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ENT > Otology > Flashcards

Otology Flashcards

1
Q

Describe otitis media with effusion (OME, glue ear)

A

sterile collection of fluid in the middle ear cleft resulting in a conductive deafness of 10-40dB and a flat tympanogram

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2
Q

What is the treatment for glue ear?

A

high spontaneous resolution rate
if glue ear is confirmed then it is revaluated at follow up 3/12
50% resolve
If there is still glue ear then grommets are inserted

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3
Q

How long do grommets last?

A

Grommets will extrude spontaneously, on average 9 months but retention for 2 years is not unusual

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4
Q

Describe acute suppurative otitis media?

ASOM

A

this is a bacterial infection of the middle ear

pus forms and pushes the eardrum outwards, this the ruptures and the pus drains. The ear drum heals within 4-5days

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5
Q

What is the treatment for acute suppurative otitis media?

ASOM

A

first line treatment is amoxicillin and clavulanic acid

myringotomy is required if condition fails to resolve or facial palsy develops
brain abscesses still occur due to neglect or inadequate treatment

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6
Q

What is cholesteatoma?

A

a disease of deep meatal skin

surgery is the only treatment option

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7
Q

What is chronic suppurative otitis media?

CSOM

A

a disease of middle ear mucosa
repeated infections
perforation may be present
chronic odourless discharge

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8
Q

How do ear drum perforations (dry) occur?

A

viral infections in childhood

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9
Q

Treatment for perforated ear drums?

A

unless causing significant deafness or preventing patient being admitted to a profession or participating in a sport (swimming) they can be left alone

if troublesome grafting can be successful - myringoplasty

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10
Q

When should tumours be suspected?

A

benign and malignant tumours are both rare
usually occur in ears where previous mastoid surgery has been performed

suspect if patient complains of discharge (blood stained) and associated with pain

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11
Q

What are the intracranial complications of temporal bone infections?

A 
brain abscess
otogenic brain abscess
extradural abscess
sigmoid sinus thrombophlebitis 
subdural abscess
meningitis
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12
Q

What is presbyacusis?

A

hearing loss due to ageing that is wear and tear on the outer hair cells and is the most common causes of sensoineural deafness

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13
Q

Describe the hearing loss seen in presbyacusis?

A

bilateral and symmetrical hearing loss

high frequency hearing loss is present which mean consonants cannot be heard - this makes speech hard to understand

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14
Q

What is otosclerosis?

A

familial condition

spongy bone formation around the oval window and as it grows it fuses with the stapes causing a CONDUCTIVE deafness

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15
Q

What is an acoustic neuroma?

A

benign tumours of the auditory nerve (CN VIII)

early symptom = unilateral hearing loss or tinnitus

early diagnosis is crucial as surgery is more successful on small tumours

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16
Q

What is noise induced hearing loss?

A

inner ear is damaged by sudden acoustic trauma or prolonged exposure to excessive noise

with prolonged exposure hearing loss may be reversible initially due to cochlear fatigue

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17
Q

What is sudden sensorineural hearing loss?

A

MEDICAL EMERGENCY

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18
Q

How is sudden sensorineural hearing loss managed?

A

early = bed rest, vasodilators, carbogen gas, steroids (40mg pred for 5 days)

late = exclude acoustic neuroma

prognosis = low frequency loses recover better then high frequency deficits and severe vertigo is an unfavourable factor

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19
Q

What is ototoxicity?

A

damage to inner ear caused by drugs

hearing loss, tinnitus, vertigo

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20
Q

What drugs cause ototoxicity?

A

aminoglycosides
diuretics
salicylates
chemotherapeutic agents

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21
Q

How is ototoxicity managed?

A

prevention is crucial and effects can not be reversed
use non ototoxic alternatives

check renal function!!!

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22
Q

Describe subjective (intrinsic) tinnitus

A

a hallucination of noises in the head or ears
it is a description of a symptom and not a diagnosis
it may be associated with hearing loss and vertigo
patients can find this unbearable

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23
Q

Describe objective (extrinsic) tinnitus

A

a noise in the head or ears that can be heard by another individual
e.g. vascular bruits

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24
Q

How should bilateral tinnitus be managed?

A

reassurance
advice on coping strategies
distraction techniques - radio, ipod

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25
Q

How should unilateral tinnitus be managed?

A

needs investigating

?vestibular schwannoma

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26
Q

Describe other ways in which patients with tinnitus can be counselled?

A

hearing aids - improved hearing helps patient ignore tinnitus
sleeping - snooze facility on alarm clock can be useful, or sedation may be required
tinnitus maskers - important adjunct
self help and support groups

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27
Q

What should you do if a patient has unilateral hearing loss or tinnitus?

A

SCREEN
MRI

?vestibular schwannoma
?acoustic neuroma

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28
Q

What test should you carry out if you suspect Presbycusis?

A

Audiogram to confirm mixed hearing loss

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29
Q

What would you seen on a normal tympanograms?

A

a peak

30
Q

What would you see on a tymphanogram of ear which contained fluid?

A

a flat line

31
Q

What is vertigo?

A

Hallucination of movement - either the world moving around you or you moving through symptoms

32
Q

What is dizziness?

A

non specific symptom encompassing vertigo, light headedness, ataxia, diplopia

33
Q

What are the three major groups used to classify vertigo?

A

Central
Cardiovascular
Peripheral

34
Q

What are some of the peripheral causes of vertigo?

A

BPPV
Migraines
Neuronitis/labrinthitis
Benign vestibulopathy

35
Q

What are the CV causes of dizziness?

A

Postural hypotension
Arrhythmias
Vasovagal

36
Q

What are the central causes of dizziness?

A 
SOLs
Multiple sclerosis 
Trauma
TIA
Migraine
37
Q

What is BPPV?

A

Benign Paroxysmal Positional Vertigo

vertigo on head movement which last secs

38
Q

What causes BPPV?

A

calcium crystals floating into semicircular canals

spontaneous or post trauma

39
Q

What is a test to confirm BPPV?

Positive?

A

Hallpikes positional head test

Positive result - rotary nystagmus lasting <40s

40
Q

What is the treatment for BPPV?

A

Epley manoeuvres

usually resolves spontaneously in one year

41
Q

How does a patient with meniere’s disease present?

A

a middle aged person with a triad of symptoms

  • recurrent attacks of vertigo (15 mins to 24 hours)
  • tinnitus
  • fluctuating and progressive sensorineural hearing loss
42
Q

Describe a typical attack of meniere’s disease?

A

tinnitus comes on and gets louder in affected ear followed by vertigo
the ear often feels blocked or full and hearing deteriorates after an attack with some recovery in the next few days

43
Q

How would you investigate suspected meniere’s?

A

pure tone audiometry

MRI necessary in all cases to exclude acoustic neuroma

44
Q

How is meunière’s treated?

A

can spontaneously resolve (70%)
reassurance impoartant

acute phase - bucastem and bed rest

salt restriction bendroflumethiazide 2.5mg in the morning
ENT referral

45
Q

What is vestibular neuronitis?

A

viral infection of vestibular nerve

46
Q

How does vestibular neruonitis present?

A

sudden onset vertigo, nausea, nystagmus

NO hearing loss or tinnitus

Bed ridden 3-4 days
Occurs in small epidemics

47
Q

How is vestibular neuritis treated?

A

vestibular sedatives

antiemetics

48
Q

What is acute labyrinthine failure/labyrinthitis?

A

sudden attack of deafness and severe vertigo with nausea and vomitting

49
Q

How long does a labyrinthitis attack last?

A

10 days to 3 weeks

50
Q

What would be seen in clinic in a patient with labrythitis?

A

nystagmus

audiogram - mod-profound sensorineural hearing loss

51
Q

How is labyrinthitis treated?

A

admit pt for IV fluids, anti-emetics and vestibular sedatives

52
Q

Describe benign vestibulopathy

A

clusters of attacks of vertigo but no hearing loss or tinnitus

idiopathic - usually resolves in 2 years

53
Q

What is the treatment for benign vestibulopathy?

A

reassurance

cawthorne-cooksey exercises

54
Q

What is migrainous vertigo?

A

Rare form of migraine

dizzy spell, intense headache, N&V, photophobia

55
Q

What is the treatment for migrainous vertigo?

A

bucastem if vommiting
cinnarizine for vertigo
try beta histone or prochlorperazine

56
Q

What is presbystasis?

Presentation?

A

Episode of unsteadiness lasting few seconds, worsens when trying to move •No loss of consciousness, nausea or vomiting

57
Q

Treatment for presbystasis?

A

usually improves spontaneously

review meds

58
Q

What is a basilar migraine?

Presentation?

A

Ataxia, mild vertigo/unsteadiness

No hearing loss, tinnitus, nausea or vomiting

Look for other signs of cerebella or brainstem lesion

59
Q

What are some tests that can be performed in clinic for vertigo?

A

nystagmus test

romberg test

60
Q

What is the function of the facial nerve?

A

sensory to anterior 2/3 of tongue

muscles of facial expression

61
Q

What are the 5 branches of facial n?

A 
Temporal 
Zygomatic
Buccal
Marginal mandibular
Cervical
62
Q

Facial palsy - What is the difference between an UMN lesion and LMN lesion?

A

LMN - forehead affected

UMN - only lower face affected

63
Q

describe the history of a patient with a facial palsy?

A

Onset = Congenital, slow or rapid progression

Symptoms = Eye closure, drooling, hyperacusis, Deafness, Otorrohea, Otalgia, Vertigo, Tinnitus

Parotid Symptoms = Pain, masses

Systemic illnesses/Hx of head trauma

64
Q

What should you examine in a patient with a facial nerve palsy?

A 
cranial nerves 
ears
parotid
oral cavity 
tonsils
65
Q

What is the house brakeman scale?

A

I Normal
II Slight weakness, barely noticable
III Obvious weakness, not disfiguring
IV Asymmetry at rest but some facial movement
VI Asymmetry at rest + no facial movement

66
Q

What investigations should be carried out for a facial nerve palsy?

A

audiogram
stapedial reflexes
MRI

67
Q

What are the conditions you should exclude?

LONG

A

..in children = Moebius Syndrome, Hemifacial Microsomia, Forceps delivery, Herpes Zoster, Acute OM

….peripheral = Trauma, Iatrogenic (surgery), Malignant Parotid Tumours, Inflammatory conditions (Sarcoidosis)

…Middle Ear = Iatrogenic, Infection (Otitis Media, Cholesteatoma, AOM, HZV, Tumours (SCC, Glomus jugulare)

…Petrous Temporal Bone = Fractures, Tumours

…Intracranial = Tumours (Neuromas, Meningiomas), Vascular (Stroke), Neurological (MS)

68
Q

What is bells palsy?

A

idiopathic LMN palsy of VII

acute onset, hemi facial, no CNS pathology, no ear pathology

cause unknown

69
Q

Management of bells palsy?

A

resolves spontaneously

oral steroids may speed recovery - consider if see patient in first 24 hours

70
Q

Describe the facial palsy caused by herpes booster infection

A

Facial palsy + Facial pain + vesicles in ear canal/pinna ± SNHR ± Vertigo

71
Q

What is the treatment of a facial palsy caused by herpes zoster infection?

A

oral steroids and acyclovir if severe palsy

72
Q

What is an autoimmune cause of a facial palsy?

A

Guillain-Barre syndrome

ENT (6 decks)

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