Otology Flashcards by Freddie Philbrook

What is tinnitus?

Any perceived sound that does not have an external stimulus

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What is the pathology of tinnitus?

No directly treatable pathology in the majority of cases but hearing loss and stress are important contributing factors

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What is the differential diagnosis for vertigo?

Benign postural vertigo
Menieres Disease
Migraine
Vestibular neuritis/labyrinthitis

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What is benign postural vertigo?

Dislodged otoconia in semicircular canals

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What are the key features of benign postural vertigo?

Vertigo (dizziness) precipitated by certain head movements lasting a few seconds

No associated symptoms

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What is the test for benign postural vertigo?

Dix-Hallpike test

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What is the treatment for BPV?

Epley manoeuvre

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What is the pathophysiology of Menieres disease?

Endolymphatic hydros (overproduction)

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What are the clinical features of Menieres Disease?

Spontaneous vertigo
Unilateral hearing loss
Fluctuating, progressive hearing loss

Duration: 30 mins- 4 hours
Frequency: every few days/weeks/ months

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What is the treatment for Meniere’s Disease?

Symptomatic: vestibular sedative (prochlorperazine)
Long term: Betahistine
Intratympanic dexamethasone/gentamicin

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What is the pathology of vestibular neuritis/labyrinthitis ?

Inflammation of vestibular nerve

Can be due to reactivation of latent HSV infection of vestibular ganglion

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What are the clinical features of labyrinthitis?

Vertigo
Sensorineural hearing loss, sometimes discharge

Duration: up to 3 days
Frequency: a few episodes

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What are the treatments for labyrinthitis?

Acute - vestibular sedatives

Chronic - vestibular rehabilitation

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What investigations are available to test auditory range and tympanic membrane?

Pure tone audiogram (tests hearing threshold)
Tymapnogram (tests middle ear function)

Type A - normal
Type B - immobile tympanic membrane (suggests middle ear condition)
Type C - suggests Eustachian tube dysfunction (middle ear low pressure)

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What disorders may occur in the outer ear?

Auricular haematoma
Foreign body
Otitis externa
Malignant Otitis externa

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What can otitis externa be a sign of?

Internal auricular malignancy

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What disorders may occur in the middle ear?

Acute otitis media
Otitis media with effusion (glue ear)
Chronic supperative otitis media
Cholesteatoma

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What can cause chronic supperative otitis media?

Cholesteatoma

2. Perforated tympanic membrane

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What complications may arise from chronic supperative otitis media?

Tympanosclerosis

Otosclerois

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What is a cholesteatoma?

Accumulation of keratinising epithelium (skin debris) in middle ear

Commonly in attic of ear

What are the symptoms of cholesteatoma?

Chronic, foul smelling discharge

Conductive hearing loss

What are the complications of cholesteatoma?

The cholesteatoma can grow and erode bone ossicles -> conductive deafness

Can compress facial nerve -> facial palsy

Vertigo

Cerebral abscess (erodes through bone superiority)

Mastoiditis (erodes posteriorly)

What is the infective organism associated with cholesteatoma?

Pseudomonas

What is the management of cholesteatoma?

Surgical removal

What is mastoiditis? | What symptoms does it cause?

Infection in the mastoid cavity Air cells fill with pus Causes tenderness, swelling and redness of mastoid process Pinna is pushed forward

What disorders may occur in the inner ear?

``` Prebyacusis (age related hearing loss) Noise induced hearing loss Ototoxic medication Infection Acoustic Schwannoma ```

What is facial palsy? | How do you differentiate between UMN + LMN palsy?

Facial palsy = paralysis of facial muscles UMN palsy = can still move forehead muscles (which receive innervation from contralateral motor cortex) Remember upper spares upper LMN = total facial weakness

What causes of facial palsy are there?

Intratemporal - cholesteatoma Extratemporal - parotid gland tumour Bell’s palsy - viral infection affecting VII nerve

What is an auricular haematoma?

Haematoma of the pinna due to trauma to external ear Common in sports injuries

How is auricular haematoma managed? | What complications are there?

Aspiration, incision + packing Cauliflower ear = occurs when delayed drainage of haematoma leads to necrosis + fibrosis of cartilage

What is otitis externa?

Inflammation of EAM | leads to narrowing +/- obstruction of external auditory meatus

What is the management of otitis externa?

Ear swab for microbiology Remove debris from EAM (microsuction) Abx/ steroid ear drops As inflammation settles, examine tympanic membrane to exclude middle ear infection Patients advised not to use cotton buds or allow water in ears

What is malignant otitis externa?

Infection of base of skull It is aggressive and spreads to bone causing osteomyelitis of skull

What Is the causative organism of malignant otitis externa

Pseudomonas

How is malignant otitis externa treated?

IV antibiotics +/- surgical debridement fatal if not treated

How can ear wax build up be managed?

Ear wax commonly blocks EAM Wax softening agent: sodium bicarbonate drops Aural toilet Microsuction of wax

What is Acute otitis media?

Acute infection of middle ear Associated with URTI which spreads via Eustachian tube Common in children

What are the causative organisms of otitis media?

Haemophilus influenzae, strep pneumoniae

What are the symptoms of acute otitis media?

Otalgia, otorrhea, hearing loss, pyrexia Pyrexia, irritability, anorexia in young children

What is the management of acute otitis media? | What complications are there?

Mx= antibiotics, analgesia Cx= perforation, necrosis of ossicles, tympanosclerosis

Symptoms of glue ear? Complications? Management?

Sterile, thick effusion Cx= hearing loss of 20-30dB (affects child's learning + behaviour long term) Mx: grommet if recurrent/ chronic > 3 months

What is chronic supportive otitis media? | symptoms + management?

Repeated/ prolonged bouts of acute otitis media Sx: otorrhea, hearing loss Mx: aural toilet (micro suction), antibiotic/ steroid ear drops

What are the causes of referred otalgia?

Infections: paranasal sinus infection, tooth infection, tonsillitis, epiglottitis, Other: parotid gland calculi, malignancy, trigeminal neuralgia

What is otosclerosis?

Disease of bony labyrinth: hard bone is replaced by spongy bone (overgrowth of abnormal bone) Overgrowth of stapes (sound fails to reach cochlea) -> conductive hearing loss

Give examples of causes of conductive hearing loss

``` Wax Foreign body Perforation/ trauma Otosclerosis Otitis media ```

Give examples of causes of sensorineural hearing loss

``` Advancing age Meniere's disease Acoustic trauma Drugs (gentamicin, furosemide) Acoustic neuroma MS ```

What is presbycusis?

Degenerative disorder of bilateral hearing loss in old age (typically high frequencies) Mx: hearing aid to amplify sound

What is acoustic trauma?

Exposure of inner ear to repeated loud noises / sudden very loud noise Sensorineural deafness due to cochlear damage

What is an Acoustic neuroma?

Schwannomas/ meningioma of vestibular division of VIII nerve | Compression of nerve by tumour causes unilateral symptoms