Otology Flashcards
What symptoms are associated with otology?
- Hearing loss
- Tinnitus
- Vertigo
- Otalgia
- Otorrhoea
- Facial weakness
What can be performed as part of an otology examination?
- Otoscope
- Microscope
- Rinne’s test
- Weber’s test
- Whispered voice testing
How does a normal ear present on Rinne’s test?
- Positive
- Air>bone
How does conductive hearing loss present on Rinne’s test?
- Negative
- Bone>air
How does sensorimeural hearing loss present on Rinne’s test?
- Positive
- Air>bone
How does normal hearing present on Weber’s test?
- Test central
- Left=right
How does sensorineural hearing loss in the right ear present on Weber’s test?
- Lateralises to left
- Left>right
How does conductive hearing loss in the right ear present on Weber’s test?
- Lateralises to right
- Right>left
How is whispered voice testing carried out?
- Whispered voice at 60cm
- Mask other ear
- No lip reading
What otology investigations can be carried out?
- Pure tone audiogram
- Tympanogram
What are the different types of tympanogram results?
- Type A normal
- Type B tympanic membrane immobile
- Type C middle ear pressure low
Give examples of disorders of the outer ear.
- Auricular haematoma
- Foreign body
- Otitis externa
- Malignant otitis externa
Give examples of disorders of the middle ear.
- Otitis media with effusion (glue ear)
- Insertion of grommet
- Acute otitis media
- Chronic suppurative otisis media: perforate tympanic membrane
- Chronic suppurative otitis media: cholesteatoma
- Suppurative otitis media: complications
- Tympanosclerosis
- Otosclerosis
Give examples of causes of inner ear conditions.
- Prebyacusis
- Noise induced hearing loss
- Ototoxic medications
- Meniere’s disease
- Head injury
- Infections
- Vestibular schwannoma (acoustic neuroma)
- Treatment of sensorineural hearing loss: hearing aids
Tinnitus
Any perception of sound
Pathology of tinnitus
No directly treatable pathology in vast majority hearing loss and stress important contributing factors
Investigation of tinnitus
Unilateral or pulsatile
Treatment of tinnitus
- Sound enrichment
- Stress management
Differential diagnosis of vertigo
- Benign positional vertigo
- Menieres disease
- Vestibular neuritis/labyrinthitis
- Migraine
Features of vertigo episodes
- Duration
- Frequency
- Associated symptoms
- Precipitating factors
Pathology of benign positional vertigo
Otoconia in semicicular canals
Clinical features of benign positional vertigo
- Vertigo precipitated by specific changes in head position
- Duration: seconds
- Frequency: several times per day
- No associated symptoms
- Positive Dix-Hallpike test
Treatment of benign positional vertigo
Epley manoeuvre
Pathology of vestibular neuritis/ labyrinthitis
Reactivation of latent HSV infection of vestibular ganglion
Clinical features of vestibular neuritis/ labyrinthitis.
- Spontaneous vertigo
- No associated symptoms (vestibular neuritis) associated unilateral hearing loss (labyrinthitis)
- Duration: days
- Frequency: few episodes
- Residual motion provoked vertigo
Treatment of vestibular neuritis/ labyrinthitis
- Vestibular sedatives for acute
- Vestibular rehabilitation for chronic
Pathology of Menieres
Endolymphatic hydrops
Clinical features of Menieres disease
- Spontaneous vertigo
- Unilateral hearing loss/tinnitus/aural fullness
- Duration: hours
- Frequency: every few days/weeks/months
- Fluctuating, progressive unilateral hearing loss
Treatment for Menieres
- betahistine
- bendofluazide
- Intratympanic dexamethasone
- Intratympanic gentamicin
- Other
Pathology of migraine
Possibly vascular or neural
Clinical features of migraine
- Spontaneous vertigo
- Duration: variable
- Frequency: variable
- Headache, sensory sensitivity, auras
- Precipitated by migraine triggers
- Past history of migraine
Treatment of migraines
- Avoid migraine triggers
- Prophylactic medication
Give examples of causes of facial palsy
- Lower motor neuron facial weakness
- Facial nerve components: intratemporal, extratemporal
- Intratemporal pathology: cholesteatoma
- Extratemporl pathology: parotid gland tumour
Bell’s palsy
Acute, idiopathic facial palsy
