Otology Flashcards
Causes of conductive hearing loss
Glue ear
Otosclerosis
Ossicular discontinuity
TM perforation
Wax
Where is the problem in conductive hearing loss
Problem in ear canal
Tympanic membrane
Middle ear
What is bone and air conduction like in sensorineural hearing loss
Both equally reduced
Causes of sensorineural hearing loss
Presbyacusis
Congenital
SSNHL
Noise induced
Air and bone conduction in mixed hearing loss?
Both AC and BC reduced but AC is worse than BC
What does tympanometry measure
Whether ear drum is working with sound
What does a flat line in tympanometry indicate
What should you check if this happens
Perforated ear drum or glue ear
check ear volume
What to do if there is conductive hearing loss unilaterally that hasn’t started after an URTI that isn’t getting better
Concerned about tumour in the post nasal space affected Eustachian tube dysfunction
What to do if someone presents with sudden onset sensorineural hearing loss
Refer urgently to ENT so they can give steroids
What can a unilateral non pulsatile tinnitus suggest
Acoustic neuroma therefore refer to ENT
What to do if someone presents with bilateral pulsatile tinnitus
INvestigate- carotid, heart, thyroid, TFT and if you can’t find cause then refer to ENT
IF there is pain but you don’t see anything what should you do
Refer to ENT as could be cancer. Check TMJ
Necrotising otitis externa
Osteomyelitis
Older patients who can be immunocompromised
Swollen canal and discharge
What things to ask in a history of a ear
Hearing: when started, progression, side
Tinnitus: pulsatile or not, severity, sleep, side
Dizziness: what they mean, duration, associated symptoms
Pain: side, nature. (cancer referred otalgia?)
Discharge: nature, side, duration
Facial nerve
Management for haematoma in ear
Requires aspiration/drainage : ENT referral as would lead to cauliflower ear
Symtoms and signs of a temporal bone fracture
Bleeding ear
CSF leaking (send this fluid off for test of beta2 transferrin as this is present in CSF)
Perforation TM +- canal laceration
Haemotypanum- blood behind tympanic membrane
Battle’s sign: bruise on mastoid
Facial palsy
Management of temporal bone fracture
CT
ENT management usually conservative
Steroids for FN palsy. Rarely FN exploration if immediate FN palsy. Management mostly directed by associated injuries
Otitis externa symptoms and examination
severe ear pain, discharge, itching, hearing loss
Pinna and tragus tender, ear canal filled with discharge, ear canal swollen, TM often not seen
Common organisms for otitis externa
Pseudomonas aeruginosa
Staph aureus
Differentials for otitis externa
Necrotising Otitis externa
Mastoiditis
Pinna perichondritis
Pinna Cellulitis
Middle ear infection
What is necrotising OE and management
Occurs in immunocompromised patients esp elderly diabetes. Severe unrelenting pain with canal granulation. Skull base osteomyelitis, look for cranial nerve palsies. Admit/scan/IVabx
What is necrotising OE and management
Occurs in immunocompromised patients esp elderly diabetes. Severe unrelenting pain with canal granulation. Skull base osteomyelitis, look for cranial nerve palsies. Admit/scan/IVabx
What is pinna perichondritis and treatment
Pinna itself red and inflamed, Louie has no cartilage and therefore is spared. Consider autoimmune disorder. IVabx
What is pinna cellulitis and treatment
Pinna itself red and inflamed including lobule
