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Y4 Neuro and special senses > Otology > Flashcards

Otology Flashcards

1
Q

What is the pathophysiology of otitis media ?

A

viral URTI’s are thought to disturb the normal nasopharyngeal microbiome allowing bacteria to infect the middle ear via the eustachian tube.

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2
Q

What are some features of otitis media ?

A

otalgia - ear tugging in children
fevers
hearing loss
recent URTI
ear discharge

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3
Q

what are some possible findings on otoscopy in otitis media ?

A

bulging tympanic membrane
opacification o erythema of the membrane
perforation with purulent otorrhoea

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4
Q

what is the management of otitis media ?

A

generally self limiting
analgesia
if abx are needed give 5-7 day course of amoxicillin

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5
Q

what are some complications of otitis media ?

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis

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6
Q

when are audiograms used ?

A

first line investigation in patients that complain of hearing loss

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7
Q

what dB is seen as essentially normal on an audiogram ?

A

20dB

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8
Q

in sensorineural hearing loss what conduction is impaired ?

A

both air and bone

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9
Q

in conductive hearing loss what conduction is impaired ?

A

only air conduction

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10
Q

what are auricular haematomas common in ?

A

rugby players and wrestlers

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11
Q

what is the management of auricular haematomas ?

A

same day ENT assessment
incision and drainage

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12
Q

why is immediate treatment important in the management of auricular haematomas ?

A

avoid a cauliflower ear

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13
Q

what is benign paroxysmal positional vertigo ( BPPV ) ?

A

A sudden onset of dizziness and vertigo triggered by changes in head position.

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14
Q

what are some features of BPPV ?

A

Vertigo triggered by changes in head position
nausea

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15
Q

what test is performed for BPPV and describe what happens ?

A

dix hallpike manoeurve - rapidily lower the patient to the supine position with an extended neck - rotatory nystagmus

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16
Q

what is the management of BPPV ?

A

epley manoeurve - symptom relief
vestibular rehab - brandt-daroff exercises
medication - betahistine - limited value

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17
Q

what is a cholesteatoma ?

A

a non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction.

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18
Q

what increases the risk of developing a cholesteatoma ?

A

cleft palate

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19
Q

what are the main features of cholesteatoma ?

A

foul smelling non-resolving discahrge
hearing loss
vertigo

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20
Q

what is seen on otoscopy in cholesteatoma ?

A

attic crust

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21
Q

what is the management of a cholesteatoma ?

A

referred to ENT for consideration of surgical removal

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22
Q

what are some causes of severe to profound hearing loss resulting in the need for a cochlear implant in children ?

A

genetic
congenital ( following maternal CMV, rubella and varicella )
idiopathic
infectious - meningitis

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23
Q

what are some causes of severe to profound hearing loss resulting in the need for a cochlear implant in adults ?

A

viral induced sudden hearing loss
ototoxicity ( aminoglycosides or loop diuretics )
otosclerosis
meniere disease
trauma

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24
Q

what vaccinations are recommended before having a cochelar implant to reduce the risk of meningitis ?

A

strep
haemophilus

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25
Q

what are some contraindications of having a cochlear implant ?

A

lesions of the 8th cranial nerve or in brain stem causing deafness
chronic infective otitis media
cochlear aplasia
tympanic membrane perforation

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26
Q

how can impacted ear wax present ?

A

pain
conductive hearing loss
tinnitus
vertigo

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27
Q

how is impacted ear wax managed ?

A

ear drops
irrigation - ear syringing

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28
Q

what is glue ear ?

A

otitis media with effusion

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29
Q

what are some risk factors for glue ear ?

A

male
siblings with glue ear
bottle feeding
day care attendance
parental smoking

30
Q

what are some features of glue ear ?

A

peaks at age 2
hearing loss is usually presenting feature

31
Q

what is the management of glue ear ?

A

active observation for 3 months
grommet insertion
adeniodectomy

32
Q

what is malignant otitis externa ?

A

uncommon type of otitis externa that is found in immunocompromised individuals
most commonly caused by pseudomonas aeruginosa

33
Q

how can malignant otitis externa spread ?

A

infection commences in the soft tissue of the external auditory meatus then progresses to involve the soft tissue and into the bony ear canal. this then progresses to the temporal bone and can cause osteomyelitis.

34
Q

what are the key features of malignant otitis externa ?

A

DM or immunosuppression
severe otalgia
temporal headaches
purulent otorrheoa
possibly dysphagia

35
Q

how is malignant otitis externa diagnosed ?

A

CT scan

36
Q

how is malignant otitis externa managed ?

A

non-resolving + worsening pain - refer to ENT
IV abx to cover pseudomonal infections

37
Q

What is Ménière’s disease ?

A

A disorder of the inner ear of unknown cause.
It is characterised by excessive pressure dilation of the endolymphatic system.

38
Q

What are some features of Ménière’s disease ?

A

Recurrent episodes of vertigo, tinnitus and hearing loss
Aural fullness
Nystagmus

39
Q

What is the management of Ménière’s disease ?

A

Acute attacks - buccal or IM prochlorperazine
Prevention - betahistine and vestibular rehab
Patients should inform the DVLA

40
Q

What are some causes of otitis externa ?

A

Infection - bacterial or fungal
Seborrhoeic dermatitis
Contact dermatitis
Recent swimming ( common trigger )

41
Q

What are some features of otitis externa ?

A

Ear pain, itch, discharge
Otoscopy - red, swollen or eczematous canal

42
Q

What is the initial management of otitis media ?

A

Topical abx

or

combined topical abx with a steroid

43
Q

What is otosclerosis ?

A

Describes the replacement of normal bone by vascular spongy bone.
It causes a progressive conductive deafness due to fixation of the stapes at the oval window.

44
Q

What inheritance pattern is otosclerosis ?

A

Autosomal dominant

45
Q

What are some features of otosclerosis ?

A

Conductive deafness
Tinnitus
Positive family history
Onset usually 20-40 years

46
Q

What is the management of otosclerosis ?

A

Hearing aid
Stapedectomy

47
Q

What is the most common cause of a perforated tympanic membrane ?

A

Infection

48
Q

What is the management of a perforated tympanic membrane ?

A

No treatment is needed
Avoid water
Prescribe abx
Myringoplasty - if does not heal by itself

49
Q

What is Presbycusis ?

A

A type of sensorineural hearing loss that affects elderly individuals.

50
Q

What frequency is most affected in Presbycusis ?

A

High frequency hearing is affected bilaterally which can lead to conversational difficulties particularly in noisy environment.

51
Q

What are some causes of Presbycusis ?

A

Precise cause is unknown
Arteriosclerosis
DM
Accumulated exposure to noise
Stress
Drug exposure ( salicylates, chemo agents )

52
Q

How does Presbycusis present ?

A

Speech becoming difficult to understand
Need for increased volume on TV
Worsening symptoms in noisy environments

53
Q

How is Rinne’s test performed ?

A

Tuning fork is placed over the mastoid process until the sound is no longer heard followed by repositioning just over the external acoustic meatus

54
Q

What is a positive Rinne’s test ?

A

AC is normally better than bone conduction

55
Q

What is a negative test for Rinne’s test ?

A

If BC is better than AC

56
Q

How is Weber’s test performed ?

A

Tuning fork is placed in the middle of the forehead equidistant from the patients ears.
The patient is then asked which side is loudest

57
Q

How does unilateral sensorineural deafness present in weber’s test ?

A

Sound is localised to the unaffected side

58
Q

How does unilateral conductive deafness present in weber’s test ?

A

Sound is localised to the affected side

59
Q

What is tinnitus ?

A

The perception of sounds in the ears or head that do not come from an outside source.

60
Q

What are some causes of tinnitus ?

A

Idiopathic
Ménière’s disease
Otosclerosis
Acoustic neuroma
Hearing loss

61
Q

What is vertigo ?

A

The false sensation that the body or environment is moving.

62
Q

What are some causes of vertigo ?

A

Viral labyrinthitis
Vestibular neuronitis
BPPV
Ménière’s disease
Acoustic neuroma

63
Q

What is viral labyrinthitis ?

A

An inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs.
Can be viral, bacterial or associated with systemic diseases

64
Q

What is the difference between viral labyrinthitis and vestibular neuritis ?

A

Vestibular neuritis - only vertigo
Viral labyrinthitis - vertigo and hearing loss

65
Q

How does viral labyrinthitis present ?

A

Vertigo
Nausea and vomiting
Hearing loss
Tinnitus

66
Q

What are some signs of viral labyrinthitis ?

A

Spontaneous unidirectional horizontal nystagmus towards the unaffected side
Sensorineural hearing loss
Gait disturbance

67
Q

How can viral labyrinthitis be managed ?

A

Episodes are usually self limiting
Prochlorperazine or antihistamines may reduce the sensation of dizziness

68
Q

What is Ramsey Hunt syndrome ?

A

Reactivation of the varicella zoster virus in the geniculate ganglion of the 7th cranial nerve.

69
Q

What are some features of Ramsey hunt syndrome ?

A

Auricular pain
Facial nerve palsy
Vesicular rash around the ear
Vertigo and tinnitus

70
Q

What is the management of Ramsey hunt syndrome ?

A

Oral aciclovir
Oral corticosteroids

Y4 Neuro and special senses (6 decks)

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