Otology Flashcards
what nerve runs right through the ear?
the facial nerve
what symptoms someone with ear problems present with?
> hearing loss > tinnitus > vertigo > otalgia > otorrhoea > facial weakness
what does otorrhoea mean?
discharge from the ear
what does oltagia mean?
pain in the ear
what is tinnitus?
hearing a sound in your ear such as a buzzing or whining
what can be used to examine the patients ear?
otoscope or microscope
in a conductive hearing loss would bone conduction be louder than air?
yes it would so the test is negative
what would a positive rinnes test suggest?
that either hearing is normal or that the hearing loss is sensorineural
what would the result of a webers test be if there was sensorineural hearing loss in the right ear?
the sound would t=be lateralised to the left
what sort of hearing loss in the right ear would lateralise sound to the right in webers test?
conductive hearing loss
what investigations can be carried out in hearing loss?
> pure tone audiogram
> tympanogram
if you do not drain an auricular haematoma what may it become?
a cauliflour ear
describe otitis externa
> very common
inflammation of the skin of the ear canal
itching, pain and discharge
how would you treat otitis externa?
> topical antibiotics and steroids
if ear is filled with debri treatment may not be effective
preventative measures, don’t put things in ears
what is malignant otitis externa?
an aggressive form of otitis externa. this is not a malignant neoplasm. severe pain and granulation tissue in the ear canal
what is glue ear?
otitis media with effusion: there is sterile fluid under the eardrum
how does a non-working Eustachian tube create an effusion under the ear drum?
the pressure cannot be equalised so a vacuum is create and fluid secreted due to the low pressure
what is a grommet?
this is the treatment for glue ear. a plastic tube inserted into the eardrum equalises the pressure. after a few months the eardrum heals and it is pushed out
when would you put in grommets?
after watchful waiting of the child and if the hearing loss is persistent and significant
what is acute otitis media?
infection of the ear durm
what can chronic suppurative otitis media lead to?
> perforated tympanic membrane
> cholesteatoma
what is cholesteatoma?
this is a collection of skin in the in middle ear caused by a Eustachian tube dysfunction that creates a vacuum so skin does not migrate out of the ear canal.
what problems can cholesteatoma lead to?
> erosion of the mastoid process
erosion of the facial nerve
erosion into the brain creating an abscess
infection of the skin lump
what complications can arise from suppurative otitis media?
> tympanosclerosis- calcium deposits in the tympanic membrane
otosclerosis- extra bone formation creating conductive hearing loss
what is presbyacusis?
progressive sensory neural deafness occurring with age
name an ototoxic medication
gentamyacin
what is the effect of menieres disease?
> deafness
tinnitus
vertigo
build up of fluid in the inner ear
what is vestibular schwannoma?
a benign tumour with sensorineural hearing loss in one ear
what would you investigate form tinnitus?
weather it is unilateral or pulsatile then get an MRI
how would you treat tinnitus?
with sound enrichment or stress management
what is the differential diagnosis for vertigo?
> benign positional vertigo
menieres disease
vestibular neuritis (labyrinthitis)
migraine
what features would you want to find out about vertigo?
> duration
frequency
associated symptoms
precipitating factors
what is the pathology of benign positional vertigo?
otoconia (calcium carbonate particles) in semi-circular canals
what are the clinical features of benign positional vertigo?
> precipitated by changes in head position > lasts seconds > happens several times a day > so associated symptoms > positive dix-hallpike test
how would you treat benign positional vertigo?
epley manoeuvre
what is vestibular neuritis?
reactivation of latent HSV infection of vestibular ganglion
what are the clinical features of vestibular neuritis?
> spontaneous vertigo > no associated symptoms > lasts days > a few episodes > residual motion provoked vertigo
how would you treat acute vestibular neuritis?
vestibular sedatives
how would you treat chronic vestibular neuritis?
vestibular rehabilitation
what is the pathology of menieres disease?
endolymphatic hydrops, raised pressure of the endolymphatic part of the cochlear
what are the clinical features of menieres disease?
> spontaneous vertigo > unilateral hearing loss > tinnitus > aural fullness > lasts hours > happens every few days/weeks/months > fluctuates and progresses to unilateral hearing loss
what is the treatment for menieres disease?
> betahistine
bendrofluazide
intratympanic dexamethasone
intratympanic gentamicin
what is the last resort treatment for menieres disease?
intratympanic gentamicin as this is injected into the middle ear and absorbed to the inner ear killing the nerve cells.
what are clinical features of migraine?
> spontaneous vertigo
variable frequency and duration
headache, sensory sensitivity
triggers
what may cause intratemporal facial palsy?
cholesteatoma
what may be an extratemporal cause for facial palsy?
parotid gland tumour
what is bells palsy?
acute idiopathic facial palsy (refer to ent to check there is n other cause)
