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Head and Neck > Otology > Flashcards

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
Q

What can the inflammation in otitis externa be caused by?

A

Bacterial infection

  • Pseudomonas aeruginosa
  • Staphylococcus aureus

Fungal infection - aspergillus or candida

Eczema

Seborrheic dermatitis

Contact dermatitis

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26
Q

What is the presentation in otitis externa?

A

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

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27
Q

How do you diagnose otitis externa?

A

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

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28
Q

What is the management of otitis externa?

A

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

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29
Q

What is the prevention of otitis externa?

A

No water or cotton buds to be used in the ear

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30
Q

What is malignant otisis externa?

A

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

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31
Q

What is the presentation of malignant otitis externa?

A

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
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32
Q

What is the management of malignant otitis externa?

A

Antibiotics for weeks or months - ciprofloxacin as the classic organism is pseudomonas

CT / MRI to assess extent of the infection

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33
Q

What is otitis media?

A

Inflammation of the middle ear

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34
Q

What is otitis media with effusion also known as?

A

Glue ear - sterile fluid is secreted in the middle ear

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35
Q

What is the presentation of otitis media?

A

Hearing loss

Speech delay

Ear pain

Systemic symptoms

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36
Q

What is the management of otitis media with effusion?

A

Observation for 3 months

Otovent

Grommet

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37
Q

What is an otovent?

A

Autoinflation device used to open up the euchachian tubes

38
Q

What is grommet?

A

Tiny tube to be entered into the ear

39
Q

What is acute suppurative otitis media?

A

Inflammation of middle ear and mastoid cavity that is characterised by pus in the ear

40
Q

What is the presentation of acute suppurative otitis media?

A

Otalgia with or without otorrhoea

41
Q

What is the management of acute suppurative otitis media?

A

Observation

Amoxicillin

42
Q

What is tympanosclerosis?

A

Calcification in tympanic membrane with or without middle ear involvement

43
Q

What is the presentation of tympanosclerosis?

A

Usually asymptomatic

44
Q

What is the management of tympanosclerosis?

A

Usually none

45
Q

What is the pathology of chronic suppurative otitis media?

A

Perforated tympanic membrane or cholesteatoma (skin in middle ear with or without mastoid bone involvement)

46
Q

What are possible complications of chronic suppurative otitis media?

A

Dead ear

Facial palsy

Meningitis

Brain abscess

47
Q

What are potential causes of perforation of tympanic membrane?

A

Infection

Trauma

Grommet

48
Q

What is the presentation of perforation of tympanic membrane?

A

Recurrent infections

Hearing loss

49
Q

What is the management of perforation of tympanic membrane?

A

Water precautions

With or without myrinoplasy

50
Q

What is myrinoplasy?

A

Operation to repair a perforation of the tympanic membrane

51
Q

What is cholesteatoma?

A

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
Q

What are possible causes of cholesteatoma?

A
  • 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
Q

What is the presentation of cholesteatoma?

A

Perisistent offensive otorrhoea - fould discharge from the ear

unilateral confuctive hearing loss

54
Q

What is the management of cholesteatoma?

A

Mastoidectomy

55
Q

What is a mastoidectomy?

A

Surgical procedure to remove diseased mastoid air calls

56
Q

What is otosclerosis?

A

One of staples in middle ear gets stuck in place

57
Q

What is the presentation of otosclerosis?

A

Conductive hearing loss

Normal tympanic membrane

58
Q

What is the pathology of otosclerosis?

A

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
Q

What is the management of otosclerosis?

A

Heading aid or stapedectomy

60
Q

What is a stapedectomy?

A

Procedure in middle ear where stape is removed

61
Q

What is sensorineural hearing loss?

A

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
Q

What are possible causes of sensorineural hearing loss?

A

Presbyacusis

Head injury

Viral infections

Noise exposure

Ototoxic medications

Acoustic neuroma

63
Q

What is the management of sensorineural hearing loss?

A

Hearing aids

64
Q

What is tinnitus?

A

Sensation of hearing a sound in the absence of external sounds

65
Q

What should be investigated with tinnitus?

A

Unilateral

Pulsatile (pulsating)

66
Q

What is the management of tinnitus?

A

Treat underlying cause

Soud enrichment

Stress management

67
Q

What is vertigo?

A

Sense of spinning dizziness

68
Q

What are the differential diagnosis of vertigo?

A

Benign positional vertigo

Menieres disease

Vestibular neuritis/labyrinthitis

Migraine

69
Q

What is benign positional vertigo?

A

Sudden sensation of spinning, feels like from the inside of your head

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
Q

What is the pathoogy of benign positional vertigo?

A

Otoconia in semi-circular canals

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
Q

What are otoconia?

A

Bio-crystals which couple mechanical forces to the sensory hair cells in the utricle and saccule

72
Q

What are the clinical features of beign positional vertigo?

A

Vertigo precipitated by specific changes in head position

Duration in seconds

No associated symptoms

Nystagmus is positional and rotatory

73
Q

What is Nystagmus?

A

Vision condition where the eyes make repetative, uncontrolled movements

74
Q

What investigation is done for benign positional vertigo?

A

Dix-Hallpike test

75
Q

What is the management of benign positional vertigo?

A

Epley manoeuvre

76
Q

What is vestibular neuritis?

A

Inflammation of vestibular nerve

77
Q

What is the pathology of vestibular neuritis/labyrinthitis?

A

Reactivation of latent HSV infection of vestibular ganglion

78
Q

What are the clinical features of vestibular neuritis?

A

Spontaneous vertigo

Associated underlateral hearing loss (labyrinthitis)

Duration is days

Nystagmus is horizontal towards the affected ear

79
Q

What is the management of vestibular neuritis/labyrinthitis?

A

Management of acute is vestibular sedatives

Management of chronic is vestibular rehabilitation

80
Q

What is Maniere’s disease?

A

Disorder of inner ear that leads to dizziness and hearing loss

81
Q

What is the pathology of Maniere’s disease?

A

Endolymphatic hydrops

82
Q

What are the clinical features of Maniere’s disease?

A

Spontaneous vertigo

Associated unilateral hearing loss/tinnitus/aural fullness

Duration is hours

83
Q

What is the management of Maniere’s disease?

A

Bendoflumethazide

Intratympanic dexamethasone

Intratympanic gentamicin

84
Q

What is a migraine?

A

Moderate to severe headache felt as throbbing pain on one side of the head

85
Q

What is the pathology of a migraine?

A

Possibly vascular or neural, but is unknown

86
Q

What are the clinical features of a migraine?

A

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
Q

What is the management of migraine?

A

Avoid migraine triggers

Prophylactic medication

88
Q

What is facial nerve palsy?

A

Function of the facial nerve (CN VII) is partly or completely lost

89
Q

What are the clinical features of facial nerve palsy?

A

Lower motor neuron facial palsy (forehead involved)

90
Q

What is the differential diagnosis of facial palsy?

A

Intratemporal such as cholesteatoma

Extratemporal such as parotid tumour

Idiopathic is called Bell’s palsy

91
Q

What is idiopathic facial palsy called?

A

Bell’s palsy

92
Q

What is the management of facial nerve palsy?

A

Treat underlying cause (if possible)

Steroids

Eye care

Head and Neck (1 decks)

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