Otology

Question 1

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

Answer 1

outer or middle ear problem

Question 2

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

Answer 2

inner ear problem

Question 3

how does the whispered voice test carried out

Answer 3

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

Question 4

what conditions affect the inner ear

Answer 4

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)

Question 5

what conditions affect the middle ear

Answer 5

otitis media with effusion

otosclerosis

acute otitis media

chronic suppurative otitis media

cholesteatoma

tympanosclerosis

Question 6

what conditions affect the outer ear

Answer 6

auricular haematoma
foreign body
otitis externa
malignant otitis externa

Question 7

describe common presenting otological symptoms

Answer 7

hearing loss
tinnitus
vertigo
otalgia
otorrhoea
facial weakness

Question 8

list some types of ear examinations

Answer 8

otoscope
microscope
hearing tests - rinnies, webers, whispered voice

Question 9

what does rinnies test compare

Answer 9

air/bone conduction

bone>air = conductive loss
air>bone = sensorineural 

test is POSITIVE when normal

Question 10

what does webers test show

Answer 10

conductive loss = sound hear better on affected side

sensorineural hearing loss = sound heard better on non affected side

Question 11

how does otitis media with effusion present

Answer 11

hearing loss
imbalance 
speech delay
behavioural problems 
academic decline

Question 12

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

Answer 12

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

Question 13

what is the treatment of OME

Answer 13

grommet (lets airgo in and bypasses blocked tube

adenoidectomy

autoinflation

Question 14

how do you remove a grommet

Answer 14

eardrums will heal on its own and push the grommet out

Question 15

what happens to the tympanic membrane in otitis media

Answer 15

inflammation gets worse until the eardrum ruptures

Question 16

how is a ruptured eardrum managed

Answer 16

get better on its own

Question 17

how does acute otitis media present

Answer 17

fever
pain +++
sleep disturbance
systemic upset 
ear discharge

Question 18

how is acute otitis media treated

Answer 18

analgesia

antibiotics (5-7 days)

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

Question 19

how does chronic suppurative otitis media (CSOM) present

Answer 19

hearing loss/repeated hearing loss

Question 20

what is CSOM with cholesteatoma

Answer 20

build up of skin behind the ear drum

Question 21

how does cholesteatoma present

Answer 21

persistent smelly ear discharge

hearing loss

Question 22

how can cholesteatoma be potentially damaging

Answer 22

build of skin can prevent the normal turnover of eardrum skin

can cause erosion of facial nerve

can cause brain abscess

Question 23

how is cholesteatoma treated

Answer 23

surgical removal of skin

Question 24

what is a complication of SCOM

Answer 24

typanosclerosis

Question 25

what is tympanosclerosis

Answer 25

calcium deposition in the eardrum - can lead to rupture

Question 26

what is otosclerosis

Answer 26

problems with the stapes bone (middle ear bone)

Question 27

what is presbyacusis

Answer 27

age associated hearing loss - high frequencies are lost

Question 28

what frequencies are lost in noise induced hearing loss

Answer 28

middle frequencies

Question 29

what frequencies are lost in menieres disease

Answer 29

low frequencies

Question 30

what is vestibular schwannoma

Answer 30

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

Question 31

what is the treatment for vestibular schwannoma

Answer 31

surgery | radiotherapy

Question 32

what is tinnitus

Answer 32

any perception of sound

Question 33

what are contributing factors to tinnitus

Answer 33

hearing loss and stress

Question 34

what factors of tinnitus is it important to investigate

Answer 34

is it unilateral | is it pulsatile

Question 35

what might pulsatile tinnitus imply

Answer 35

linked to a vascular problem in the skull base

Question 36

what is vertigo

Answer 36

hallucination of movement - dizziness, sensation of loss of balance

Question 37

what questions would you ask for someone who complains of vertigo

Answer 37

duration of episode, frequency, associated symptoms, precipitating factors

Question 38

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

Answer 38

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

Question 39

what causes benign positional vertigo

Answer 39

otoconia (otolith) in the semi-circular canals

Question 40

what are the clinical features of being positional vertigo

Answer 40

duration: seconds frequency: several times per day no associated symptoms precipitating factors: specific changes in head position

Question 41

what can diagnose benign positional vertigo

Answer 41

postitive Dix-Hallpike test

Question 42

how can you treat benign positional vertigo

Answer 42

Epley manoeuvre

Question 43

what causes vestibular neuritis/ labyrinthitis?

Answer 43

reactivation of latent HSV infection of vestibular ganglion

Question 44

what are the clinical features of vestibular neuritis/labrynthitis vertigo

Answer 44

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

Question 45

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

Answer 45

acute - vestibular sedatives chronic - vestibular rehabilitation

Question 46

what causes menieres disease

Answer 46

endolymphatic hydrops | abnormal fluctuation in the endolymph fluid

Question 47

what are the clinical features of Menieres vertigo

Answer 47

duration: hours frequency: every few days/ weeks/ months, associated symptoms: fluctuating, progressive unilateral hearing loss (eventually becomes permanent) precipitating factors: none (spontaneous)

Question 48

how do you treat menieres disease vertigo

Answer 48

betahistine (vertigo), bendrofluazide (high BP med), intratympanic dexamethasone (corticosteroid), intratympanic gentamicin (AB)

Question 49

what are the clinical features of migraine vertigo

Answer 49

duration: variable frequency: variable associated factors: sensory sensitivities, auras, past history, precipitating factors: spontaneous vertigo, precipitated by migraine triggers

Question 50

how do you treat migraines

Answer 50

avoid migraine triggers prophylactic medication

Question 51

is facial palsy an upper or lower motor neurone facial weakness

Answer 51

lower

Question 52

what intratemporal pathology can lead to facial palsy

Answer 52

cholesteatoma

Question 53

what extratemporal pathology can lead to facial palsy

Answer 53

parotid gland tumour

Question 54

what is bells palsy

Answer 54

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

Question 55

what is the onset of bells palsy

Answer 55

acute

Question 56

what causes Bells palsy

Answer 56

idiopathic