Otology Flashcards
what are the common presenting symptoms in otology cases?
hearing loss tinnitus vertigo otalgia otorrhoea facial weakness
what is the medical term for discharge form the ear?
otorrhoea
what is the medical term for sensation of movement?
vertigo
what is the medical term for sensation of sound when there is no external sound?
tinnitus
why is facial weakness a common symptoms associated with otology cases?
the facial nerve which supplies the face supplies sensation to the anterior part of the external auditory canal
what examinations are carried out in otology cases?
otoscopy
microscopy
tuning fork tests - Rinne’s & Weber’s
whispered voice test
what investigations are carried out in otology cases?
pure tone audiometry
tympanogram
in someone with sensorineural hearing loss, would they test positive or negative in the Rinne’s test?
positive
in someone with conductive hearing loss would they test positive or negative in the Rinne’s test?
negative
conduction bone > air
if someone has conductive hearing loss what would you expect the results to be like in the Weber’s test?
they would have lateralisation of sound > in the ear affected
i.e. if they had conductive hearing loss in their right ear they would hear the sound greater in the right ear during the test
if someone has sensorineural hearing loss what would you expect the results to be like in the Weber’s test?
they would hear sound greater on the side that isn’t affected.
i.e. if they had hearing loss in the left ear then they would hear the sound greater on the right ear
concerning pure tone audiometry, what is considered normal hearing?
> 20dB
concerning typanogram, what is type B and Type C?
type B = low middle ear compliance (perforated drum or fluid in the middle ear)
type C = low middle ear pressure (eustachian tube not working)
is conductive and sensorineural hearing loss reversible?
conductive is reversible
sensorineural isn’t reversible
what is a complication from a pinna haematoma?
cauliflower ear
what is the management for auricular/pinna haematoma?
incision and drainage
antibiotics
pressure dressing
what is a condition of inflammation of the external auditory meatus?
otitis externa
what is malignant otitis externa?
osteomyelitis of the temporal bone
what is the management for otitis media with effusion?
observation for 3 months
otovent
grommets
what is characteristic of acute suppurative otitis media?
pus in the middle ear
what is the presentation of acute supportive otitis media?
otalgia with or without tympanic membrane rupture which eases the pain and then causes otorrhoea
what is the management for acute supportive otitis media?
observation
amoxicillin
what are 2 conditions of chronic suppurative otitis media?
perforation of the tympanic membrane
cholesteatoma
what are causes of perforation of the tympanic membrane?
infection
trauma
grommet
what is the presentation of perforated tympanic membrane?
hearing loss
recurrent / chronic infection
otalgia
what is the management of a perforated tympanic membrane?
water precautions
myringoplasty
what are the causes of cholesteatoma ?
eustachian tube dysfunction
impaired skin migration out of the ear
what is the presentation of cholesteatoma?
persistant offensive otorrhoea
what is the management of cholesteatoma?
mastoidectomy (remove diseased mastoid cells)
what are the managements for tinnitus?
treat underlying cause
sound enhancement
stress management
what are the differential diagnoses of vertigo?
benign paroxysmal positional dysfunction
migraine
menieres disease
vestibular neuritis/ labrynthitis
what causes BPPD?
otoconia in the semis circular ear canals
what are the clinical features of BPPD?
vertigo precipitated by specific changes in head movement
lasts only seconds
no associated symptoms
nystagmus is positional and rotatory
what is the investigation and management for BPPD?
dix-halpike test
epley manoeure
what is vestibular neuritis/ labyrinthitis?
reactivation of latent HSV infection of vestibular ganglion
what is the difference between vestibular neuritis and labyrinthitis?
there is hearing loss in labyrinthitis
no hearing loss in vestibular neuritis
what is the clinical features of vestibular neuritis / labyrinthitis?
spontaneous vertigo lasting for days
nystagmus is horizontal and towards the ear
what is the management for vestibular neuritis / labyrinthitis?
acute - vestibular sedatives
chronic - vestibular rehabilitation
what is Meniere’s disease?
endolymphatic hydrops (raised pressure in the endolymph)
what are the clinical features of Menieres disease?
spontaneous vertigo
associated unilateral hearing loss/ tinnitus / aural fullness
last for hours
wha is the management for menieres disease?
bendroflumethazide
intratympanic dexamethasone
intratympanic gentamicin
what can be the differential diagnosis of facial nerve palsy?
intratemporal e.g. cholesteatoma
extratemporal e.g. parotid tumour
idiopathic e.g. Bell’s palsy
what is the treatment for bells palsy?
steroids
eye care
what is the name of the condition caused by calcification of the tympanic membrane?
tympanosclerosis
what is malignant otitis externa and how do you treat it?
osteomyelitis of the temporal bone
amoxicillin
what is otosclerosis?
fixation of the stapes by an extra bone causing conductive hearing loss hearing loss
what are the causes of sensorineural hearing loss?
presbycusis (old age) tumour i.e. acoustic neuroma head injury noise exposure ototoxic medications viral infections
if there is a facial nerve palsy, is it typically LMN or UMN? and how would you differentiate the two?
a facial nerve palsy is LMN damage and damage of UMN causing facial palsy is typically due to a stroke
with the LMN affected in facial palsy the forehead is involved (so the forehead won’t be able to move either). however if it is UMN then the forehead isn’t involved
what causative organism is responsible for otitis externa?
pseudomonas aeruginosa
what causative organism is responsible for otitis media?
strep. pneumonia
h. influenzar
mortadella catahharis
