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HEAD & NECK > Otology > Flashcards

Otology Flashcards

1
Q

is a conductive hearing loss an outer or inner ear problem?

A

outer or middle ear problem

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2
Q

is a sensorineural hearing loss an outer or inner ear problem?

A

inner ear problem

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3
Q

how does the whispered voice test carried out

A

whispered voice at 60cm, mask other ear, no lip reading

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4
Q

what conditions affect the inner ear

A

presbyacusis: age associated, affects high frequencies

noise induced hearing loss

ototoxic medications

Ménière’s disease: low frequency hearing loss

head injury

infections

vestibular schwannoma (acoustic neuroma)

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5
Q

what conditions affect the middle ear

A

otitis media with effusion

otosclerosis

acute otitis media

chronic suppurative otitis media

cholesteatoma

tympanosclerosis

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6
Q

what conditions affect the outer ear

A

auricular haematoma
foreign body
otitis externa
malignant otitis externa

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7
Q

describe common presenting otological symptoms

A 
hearing loss
tinnitus
vertigo
otalgia
otorrhoea
facial weakness
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8
Q

list some types of ear examinations

A

otoscope
microscope
hearing tests - rinnies, webers, whispered voice

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9
Q

what does rinnies test compare

A

air/bone conduction

bone>air = conductive loss
air>bone = sensorineural

test is POSITIVE when normal

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10
Q

what does webers test show

A

conductive loss = sound hear better on affected side

sensorineural hearing loss = sound heard better on non affected side

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11
Q

how does otitis media with effusion present

A 
hearing loss
imbalance 
speech delay
behavioural problems 
academic decline
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12
Q

what kind of fluid is present under the ear drum in otitis media with effusion (OME) and why is it there

A

sterile fluid

secreted if the pressure cannot be normalised between the middle and outer ear

because potential blockage of post-nasal space

blocked eustatian tube
adenoid hypertrophy

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13
Q

what is the treatment of OME

A

grommet (lets airgo in and bypasses blocked tube

adenoidectomy

autoinflation

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14
Q

how do you remove a grommet

A

eardrums will heal on its own and push the grommet out

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15
Q

what happens to the tympanic membrane in otitis media

A

inflammation gets worse until the eardrum ruptures

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16
Q

how is a ruptured eardrum managed

A

get better on its own

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17
Q

how does acute otitis media present

A 
fever
pain +++
sleep disturbance
systemic upset 
ear discharge
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18
Q

how is acute otitis media treated

A

analgesia

antibiotics (5-7 days)

  • 1st line = amoxycillin/co-amoxicalv
  • 2nd line = erythromycin/clarithromycin
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19
Q

how does chronic suppurative otitis media (CSOM) present

A

hearing loss/repeated hearing loss

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20
Q

what is CSOM with cholesteatoma

A

build up of skin behind the ear drum

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21
Q

how does cholesteatoma present

A

persistent smelly ear discharge

hearing loss

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22
Q

how can cholesteatoma be potentially damaging

A

build of skin can prevent the normal turnover of eardrum skin

can cause erosion of facial nerve

can cause brain abscess

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23
Q

how is cholesteatoma treated

A

surgical removal of skin

24
Q

what is a complication of SCOM

A

typanosclerosis

25
Q

what is tympanosclerosis

A

calcium deposition in the eardrum - can lead to rupture

26
Q

what is otosclerosis

A

problems with the stapes bone (middle ear bone)

27
Q

what is presbyacusis

A

age associated hearing loss - high frequencies are lost

28
Q

what frequencies are lost in noise induced hearing loss

A

middle frequencies

29
Q

what frequencies are lost in menieres disease

A

low frequencies

30
Q

what is vestibular schwannoma

A

benign primary intracranial tumour of the myelin-forming cells of the vestibular nerve (CN8)

31
Q

what is the treatment for vestibular schwannoma

A

surgery

radiotherapy

32
Q

what is tinnitus

A

any perception of sound

33
Q

what are contributing factors to tinnitus

A

hearing loss and stress

34
Q

what factors of tinnitus is it important to investigate

A

is it unilateral

is it pulsatile

35
Q

what might pulsatile tinnitus imply

A

linked to a vascular problem in the skull base

36
Q

what is vertigo

A

hallucination of movement - dizziness, sensation of loss of balance

37
Q

what questions would you ask for someone who complains of vertigo

A

duration of episode, frequency, associated symptoms, precipitating factors

38
Q

what are the possible differential diagnosis’ for someone presenting with vertigo

A

benign positional vertigo,
Ménières disease,
vestibular neuritis/labyrinthitis,
migraine

39
Q

what causes benign positional vertigo

A

otoconia (otolith) in the semi-circular canals

40
Q

what are the clinical features of being positional vertigo

A

duration: seconds
frequency: several times per day

no associated symptoms

precipitating factors: specific changes in head position

41
Q

what can diagnose benign positional vertigo

A

postitive Dix-Hallpike test

42
Q

how can you treat benign positional vertigo

A

Epley manoeuvre

43
Q

what causes vestibular neuritis/ labyrinthitis?

A

reactivation of latent HSV infection of vestibular ganglion

44
Q

what are the clinical features of vestibular neuritis/labrynthitis vertigo

A

duration: days
frequency: few episodes (3 episodes of decreasing severity common)

associated symptoms: none if vestibular neuritis, associated unilateral hearing loss in labyrinthitis,

precipitating factors: none

45
Q

how do you treat acute and chronic vestibular neuritis/labyrinthitis respectively

A

acute - vestibular sedatives

chronic - vestibular rehabilitation

46
Q

what causes menieres disease

A

endolymphatic hydrops

abnormal fluctuation in the endolymph fluid

47
Q

what are the clinical features of Menieres vertigo

A

duration: hours
frequency: every few days/ weeks/ months, associated
symptoms: fluctuating, progressive unilateral hearing loss (eventually becomes permanent)

precipitating factors: none (spontaneous)

48
Q

how do you treat menieres disease vertigo

A

betahistine (vertigo),

bendrofluazide (high BP med),

intratympanic dexamethasone (corticosteroid),

intratympanic gentamicin (AB)

49
Q

what are the clinical features of migraine vertigo

A

duration: variable
frequency: variable

associated factors: sensory sensitivities, auras, past history,

precipitating factors: spontaneous vertigo, precipitated by migraine triggers

50
Q

how do you treat migraines

A

avoid migraine triggers

prophylactic medication

51
Q

is facial palsy an upper or lower motor neurone facial weakness

A

lower

52
Q

what intratemporal pathology can lead to facial palsy

A

cholesteatoma

53
Q

what extratemporal pathology can lead to facial palsy

A

parotid gland tumour

54
Q

what is bells palsy

A

paralysis of the facial nerve causing muscular weakness in one side of the face

55
Q

what is the onset of bells palsy

A

acute

56
Q

what causes Bells palsy

A

idiopathic

HEAD & NECK (13 decks)

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