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ENT > Otology > Flashcards

Otology Flashcards

1
Q

What specific questions in the history should be asked in otology? (7)

A 
Deafness
Tinittus
Vertigo
Otorrhoea 
Otalgia

Time pattern / precipitating factors
Exposure to drugs / environmental noise

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2
Q

What 2 predisposing factors/conditions involved in otitis externa

A

Eczema (can lead to infection)

Trauma

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3
Q

What are the symptoms of otitis externa (3)

A

Otalgia
Otorrhoea (would be purulent)
Hearing loss (due to narrowed EAM)

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4
Q

What would be seen O/E in otitis externa (2)

And what specifically would be seen in Chronic Otitis Externa?

A

Tenderness on movement in tragus + postauricular
Poss skin cracked/crust (risk fungal infection)

Chronic - thickened/fissured skin + permanently moist

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5
Q

What are the possible treatments for otitis externa? (4)

What important to exclude when cleared?

A

Aural toilet (washing out ear)
Abx drops (or systemic if severe)
Steroid drops
Antifungals (eg glycerine) can be used to withdraw moisture

Important to check for otitis media as is a common cause

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6
Q

Who is malignant otitis externa seen in?

What is the common causative organism?

A

Elderly + diabetes

Pseudomonas

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7
Q

What are the complications of malignant (pseudomonal) otitis externa?

How is it treated?

A

Spreads to bone causing osteomyelitis of skull base

Can damage facial nerve + other nerves that exit thru jugular foramen (9/10/11)

IV Abx + poss surgical debridement

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8
Q

What are the complications of a trauma-related haematoma of the external ear? (2)

A

If not drained, can cause dense scarring/thickening of the ear
Infection can lead to cartilage necrosis + gross deformity

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9
Q

Define presbyacusis + its cause / features

+ its management

A

Degenerative hearing loss of old age

Caused by atrophy of labyrinth and cochlear nerve fibres

Gradual hearing loss in both ears w/wo tinittus
Mainly affects higher frequencies

Not cured but hearing aid amplifies sound + masks tinittus

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10
Q

What is cholesteatoma
Where exactly is it
What is it classed as

A

Cyst/sac of keratinising squamous epithelium - half necrotic, half proliferative
Epitympanic part of middle ear

Classed as Chronic Suppurative Otitis Media (CSOM)

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11
Q

What are the symptoms (2) + signs (3) of Cholesteatoma

How is it treated

A

Foul smelling discharge
Conductive hearing loss

Attic retraction w/ squamous debris
Attic perforation + discharge
Attic aural polyps

Surgical excision (op required depends on extent)

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12
Q

What are the complications of Cholesteatoma (which a pt may initially present with) (3) (Otologically Is Very Fucked)

A

Facial nerve palsy
Vertigo
Intracranial sepsis
Ossicular damage

(Condition is able to erode bone so all middle ear / mastoid structures at risk

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13
Q

Whats the difference between glue ear and acute (suppurative) otitis media?

A

Glue ear = otitis media with effusion of sterile (non-purulent) fluid

Acute = accumulation of pus creating pressure on tympanic membrane (usually URTI via eustachian tube)

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14
Q

What are the symptoms of acute otitis media + complications

A 
Otalgia 
Otorrhoea
Hearing loss (conductive)
Pyrexia
Systemic upset
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15
Q

How is acute otitis media treated?

A

Abx + analgesics
Abx/steroid drops if discharging
Nasal decongestants can speed up recovery

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16
Q

What is the aetiology behind glue ear?

What proportion of children get it ?

A

Poor ventilation of middle ear cavity leading to sterile/non-purulent effusion build-up

Causes include:
recurrent acute otitis media
infection/allergy of middle ear mucosa
eustachian tube dysfunction

70-80% children

17
Q

What are the symptoms of glue ear

Long term effects/ complications of glue ear

A

Mild conductive hearing loss

Long-term can affect child’s behaviour/schooling
Chronic effusion predisposes to recurrent attacks of acute otitis media

18
Q

When is treatment required in glue ear?

What is the management?

A

If symptomatic + not resolved within 3m

Grommets / hearing aids (equally effective)
Only for few years as child usually grows out

19
Q

What is Chronic Suppurative Otitis Media
+ its complications
+ treatment

A

prolonged/repeated otitis media (otalgia, otorrhoea, hearing loss)
Can damage tympanic membrane and cause a non-healing perforation (normally hearing loss mild at 10-20dB but in membrane involvement can be 50-70dB)

Treatment is aural toileting + abx/steroid drops
Surgical repear of ear drum poss necessary

20
Q

Describe the pathophysiology behing otosclerosis

A

Labyrinth bone replaces from hard to spongy

Overgrowth can affect stepes footplate leading to fixation + conductive loss
OR less commonly
Toxins produced by new bone can damage cochlear and cause sensorineural loss

21
Q

What are the poss symptoms of otosclerosis (4)

A

Bilateral hearing loss**
Paracusis willsii (better hearing with background noise)
Tinittus
Positional vertigo

22
Q

How is a diagnosis of otoslcerosis made?

A

Consider when conductive hearing loss with normal ear drum

Conclusively done by surgical examination of stapes footplate (commonest prob is fixation)

23
Q

How is symptomatic otosclerosis treated?

A

Mild - observation / hearing aid

Large conductive loss - surgically replace stapes with Teflon piston

24
Q

What is noise induced hearing loss?

+ how can symptoms become permanent

A

Loud auditory stimulus causing mild hearing loss / tinittus that quickly resolves
Repeated traumas of this type can lead to permanent symps
OR
Very loud nosie e.g. explosion

25
Q

What type of hearing loss is seen in noise-induced?

A

Mainly sensorineural

Also consider conductive due to tympanic membrane rupture + middle ear damage

26
Q

What would be seen on an audiogram of noise induced hearing loss / tinnitus

How is it managed

A

Dip at 4Hz

Hearing aid if poss
Tinittus counselling

27
Q

What are some intrinsic causes of tinnitus (10)

Tiny Liz March Is Very Cautious Towards Noisy Places Or Drugs

A 
Drugs
Labyrinthitis
Meniere's
Otosclerosis
Trauma
Noise induced
Vascular
Presbyacusis
Idiopathic
CN8 tumour
Temporal lobe epilepsy
28
Q

What is obscure auditory dysfunction
What will investigations show
How managed

A

Difficulty hearing in noisy environments
But with normal audiogram - more complex tests can be done e.g. pitch discrimination, sound pattern recognition tests
Conservative (training programmes or sitting front of classroom etc) or Hearing aid

ENT (6 decks)

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