Q

What are the components of the external ear?

A
  1. Pinna (auricle)
  2. External auditory meatus
  3. Lateral wall of the tympanic membrane

Internal Medicine (106 decks)

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