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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
How should unilateral tinnitus be managed?
needs investigating | ?vestibular schwannoma
26
Describe other ways in which patients with tinnitus can be counselled?
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
27
What should you do if a patient has unilateral hearing loss or tinnitus?
SCREEN MRI ?vestibular schwannoma ?acoustic neuroma
28
What test should you carry out if you suspect Presbycusis?
Audiogram to confirm mixed hearing loss
29
What would you seen on a normal tympanograms?
a peak
30
What would you see on a tymphanogram of ear which contained fluid?
a flat line
31
What is vertigo?
Hallucination of movement - either the world moving around you or you moving through symptoms
32
What is dizziness?
non specific symptom encompassing vertigo, light headedness, ataxia, diplopia
33
What are the three major groups used to classify vertigo?
Central Cardiovascular Peripheral
34
What are some of the peripheral causes of vertigo?
BPPV Migraines Neuronitis/labrinthitis Benign vestibulopathy
35
What are the CV causes of dizziness?
Postural hypotension Arrhythmias Vasovagal
36
What are the central causes of dizziness?
``` SOLs Multiple sclerosis Trauma TIA Migraine ```
37
What is BPPV?
Benign Paroxysmal Positional Vertigo vertigo on head movement which last secs
38
What causes BPPV?
calcium crystals floating into semicircular canals spontaneous or post trauma
39
What is a test to confirm BPPV? Positive?
Hallpikes positional head test Positive result - rotary nystagmus lasting <40s
40
What is the treatment for BPPV?
Epley manoeuvres usually resolves spontaneously in one year
41
How does a patient with meniere's disease present?
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
Describe a typical attack of meniere's disease?
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
How would you investigate suspected meniere's?
pure tone audiometry | MRI necessary in all cases to exclude acoustic neuroma
44
How is meunière's treated?
can spontaneously resolve (70%) reassurance impoartant acute phase - bucastem and bed rest salt restriction bendroflumethiazide 2.5mg in the morning ENT referral
45
What is vestibular neuronitis?
viral infection of vestibular nerve
46
How does vestibular neruonitis present?
sudden onset vertigo, nausea, nystagmus NO hearing loss or tinnitus Bed ridden 3-4 days Occurs in small epidemics
47
How is vestibular neuritis treated?
vestibular sedatives | antiemetics
48
What is acute labyrinthine failure/labyrinthitis?
sudden attack of deafness and severe vertigo with nausea and vomitting
49
How long does a labyrinthitis attack last?
10 days to 3 weeks
50
What would be seen in clinic in a patient with labrythitis?
nystagmus | audiogram - mod-profound sensorineural hearing loss
51
How is labyrinthitis treated?
admit pt for IV fluids, anti-emetics and vestibular sedatives
52
Describe benign vestibulopathy
clusters of attacks of vertigo but no hearing loss or tinnitus idiopathic - usually resolves in 2 years
53
What is the treatment for benign vestibulopathy?
reassurance | cawthorne-cooksey exercises
54
What is migrainous vertigo?
Rare form of migraine | dizzy spell, intense headache, N&V, photophobia
55
What is the treatment for migrainous vertigo?
bucastem if vommiting cinnarizine for vertigo try beta histone or prochlorperazine
56
What is presbystasis? Presentation?
Episode of unsteadiness lasting few seconds, worsens when trying to move •No loss of consciousness, nausea or vomiting
57
Treatment for presbystasis?
usually improves spontaneously | review meds
58
What is a basilar migraine? Presentation?
Ataxia, mild vertigo/unsteadiness No hearing loss, tinnitus, nausea or vomiting Look for other signs of cerebella or brainstem lesion
59
What are some tests that can be performed in clinic for vertigo?
nystagmus test romberg test
60
What is the function of the facial nerve?
sensory to anterior 2/3 of tongue muscles of facial expression
61
What are the 5 branches of facial n?
``` Temporal Zygomatic Buccal Marginal mandibular Cervical ```
62
Facial palsy - What is the difference between an UMN lesion and LMN lesion?
LMN - forehead affected | UMN - only lower face affected
63
describe the history of a patient with a facial palsy?
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
What should you examine in a patient with a facial nerve palsy?
``` cranial nerves ears parotid oral cavity tonsils ```
65
What is the house brakeman scale?
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
What investigations should be carried out for a facial nerve palsy?
audiogram stapedial reflexes MRI
67
What are the conditions you should exclude? LONG
..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
What is bells palsy?
idiopathic LMN palsy of VII acute onset, hemi facial, no CNS pathology, no ear pathology cause unknown
69
Management of bells palsy?
resolves spontaneously | oral steroids may speed recovery - consider if see patient in first 24 hours
70
Describe the facial palsy caused by herpes booster infection
Facial palsy + Facial pain + vesicles in ear canal/pinna ± SNHR ± Vertigo
71
What is the treatment of a facial palsy caused by herpes zoster infection?
oral steroids and acyclovir if severe palsy
72
What is an autoimmune cause of a facial palsy?
Guillain-Barre syndrome

ENT (6 decks)

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