Otology Flashcards
SNHL - general
inner ear issues
rinne positive (air > bone), weber contralateral PTA: air = bone, both decreased
causes: presbycusis, acoustic neuroma, sudden SNHL, noise-induced, Meniere’s, barotrauma, trauma, ototoxicity, RHS
CHL -general
middle/external ear issues
rinne negative (air air, bone normal
causes: AOM, ASOM, CSOM, OME, OE, cholesteotoma, retractions, tympanosclerosis, otosclerosis, perforation, haemotympanum, ossicular fracture
tinnitus - definitions
subjective = no stimulus objective = internal stimulus physiological = 10-15m duration
history questions
hearing loss otorrhoea, itch (common) tinnitus and dizziness (common) taste/face: CN VII in middle ear otalgia: can be referred H/N
otoscopy signs
cone of light anterior/ipsilateral; handle, canal walls, umbo, colour
TSclerosis: whitening; calc/collagenous scar;
glue ear: d/c, tight, red/injected
perforation: hole
cholesteatoma: black/grey mass
granulations and polyps
AOM: tense, red, bulging
Bullous myringitis: tense blood blisters, fluid level; max pain 3/7; viral (supportive Rx)
cholesteatoma
sac of skin cells in attic; neg pressure sucks in (retraction pocket)
enlarges and erodes: CN VII, skull, ossicles, mastoid, sigmoid sinus
foul d/c, attic retraction, debris, ?perforation/polyps
CHL, SNHL, vertigo, CN VII palsy, intracranial abscess/sepsis, sigmoid sinus thrombosis
Rx: mastoidectomy (removal); f/u to clean and dress
glue ear (OME)
affects 70-80% of kids at least once
thick sticky sterile effusion due to poor ventilation (AOM, allergy, ET dysfunction)
mild hearing loss (20-30dB), type B TGram, repeated AOM
self-resolving but may need grommets or HA if >3/12 + QOL impact
risk of CSOM
CSOM
prolonged repeated OM; damages TM causing non-healing perforation + CHL risk of intracranial sepsis hearing loss (10-20db), ororrhoea, ?ossicular disruption
Rx: aural toilet + ABx steroid drops
myringoplasty +/- mastoidectomy if needed
otosclerosis
compact bone replaces by spongy bone; stapes fixation and CHL; can cause SNHL through toxins
FHx (AD) high risk; 1%; often aSx; onset 20-40yo
bilateral hearing loss +/- tinnitus +/- positional vertigo paracusis willsii (better with background noise), flamingo tinge (10% have hyperaemic TM)
Rx: observation, HA, stapedectomy + replacement if severe
external ear signs
anatomy: pits, sinuses, tags, masses ulceration, haematoma, avulsion inflammation/infection: red, scaly/crusted, d/c, pain abscess formation: d/c, pain, mass discolouration
Rinne and Weber 512Hz
Rinne: bone (mastoid; 1) vs. air (2)
positive: 2>1; normal or SNHL
negative: 1>2; CHL or dead ear (transmitted- mask)
Weber: localise hearing loss
SNHL: contralateral hears better
CHL: ipsilateral hears better
PTA results
left: X, ] (masked)
right: O, [ (masked)
mask if >40dB difference
30-40: mild (whispers ok)
40-60: mod (raised voices)
60-80: severe
>80: profound (shouting)
SNHL: bone = air; CHL: bone >air; never air > bone
noise-induced: 4Hx dip (3-6KHx); air = bone
prebyacusis: high freq; air = bone, bilateral
ossicular: Carhart’s notch (bone drop 2K), bone > air
hereditary: ‘cookie bire loss
otosclerosis: bone > air
dead ear: mixed, bone > , both reduced, masking increases thresholdair
Tympanograms
type A: normal; peak ~0
type B: flat; fluid in middle ear
type C: left shift (peak
ASOM
associated with URTI
pus, pressure, pain; CHL
perforation: otorrhoea and decreasing pain
TM: retracted, then congested and bulging (pus)
Rx: ABx (Augmentin), analgesia, keep dry; top ABx/steroid for d/c,
myringotomy if non-healing, CN VII, or complications
risk of brain abscess
Noise-induced HL
repeated trauma causes permanent damage (other resolves)
SNHL > CHL (TM rupture, ME damage)
tinnitus, 4KHz dip
Rx: support, tinnitus counselling, HA
prevention!
