Otology Flashcards
Common presenting symptoms in otology
Otalgia Otorrhoea Hearing loss Tinnitus Vertigo Facial weakness
What is Rinne’s test used to test?
Bone conduction - determines whether hearing loss is conductive or sensorineural
What would be the result of Rinne’s test in a patient with conductive hearing loss?
Bone conduction would be better than air conduction
What would be the result of Rinne’s test in a patient with sensorineural hearing loss?
Air conduction would be better than bone conduction
What can Weber’s test show?
Conductive hearing loss
Sounds greater than what intensity (decibels) can cause hearing loss after a few hours?
85dB
What is the normal range of human hearing (Hz)?
20-20,000 Hz
What does tympanometry allow?
Diagnosis and monitoring of problems in the middle ear
Tympanometry measures
the movement of the tympanic membrane in responses to changes in pressure
What abnormalities might be identified on tympanometry?
Fluid in the middle ear
Otitis media
Perforated eardrum
Problems with the Eustachian tube
What is vertigo?
“a hallucination of movement” -the sensation that you, or the things around you, are moving/spinning
What are the key features to determine in a patient with vertigo?
Duration
Frequency
Associated symptoms
Precipitating factors
What is benign positional vertigo?
Vertigo precipitated by specific changes in position (particularly rolling over in bed)
What is the cause of benign positional vertigo?
Otoconia (calcium carbonate particles) in the semicircular canals
What test would be positive in a patient with benign positional vertigo?
Dix-Hallpike test
What is the treatment for benign positional vertigo?
Epley manoeuvre
What is the cause of Meniere’s disease?
Endolymphatic hydrops - pressure in endolymphatic component is increased
What are the symptoms of Meniere’s disease?
Spontaneous vertigo
Associated unilaterall hearing loss, tinnitus and aural fullness
Duration of hours
Frequency - every few weeks-months
Possible conservative treatments for Meniere’s disease
Low salt diet Betahistine Benfrofluazide Intratympanic dexamethasone Endolymphatic sac decompression
Possible destructive treatments for Meniere’s disease
Intratympanic gentamicin
Vestibular nerve section
Labyrinthectomy
What is the cause of vestibular neuritis?
Reactivation of latent herpes simplex virus with injection of vestibular ganglion
Symptoms of vestibular neuritis
Spontaneous vertigo Hearing loss Tinnitus Duration of days Single episode Associated unilateral hearing loss Residual motion-provoked vertigo
Treatment of acute vestibular neuritis
Vestibular sedative
Treatment of chronic vestibular neuritis
Vestibular rehabilitation
Symptoms of migraine
Spontaneous vertigo Headache Photophobia Phonophobia Hearing loss, tinnitus
Treatment of migraine
Avoid triggers
Prophylactic pharmacological treatment
What is tinnitus?
Ringing/buzzing in the ears
Treatment of tinnitus
Sound enrichment and stress management
What is otitis media?
Painful inflammation and infection of the middle ear
Symptoms of otitis media
Crying/Irritability/Sleeplessness/Pulling on the ears in children Ear pain Headache Neck pain Feeling of fullness in the ear Fluid drainage from ear Fever, vomiting, diarrhoea if systemically unwell Hearing loss Loss of balance
Causes of acute otitis media
Eustachian tube blocked/swollen, trapping fluid in the middle ear which becomes infected
Allergies, cold etc.
Infected/enlarged adenoids
Smoking
Treatment of acute otitis media
Analgesia
Antibiotic eardrops
Apply warm, moist compress over affected ear
What is chronic otitis media
Long-standing, persistently draining perforation of eardrum
Causes of chronic otitis media
Acute otitis media
Blockage of eustachian tube
What can cause flare-ups of chronic otitis media?
Cold infection
Ear infection
Water entering middle ear
Treatment of chronic otitis media
Antibiotic eardrops
Oral antibiotics if systemically unwell
Tympanoplasty
Removal of cholesteatoma
What is otitis externa?
Inflammation of the external ear canal
Causes of otitis externa
Commonly caused by bacteria and fungi
Treatment of otitis externa
Clean the ear
Micro-suction, microbiology swab
Topical antibiotics
Oral antibiotics if systemically unwell
Treatment of otitis externa if spread to base of skull/nerves occurs
Hospital admission
IV antibiotics
What is Bell’s palsy?
Acute, idiopathic facial nerve palsy
Treatment of Bell’s palsy
Most people recover within a couple of months without treatment
Corticosteroids
Antivirals
