Otology Flashcards
(96 cards)
1
Q
Which landmarks should you know of the pinna?
A
concha
helix
antihelix
tragus
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
3
Q
Which part should you straighten out before performing ear exam for the ear canal
A
posterior part of external ear
4
Q
is the lateral tympanic membrane middle or outer ear?
A
outer
5
Q
What are the layers of the pinna?
A
?
6
Q
What is the cone of light?
A
anteroinferior quadrant- when performed otoscopy
7
Q
What are the bones of the middle ear? /auditory ossicles
A
malleus, incus, stapes
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.
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.
10
Q
Which nerve travels alongside vestibulocochlear nerve?
A
facial nerve
11
Q
Which nerve travels between the auditory ossicles that can be damaged in surgery?
A
chorda tympani- supplies ant 2/3 taste?
12
Q
Which cells are found in the inner ear?
A
hair cells- cochlear nerve
13
Q
What is normal tympanometry?
A
type A
14
Q
WHat does tympanometry assess?
A
middle ear
15
Q
What is the cause of pinna haematoma?
A
trauma
can be sponatneous- anticoagulant
16
Q
List two complications of pinna haematoma
A
abscess
cauliflower ear
17
Q
What is the treatment of pinna haematoma?
A
immediate drainage and resection if AVN
18
Q
WHy is pinna haemtoma an emergency?
A
cartilage has no blood supply
blood clot accumulates in subchondral layer- avascular necrosis
19
Q
What are the layers of the pinna
A
epidermis
dermis
perichondrium
subcutaneous tissue
cartilage
20
Q
Which organisms cause of otitis externa? acute
A
aeruginosa
staph aureus
pseudomonas
(Swimmer’s ear)
21
Q
What are causes of chronic otitis externa?
A
eczematous ear canal
itchy
22
Q
Who gets necrotising otitis externa?
A
elderly
diabetic
immunocompromised
23
Q
What is the treatment for acute otitis externa?
A
antibiotic drops
aural toilet?
24
Q
What is a complication of necrotising otitis externa?
A
cranial nerve palsy
25
What is necrotising otitis externa?
skull base osteomyelistis
26
What is the causative agent of necrotising otitis externa?
pseudomonas aeruginosa
27
What is the treatment for necrotising otitits externa?
6-8 weeks of IV antibiotics
28
What are the investigations for necrotising otitits externa?
CT
swabs
29
How is chronic otitis media divided?
mucosal- tymphanic membrane perforation
Squamous- cholestoma ?
30
Treatment for simple tympanic membrane perforation?
no swimming, water sports
no treatment really
31
Indications for repair perforation?
recurrent perforations
suppurative perforation
32
What are the causes of cholesteatoma?
iatrogenic- e.g. from previous tympanic membrane repair
tympanic membrane retraction
33
What is the treatment for cholesteatoma?
=erosion
surgery tympanomastoidectomy
34
List two complications of cholesteatoma
hearing loss
erosion into facial canal- facial weakness
meningitis, brain abscess
35
What is cholesteatoma?
squamous epithelium and keratin debris in middle ear and mastoid. Benign but erosive process
36
Name another middle ear condition
otosclerosis= fixation of stapes footplate
progressive conductive hearing loss
37
Treatment for otosclerosis
stapedectomy surgery
hearing aid
38
What are the causes of sudden sensironeural hearing loss?
viral or bacterial infection
ototoxicity
autoimmune conditions
noise exposure
trauma
39
What is the treatment of sudden inner ear hearing loss
steroid injections
40
What are the three vestibular conditions you need to know?
vestibular neuritis/acute labyrinthitis
BBPV
merniere's disease
41
What are the features of vestibular neuritis?
preceding URTI
acute onset, lasts days to week
disabling vertigo nausea and vomiting
42
What is the test for diagnosing BBPV?
Dix Hallpike
43
What is the treatment for BPPV?
Epley manouvre
44
Which is the semicircular canal that is most commonly affected in BBPV
posterior
45
What are the features of merniere's disease
tinnitus, aural fullness, hearing loss, episodic vertigo
46
List three causes for sensorineural hearing loss
age related
congenital hearing loss
infection- e.g. meningitis
trauma/noise exposure
drugs
47
List two drugs that are ototoxic
aminoglycosides
chemotherapeutic agents
48
List two causes of conductive hearing loss
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
Three differentials for tinnitus?
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
Name a common drug that can causes tinnitus in overdose
aspirin overdose- reversible
51
List two differentials for vertigo
BBPV
Merniere's disease
Vestibular neuronitis
Non ear related/central
drugs + alcohol
52
Name one non ear related cause of vertigo
atypical migraine
cerebellar disease
53
Three differentials for otalgia
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
Define otorrhoea
discharge from ear
55
List two differentials for otorrhoea (discharge)
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
What is vestibular schwannoma?
benign growth of schwann cells of vestibular nerve
57
What are the features of vestibular schwannoma?
unilateral hearing loss
tinnitues
balance disturbance
58
Which nerves can be affected with vestibular schwannoma
vestibucochlear nerve
facial nerve
trigeminal nerve
59
what is the management of vestibular schwannoma?
interval scanning
surgery
radiotherapy
60
Why do diabetic patients require special care of otitis externa?
osteomyelitis of temporal bone
61
what is the mode of inheritance of otosclerosis?
autosomal dominant
62
what is the treatment of otitis externa?
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
Name three complications of cholesteatoma
hearing loss
tinnitus
vertigo
facial palsy
intracranial infection
64
What is the treatment of mucosal otitis media?
microsuction
topical antibiotics and steroids
65
What is the difference between squamous and mucosal otitis media
squamous= squamous tissue retained in middle ear following perf
mucosal= no squamous debris in middle ear
66
List three organisms that cause acute otitis media
strep pneumoniae
h influenzae
moraxella catarrhalis
67
What are the indications for antibiotic prescription in acute otitis media?
<2 years
>49-72 hr fever
68
List two complications of acute otitis media
acute mastoiditis
facial nerve palsy
intracranial infection
otitis media with effusion= glue ear
69
What is another name for glue ear
otitis media with effusion
70
Why is glue ear more common in children?
due to poor eustachian tube function
71
When would you treat glue ear?
if bilateral hearing loss >3 months
72
What is the treatment for glue ear?
grommets
73
WHat is the medical management of merniere's disease?
low salt/caffeine diet
diuretics
betahistine
74
List three classes of ototoxic drugs and one example
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
Three differentials for sudden onset sensorineural hearing loss
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
What is the treatment for sudden onset sensorineural hearing loss
high dose oral steroids
77
Patient with vesicles on ear and facial paralysis. What is the diagnosis?
Ramsay Hunt syndrome
78
What are the causes of Ramsay hunt syndrome?
shingles
chicken pox
idiopathic
79
What is the most important problem with ramsay hunt syndrome?
dry eyes- patch over night and eye drops
80
Which nerve is affected in Ramsay Hunt syndrome?
facial nerve
81
List two features of otosclerosis
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
82
What is the cause of otosclerosis?
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
Why do you get vertigo?
unopposed action potentials of contralateral ear/labrinth + eye deviation
84
What features would you see in someone with an episode of merniere's?
unilateral sensironeural hearing loss
85
Which other assessments should you do when examining a vestibular issue? / what are differentials for vertigo/light headedness
postural hypotension- lying and standing BP
cerebellar exam
visual assessment
T2DM B12
86
Lifestyle advice for merniere's?
reduced salt and caffein intake
87
Name one pharmacological agent for merniere's disease
beta histine
bendroflumethiazide (if taking antihistamine already)
prochlorperazine
88
What is the rescue medication for merniere's?
prochlorperazine- only use for a couple of days
89
What are the surgical options for merniere's?
grommets
chemical labrinthectomy
tympanic injection with steroid
90
What is a chemical labrinthectomy?
injection of gentamicin behind tympanic membrane to cause toxicity and death of vestibular system
91
What type of nystagmus do you get with a peripheral issue?
horizontal
92
What type of nystagmus do you get with central issue?
vertical
93
What is the function of HINTS?
determining whether vertigo is central or peripheral
94
What are the components of HINTS?
Head impulse
Nystagmus
Test of skew
95
List the three positive features of HINTS exam that would indicate a central problem for the cause of vertigo
Normal head test
Vertical/ bidirectional nystagmus
Vertical skew (position of iris)
96
How to perform head test in HINTS?
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
