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1 ENT > Otology > Flashcards

Otology Flashcards

1
Q

Which landmarks should you know of the pinna?

A

concha
helix
antihelix
tragus

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2
Q

Why is pinna haematoma treated as an emergency?

A

?? haematoma formation between perichondrium and cartilage, where cartilage has poor vascular supply- Avascular necrosis risk

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3
Q

Which part should you straighten out before performing ear exam for the ear canal

A

posterior part of external ear

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4
Q

is the lateral tympanic membrane middle or outer ear?

A

outer

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5
Q

What are the layers of the pinna?

A

?

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6
Q

What is the cone of light?

A

anteroinferior quadrant- when performed otoscopy

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7
Q

What are the bones of the middle ear? /auditory ossicles

A

malleus, incus, stapes

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8
Q

What is the oval window?

A

membrane-covered opening from the middle ear to the cochlea of the inner ear. Sound waves cause vibration of the tympanic membrane and the ossicles transmit those vibrations to the oval window, which leads to movement of fluid within the cochlea and activation of receptors for hearing.

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9
Q

What is the round window?

A

membrane-covered opening in the cochlea that bulges outward in response to pressure placed on the oval window by the ossicles.

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10
Q

Which nerve travels alongside vestibulocochlear nerve?

A

facial nerve

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11
Q

Which nerve travels between the auditory ossicles that can be damaged in surgery?

A

chorda tympani- supplies ant 2/3 taste?

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12
Q

Which cells are found in the inner ear?

A

hair cells- cochlear nerve

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13
Q

What is normal tympanometry?

A

type A

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14
Q

WHat does tympanometry assess?

A

middle ear

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15
Q

What is the cause of pinna haematoma?

A

trauma
can be sponatneous- anticoagulant

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16
Q

List two complications of pinna haematoma

A

abscess
cauliflower ear

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17
Q

What is the treatment of pinna haematoma?

A

immediate drainage and resection if AVN

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18
Q

WHy is pinna haemtoma an emergency?

A

cartilage has no blood supply
blood clot accumulates in subchondral layer- avascular necrosis

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19
Q

What are the layers of the pinna

A

epidermis
dermis
perichondrium
subcutaneous tissue
cartilage

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20
Q

Which organisms cause of otitis externa? acute

A

aeruginosa
staph aureus
pseudomonas
(Swimmer’s ear)

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21
Q

What are causes of chronic otitis externa?

A

eczematous ear canal
itchy

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22
Q

Who gets necrotising otitis externa?

A

elderly
diabetic
immunocompromised

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23
Q

What is the treatment for acute otitis externa?

A

antibiotic drops
aural toilet?

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24
Q

What is a complication of necrotising otitis externa?

A

cranial nerve palsy

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25
Q

What is necrotising otitis externa?

A

skull base osteomyelistis

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26
Q

What is the causative agent of necrotising otitis externa?

A

pseudomonas aeruginosa

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27
Q

What is the treatment for necrotising otitits externa?

A

6-8 weeks of IV antibiotics

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28
Q

What are the investigations for necrotising otitits externa?

A

CT
swabs

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29
Q

How is chronic otitis media divided?

A

mucosal- tymphanic membrane perforation
Squamous- cholestoma ?

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30
Q

Treatment for simple tympanic membrane perforation?

A

no swimming, water sports
no treatment really

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31
Q

Indications for repair perforation?

A

recurrent perforations
suppurative perforation

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32
Q

What are the causes of cholesteatoma?

A

iatrogenic- e.g. from previous tympanic membrane repair
tympanic membrane retraction

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33
Q

What is the treatment for cholesteatoma?

A

=erosion

surgery tympanomastoidectomy

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34
Q

List two complications of cholesteatoma

A

hearing loss
erosion into facial canal- facial weakness
meningitis, brain abscess

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35
Q

What is cholesteatoma?

A

squamous epithelium and keratin debris in middle ear and mastoid. Benign but erosive process

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36
Q

Name another middle ear condition

A

otosclerosis= fixation of stapes footplate
progressive conductive hearing loss

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37
Q

Treatment for otosclerosis

A

stapedectomy surgery
hearing aid

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38
Q

What are the causes of sudden sensironeural hearing loss?

A

viral or bacterial infection
ototoxicity
autoimmune conditions
noise exposure
trauma

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39
Q

What is the treatment of sudden inner ear hearing loss

A

steroid injections

40
Q

What are the three vestibular conditions you need to know?

A

vestibular neuritis/acute labyrinthitis
BBPV
merniere’s disease

41
Q

What are the features of vestibular neuritis?

A

preceding URTI
acute onset, lasts days to week
disabling vertigo nausea and vomiting

42
Q

What is the test for diagnosing BBPV?

A

Dix Hallpike

43
Q

What is the treatment for BPPV?

A

Epley manouvre

44
Q

Which is the semicircular canal that is most commonly affected in BBPV

A

posterior

45
Q

What are the features of merniere’s disease

A

tinnitus, aural fullness, hearing loss, episodic vertigo

46
Q

List three causes for sensorineural hearing loss

A

age related
congenital hearing loss
infection- e.g. meningitis
trauma/noise exposure
drugs

47
Q

List two drugs that are ototoxic

A

aminoglycosides
chemotherapeutic agents

48
Q

List two causes of conductive hearing loss

A

otitis media with effusion= glue ear
perforation of tympanic membrane
cholesteatoma= retention of squamous debris within middle ear space
otosclerosis
congenital anomalies of external ear/middle

49
Q

Three differentials for tinnitus?

A

Loud noise exposure – Bilateral, non-pulsatile, irreversible
Vestibular schwannoma – Unilateral / asymmetric, non-pulsatile – consider MRI
Drugs
Meniere’s disease – Unilateral / bilateral, increase during attacks
Vascular lesions (pulsatile) – e.g. glomus tumours, AV malformations, Carotid bruits

50
Q

Name a common drug that can causes tinnitus in overdose

A

aspirin overdose- reversible

51
Q

List two differentials for vertigo

A

BBPV
Merniere’s disease
Vestibular neuronitis
Non ear related/central
drugs + alcohol

52
Q

Name one non ear related cause of vertigo

A

atypical migraine
cerebellar disease

53
Q

Three differentials for otalgia

A

External ear – Otitis externa, furunculosis, pinna infections
Middle ear – Acute otitis media (common), Chronic otitis media (pain rare)
Temporomandibular joint dysfunction – tender over TMJ, crepitus
Referred pain from head and neck (neoplastic / inflammatory)
Neoplasm of ear (rare)

54
Q

Define otorrhoea

A

discharge from ear

55
Q

List two differentials for otorrhoea (discharge)

A

Otitis externa – classically serous
Acute Otitis media – when complicated by perforation classically mucoid – usually heals up
Chronic otitis media – perforation > 3 months (squamous / mucosal, active / inactive)
Foreign body – secondary infection
Neoplasm – rare e.g. SCC of EAM, Glomus tumour

56
Q

What is vestibular schwannoma?

A

benign growth of schwann cells of vestibular nerve

57
Q

What are the features of vestibular schwannoma?

A

unilateral hearing loss
tinnitues
balance disturbance

58
Q

Which nerves can be affected with vestibular schwannoma

A

vestibucochlear nerve
facial nerve
trigeminal nerve

59
Q

what is the management of vestibular schwannoma?

A

interval scanning
surgery
radiotherapy

60
Q

Why do diabetic patients require special care of otitis externa?

A

osteomyelitis of temporal bone

61
Q

what is the mode of inheritance of otosclerosis?

A

autosomal dominant

62
Q

what is the treatment of otitis externa?

A

aural toilet= Aural toilet is a procedure used to clean the external auditory meatus (EAM) of the ear of wax, discharge and debris.
topical steroids and antibiotics

63
Q

Name three complications of cholesteatoma

A

hearing loss
tinnitus
vertigo
facial palsy
intracranial infection

64
Q

What is the treatment of mucosal otitis media?

A

microsuction
topical antibiotics and steroids

65
Q

What is the difference between squamous and mucosal otitis media

A

squamous= squamous tissue retained in middle ear following perf
mucosal= no squamous debris in middle ear

66
Q

List three organisms that cause acute otitis media

A

strep pneumoniae
h influenzae
moraxella catarrhalis

67
Q

What are the indications for antibiotic prescription in acute otitis media?

A

<2 years
>49-72 hr fever

68
Q

List two complications of acute otitis media

A

acute mastoiditis
facial nerve palsy
intracranial infection
otitis media with effusion= glue ear

69
Q

What is another name for glue ear

A

otitis media with effusion

70
Q

Why is glue ear more common in children?

A

due to poor eustachian tube function

71
Q

When would you treat glue ear?

A

if bilateral hearing loss >3 months

72
Q

What is the treatment for glue ear?

A

grommets

73
Q

WHat is the medical management of merniere’s disease?

A

low salt/caffeine diet
diuretics
betahistine

74
Q

List three classes of ototoxic drugs and one example

A

Aminoglycosides e.g. gentamycin
Loop diuretics e.g. furosemide
Cytotoxis agents e.g. cisplatin
Beta blockers e.g. atenolol
Salicylates e.g. asprin (reversible on withdrawing)

75
Q

Three differentials for sudden onset sensorineural hearing loss

A

The majority of sudden-onset sensorineural hearing loss is idiopathic in nature, however it can be attributed to:
autoimmune conditions (e.g. Behcet’s or SLE)
infectious causes (e.g. bacterial meningitis, mumps, Lyme’s disease)
metabolic causes (e.g. diabetes, hypothyroidism)
neoplasm

76
Q

What is the treatment for sudden onset sensorineural hearing loss

A

high dose oral steroids

77
Q

Patient with vesicles on ear and facial paralysis. What is the diagnosis?

A

Ramsay Hunt syndrome

78
Q

What are the causes of Ramsay hunt syndrome?

A

shingles
chicken pox
idiopathic

79
Q

What is the most important problem with ramsay hunt syndrome?

A

dry eyes- patch over night and eye drops

80
Q

Which nerve is affected in Ramsay Hunt syndrome?

A

facial nerve

81
Q

List two features of otosclerosis

A

Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history

82
Q

What is the cause of otosclerosis?

A

replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults

83
Q

Why do you get vertigo?

A

unopposed action potentials of contralateral ear/labrinth + eye deviation

84
Q

What features would you see in someone with an episode of merniere’s?

A

unilateral sensironeural hearing loss

85
Q

Which other assessments should you do when examining a vestibular issue? / what are differentials for vertigo/light headedness

A

postural hypotension- lying and standing BP
cerebellar exam
visual assessment
T2DM B12

86
Q

Lifestyle advice for merniere’s?

A

reduced salt and caffein intake

87
Q

Name one pharmacological agent for merniere’s disease

A

beta histine
bendroflumethiazide (if taking antihistamine already)
prochlorperazine

88
Q

What is the rescue medication for merniere’s?

A

prochlorperazine- only use for a couple of days

89
Q

What are the surgical options for merniere’s?

A

grommets
chemical labrinthectomy
tympanic injection with steroid

90
Q

What is a chemical labrinthectomy?

A

injection of gentamicin behind tympanic membrane to cause toxicity and death of vestibular system

91
Q

What type of nystagmus do you get with a peripheral issue?

A

horizontal

92
Q

What type of nystagmus do you get with central issue?

A

vertical

93
Q

What is the function of HINTS?

A

determining whether vertigo is central or peripheral

94
Q

What are the components of HINTS?

A

Head impulse
Nystagmus
Test of skew

95
Q

List the three positive features of HINTS exam that would indicate a central problem for the cause of vertigo

A

Normal head test
Vertical/ bidirectional nystagmus
Vertical skew (position of iris)

96
Q

How to perform head test in HINTS?

A

hold head in between hands, ask for pain in neck or stiffness (e.g. RA), get patient to fixate on tip of your nose, jerk head to one side randomly. If patient has to adjust eyes after you have moved their head then abnormal- peripheral cause

1 ENT (9 decks)

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