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Otology Flashcards

1
Q

What is otology?

A

The study of anatomy and diseases of the ear

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2
Q

What are some examples of some symptoms related to otology?

A

Hearing loss

Tinnitus

Vertigo

Otalgia

Otorrhoea

Facial weakness

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3
Q

What is hearing a sound in the absence of external sounds called?

A

Tinnitus

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4
Q

What is a sense of spinning dizziness called?

A

Otalgia

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5
Q

What is discharge from the ear called?

A

Otorrhoea

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6
Q

What is ear pain called?

A

Otalgia

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7
Q

What are some different methods of ear examination?

A

Otoscopy

Microscopy

Rinne’s test

Weber’s test

Whispered voice test

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8
Q

What are the 3 possible outcomes from the Rinne’s test?

A

A (normal ear, air > bone so test is positive)

B (conductive hearing loss, bone > air so test is negative)

C (sensorineural hearing loss, air > bone so test is positive)

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9
Q

What are the 3 possible outcomes of the Weber’s test?

A

A (normal hearing in both ears, left=right so test is central)

B (sensorineural hearing loss in right ear, left>right so test lateralises to the left)

C (conductive hearing loss right ear, right>left so test lateralises to the right)

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10
Q

What is the Whispered voice test?

A

Whispered voice at 60cm with the other ear masked and no lip reading

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11
Q

What are different methods of ear investigations?

A

Pure tone audiogram

Tympanogram

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12
Q

What are the 3 outcomes of pure tone audiogram?

A

A (normal hearing, better than 20dB)

B (conductive hearing loss, bone conduction better than air condiction)

C (sensorineural hearing loss, bone conduction the same as air conduction)

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13
Q

What are the 3 outcomes of tympanogram?

A

A (normal middle ear pressure and compliance)

B (low middle ear compliance)

C (low middle ear pressure)

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14
Q

What is pure tone audiogram?

A

Test to identify hearing thresholds of someone

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15
Q

What is a tympanogram?

A

Graphic representation of the relationship between air pressure in the ear canal and the movement of the tympanic membrane

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16
Q

What is the tympanic membrane also known as?

A

Ear drum

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17
Q

What are examples of disorders of the ear?

A

Auricular haematoma

Forign body

Otitis externa

Malignant otitis externa

Otitis media with effusion

Acute suppurative otitis media

Tympanosclerosis

Chronic suppurative otitis media

Perforation of tympanic membrane

Cholesteatoma

Otosclerosis

Sensineural hearing loss

Tinnitus

Vertigo

Benign positional vertigo

Vestibular neuritis/labyrinthitis

Meniere’s disease

Migraine

Facial nerve palsy

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18
Q

What is auricular haematoma?

A

Collection of blood underneath the perichondrium of the ear

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19
Q

What is the management of auricular haematoma?

A

Incision and drainage

Pressure dressing

Antibiotics

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20
Q

What is a possible complication of auricular haematoma?

A

Cauliflower ear

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21
Q

What is the management of a forign body in the ear?

A

Removal

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22
Q

Explain the order of urgency for different kinds of forign bodies in the ear?

A

Button battery > organic > inorganic

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23
Q

What is otitis externa?

A

Inflammation of external auditory meatus - usually caused by infection but not necessarily

Infection can be localised or diffuse

It can spread to the external ear - pinna

Can be acute - less than 3 weeks

Can be chronic - more than 3 weeks

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24
Q

What is otitis externa known as?

A

Swimmers ear

Exposure to water whilst swimming can lead to inflammation in the ear canal

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25
What can the inflammation in otitis externa be caused by?
Bacterial infection - Pseudomonas aeruginosa - Staphylococcus aureus Fungal infection - aspergillus or candida Eczema Seborrheic dermatitis Contact dermatitis
26
What is the presentation in otitis externa?
Pain Discharge Itching Conductive hearing loss - because of the inflammation of the external auditory meatus examination can show - erythema and swelling in the ear canal, tenderness of the ear canal, pus or discharge, lymphadenopathy
27
How do you diagnose otitis externa?
Diagnosis can be made clinically with an examination of the ear canal - otoscopy An ear swab can be used to identify the causative organism but is not usually required
28
What is the management of otitis externa?
Antibiotic/steroid ear drops with or without suction under microscopy e.g. neomycin, dexamethason and acetic acid If caused by fungal infections - clomitrazole ear drops
29
What is the prevention of otitis externa?
No water or cotton buds to be used in the ear
30
What is malignant otisis externa?
Osteomyelitis of temporal bone Severe and potentially life threatening form of otitis externa Infection spreads from ear canal to the bones surrounding the ear canal and skull
31
What is the presentation of malignant otitis externa?
Severe pain in elderly diabetic Granulations in external auditory meatus with or without cranial nerve palsies - granulation tissue at the junction between the bone and cartilage in the ear canal is a key finding that indicates malignant otitis externa
32
What is the management of malignant otitis externa?
Antibiotics for weeks or months - ciprofloxacin as the classic organism is pseudomonas CT / MRI to assess extent of the infection
33
What is otitis media?
Inflammation of the middle ear
34
What is otitis media with effusion also known as?
Glue ear - sterile fluid is secreted in the middle ear
35
What is the presentation of otitis media?
Hearing loss Speech delay Ear pain Systemic symptoms
36
What is the management of otitis media with effusion?
Observation for 3 months Otovent Grommet
37
What is an otovent?
Autoinflation device used to open up the euchachian tubes
38
What is grommet?
Tiny tube to be entered into the ear
39
What is acute suppurative otitis media?
Inflammation of middle ear and mastoid cavity that is characterised by pus in the ear
40
What is the presentation of acute suppurative otitis media?
Otalgia with or without otorrhoea
41
What is the management of acute suppurative otitis media?
Observation Amoxicillin
42
What is tympanosclerosis?
Calcification in tympanic membrane with or without middle ear involvement
43
What is the presentation of tympanosclerosis?
Usually asymptomatic
44
What is the management of tympanosclerosis?
Usually none
45
What is the pathology of chronic suppurative otitis media?
Perforated tympanic membrane or cholesteatoma (skin in middle ear with or without mastoid bone involvement)
46
What are possible complications of chronic suppurative otitis media?
Dead ear Facial palsy Meningitis Brain abscess
47
What are potential causes of perforation of tympanic membrane?
Infection Trauma Grommet
48
What is the presentation of perforation of tympanic membrane?
Recurrent infections Hearing loss
49
What is the management of perforation of tympanic membrane?
Water precautions With or without myrinoplasy
50
What is myrinoplasy?
Operation to repair a perforation of the tympanic membrane
51
What is cholesteatoma?
Abnormal collection of squamour spithelial cells in the middle ear It is non cancerous but can invade local tissues and nerves and erode the bones of the middle ear
52
What are possible causes of cholesteatoma?
* Eustachian tube dysfunction * If there is low pressure under the eardrum as a result of it, can lead to retraction of the ear drum or pocket in the ear drum What happens in that pocket, the normal migration of skin out of the ear doesn’t work * Skin gets trapped in that retraction of ear drum * Over a long period of time, the lump of dead skin underneath the ear drum can spread backwards into the mastoid bone behind the ear * Impaired skin migration
53
What is the presentation of cholesteatoma?
Perisistent offensive otorrhoea - fould discharge from the ear unilateral confuctive hearing loss
54
What is the management of cholesteatoma?
Mastoidectomy
55
What is a mastoidectomy?
Surgical procedure to remove diseased mastoid air calls
56
What is otosclerosis?
One of staples in middle ear gets stuck in place
57
What is the presentation of otosclerosis?
Conductive hearing loss Normal tympanic membrane
58
What is the pathology of otosclerosis?
The auditory ossicles are the tiny bones in the middle ear that transmit sound vibrations from the tympanic membrane to the cochlea. They are the malleus, incus and stapes. The stapes is connected to the oval window (fenestra ovalis) of the cochlea, where it transmits vibrations into the cochlea, which converts them into sensory signals. In patients with otosclerosis, these tiny bones in the middle are affected by abnormal bone remodelling and formation. This mainly affects the base of the stapes, where it attaches to the oval window, causing stiffening and fixation and preventing it from transmitting sound effectively. It causes conductive hearing loss.
59
What is the management of otosclerosis?
Heading aid or stapedectomy
60
What is a stapedectomy?
Procedure in middle ear where stape is removed
61
What is sensorineural hearing loss?
Type of hearing loss where the root cause lies in the inner ear or sensory organ (cochlea and associated structures) or the vestibulocochlear nerve (CN VIII)
62
What are possible causes of sensorineural hearing loss?
Presbyacusis Head injury Viral infections Noise exposure Ototoxic medications Acoustic neuroma
63
What is the management of sensorineural hearing loss?
Hearing aids
64
What is tinnitus?
Sensation of hearing a sound in the absence of external sounds
65
What should be investigated with tinnitus?
Unilateral Pulsatile (pulsating)
66
What is the management of tinnitus?
Treat underlying cause Soud enrichment Stress management
67
What is vertigo?
Sense of spinning dizziness
68
What are the differential diagnosis of vertigo?
Benign positional vertigo Menieres disease Vestibular neuritis/labyrinthitis Migraine
69
What is benign positional vertigo?
Sudden sensation of spinning, feels like from the inside of your head ## Footnote Benign paroxysmal positional vertigo (BPPV) is a common cause of recurrent episodes of vertigo triggered by head movement. It is a peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain. It is more common in older adults.
70
What is the pathoogy of benign positional vertigo?
Otoconia in semi-circular canals ## Footnote BPPV is caused by crystals of calcium carbonate called otoconia that become displaced into the semi-circular canals. This occurs most often in the posterior semi-circular canal. They may be displaced by a viral infection, head trauma, ageing or without a clear cause. The crystals disrupt the normal flow of endolymph through the canals, confusing the vestibular system. Head movement creates the flow of endolymph in the canals, triggering episodes of vertigo.
71
What are otoconia?
Bio-crystals which couple mechanical forces to the sensory hair cells in the utricle and saccule
72
What are the clinical features of beign positional vertigo?
Vertigo precipitated by specific changes in head position Duration in seconds No associated symptoms Nystagmus is positional and rotatory
73
What is Nystagmus?
Vision condition where the eyes make repetative, uncontrolled movements
74
What investigation is done for benign positional vertigo?
Dix-Hallpike test
75
What is the management of benign positional vertigo?
Epley manoeuvre
76
What is vestibular neuritis?
Inflammation of vestibular nerve
77
What is the pathology of vestibular neuritis/labyrinthitis?
Reactivation of latent HSV infection of vestibular ganglion
78
What are the clinical features of vestibular neuritis?
Spontaneous vertigo Associated underlateral hearing loss (labyrinthitis) Duration is days Nystagmus is horizontal towards the affected ear
79
What is the management of vestibular neuritis/labyrinthitis?
Management of acute is vestibular sedatives Management of chronic is vestibular rehabilitation
80
What is Maniere's disease?
Disorder of inner ear that leads to dizziness and hearing loss
81
What is the pathology of Maniere's disease?
Endolymphatic hydrops
82
What are the clinical features of Maniere's disease?
Spontaneous vertigo Associated unilateral hearing loss/tinnitus/aural fullness Duration is hours
83
What is the management of Maniere's disease?
Bendoflumethazide Intratympanic dexamethasone Intratympanic gentamicin
84
What is a migraine?
Moderate to severe headache felt as throbbing pain on one side of the head
85
What is the pathology of a migraine?
Possibly vascular or neural, but is unknown
86
What are the clinical features of a migraine?
Spontaneous vertigo Duration is variable With or without headache, sensory sensitivity With or without precipitated migraine triggers With or without past history of migraine
87
What is the management of migraine?
Avoid migraine triggers Prophylactic medication
88
What is facial nerve palsy?
Function of the facial nerve (CN VII) is partly or completely lost
89
What are the clinical features of facial nerve palsy?
Lower motor neuron facial palsy (forehead involved)
90
What is the differential diagnosis of facial palsy?
Intratemporal such as cholesteatoma Extratemporal such as parotid tumour Idiopathic is called Bell's palsy
91
What is idiopathic facial palsy called?
Bell's palsy
92
What is the management of facial nerve palsy?
Treat underlying cause (if possible) Steroids Eye care

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