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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
what are some contraindications of having a cochlear implant ?
lesions of the 8th cranial nerve or in brain stem causing deafness chronic infective otitis media cochlear aplasia tympanic membrane perforation
26
how can impacted ear wax present ?
pain conductive hearing loss tinnitus vertigo
27
how is impacted ear wax managed ?
ear drops irrigation - ear syringing
28
what is glue ear ?
otitis media with effusion
29
what are some risk factors for glue ear ?
male siblings with glue ear bottle feeding day care attendance parental smoking
30
what are some features of glue ear ?
peaks at age 2 hearing loss is usually presenting feature
31
what is the management of glue ear ?
active observation for 3 months grommet insertion adeniodectomy
32
what is malignant otitis externa ?
uncommon type of otitis externa that is found in immunocompromised individuals most commonly caused by pseudomonas aeruginosa
33
how can malignant otitis externa spread ?
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
what are the key features of malignant otitis externa ?
DM or immunosuppression severe otalgia temporal headaches purulent otorrheoa possibly dysphagia
35
how is malignant otitis externa diagnosed ?
CT scan
36
how is malignant otitis externa managed ?
non-resolving + worsening pain - refer to ENT IV abx to cover pseudomonal infections
37
What is Ménière’s disease ?
A disorder of the inner ear of unknown cause. It is characterised by excessive pressure dilation of the endolymphatic system.
38
What are some features of Ménière’s disease ?
Recurrent episodes of vertigo, tinnitus and hearing loss Aural fullness Nystagmus
39
What is the management of Ménière’s disease ?
Acute attacks - buccal or IM prochlorperazine Prevention - betahistine and vestibular rehab Patients should inform the DVLA
40
What are some causes of otitis externa ?
Infection - bacterial or fungal Seborrhoeic dermatitis Contact dermatitis Recent swimming ( common trigger )
41
What are some features of otitis externa ?
Ear pain, itch, discharge Otoscopy - red, swollen or eczematous canal
42
What is the initial management of otitis media ?
Topical abx or combined topical abx with a steroid
43
What is otosclerosis ?
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
What inheritance pattern is otosclerosis ?
Autosomal dominant
45
What are some features of otosclerosis ?
Conductive deafness Tinnitus Positive family history Onset usually 20-40 years
46
What is the management of otosclerosis ?
Hearing aid Stapedectomy
47
What is the most common cause of a perforated tympanic membrane ?
Infection
48
What is the management of a perforated tympanic membrane ?
No treatment is needed Avoid water Prescribe abx Myringoplasty - if does not heal by itself
49
What is Presbycusis ?
A type of sensorineural hearing loss that affects elderly individuals.
50
What frequency is most affected in Presbycusis ?
High frequency hearing is affected bilaterally which can lead to conversational difficulties particularly in noisy environment.
51
What are some causes of Presbycusis ?
Precise cause is unknown Arteriosclerosis DM Accumulated exposure to noise Stress Drug exposure ( salicylates, chemo agents )
52
How does Presbycusis present ?
Speech becoming difficult to understand Need for increased volume on TV Worsening symptoms in noisy environments
53
How is Rinne’s test performed ?
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
What is a positive Rinne’s test ?
AC is normally better than bone conduction
55
What is a negative test for Rinne’s test ?
If BC is better than AC
56
How is Weber’s test performed ?
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
How does unilateral sensorineural deafness present in weber’s test ?
Sound is localised to the unaffected side
58
How does unilateral conductive deafness present in weber’s test ?
Sound is localised to the affected side
59
What is tinnitus ?
The perception of sounds in the ears or head that do not come from an outside source.
60
What are some causes of tinnitus ?
Idiopathic Ménière’s disease Otosclerosis Acoustic neuroma Hearing loss
61
What is vertigo ?
The false sensation that the body or environment is moving.
62
What are some causes of vertigo ?
Viral labyrinthitis Vestibular neuronitis BPPV Ménière’s disease Acoustic neuroma
63
What is viral labyrinthitis ?
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
What is the difference between viral labyrinthitis and vestibular neuritis ?
Vestibular neuritis - only vertigo Viral labyrinthitis - vertigo and hearing loss
65
How does viral labyrinthitis present ?
Vertigo Nausea and vomiting Hearing loss Tinnitus
66
What are some signs of viral labyrinthitis ?
Spontaneous unidirectional horizontal nystagmus towards the unaffected side Sensorineural hearing loss Gait disturbance
67
How can viral labyrinthitis be managed ?
Episodes are usually self limiting Prochlorperazine or antihistamines may reduce the sensation of dizziness
68
What is Ramsey Hunt syndrome ?
Reactivation of the varicella zoster virus in the geniculate ganglion of the 7th cranial nerve.
69
What are some features of Ramsey hunt syndrome ?
Auricular pain Facial nerve palsy Vesicular rash around the ear Vertigo and tinnitus
70
What is the management of Ramsey hunt syndrome ?
Oral aciclovir Oral corticosteroids

Y4 Neuro and special senses (6 decks)

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