Otology Flashcards
What are the common symptoms of otology?
Hearing loss Tinnitus Vertigo Otalgia Otorrhea Facial weakness
How can otological symptoms be examined?
Otoscopy/microscopy Rinne's test Weber's test Whispered voice test Pure tone audiogram Tympanogram
When is Rinne’s test positive and negative and what does each of these indicate?
Positive when more audible in air than in bone
Negative test indicates conductive hearing loss
Positive test can be normal ear or sensorineural hearing loss
How does sensorineural and conductive hearing loss present in Weber’s test?
Sensorineural- lateralises (is more audible) away from affected ear
Conductive hearing loss lateralises towards affected ear
How is auricular haematoma managed?
Incision and drainage
Pressure dressing
Antibiotics
Possible complication: cauliflower ear
How is a foreign body managed?
Removal
Urgency- battery>organic>inorganic
What is otitis externa and how is it managed?
Inflammation of external auditory meatus
Management-
Antibiotic/steroid ear drops with potential suction under microscope
What is malignant otitis externa, how does it present and how is it managed?
Osteomyelitis of temporal bone Presentation- Severe pain in elderly diabetic Granulations in external auditory meatus Potential cranial nerve palsies Management- give antibiotics for weeks-months
What is otitis media with effusion, how does it present and how is it managed?
Sterile fluid in the middle ear
Presentation- hearing loss, speech delay
Management- Observation for 3 months, otovent, grommet
What is acute suppurative otitis media, how does it present and how is it managed?
Pus in the middle ear
Presentation- otalgia with potential otorrhea
Management- observation, amoxicillin
What is tympanosclerosis, how does it present and how is it managed?
Calcification in tympanic membrane +/- middle ear
Presentation- usually asymptomatic
Management- usually none
What are the causes of chronic suppurative otitis media?
Can be caused by a perforated tympanic membrane or cholesteatoma
What are the possible complications of chronic suppurative otitis media?
“Dead ear”
Facial palsy
Meningitis
Brain abscess
What are the causes of a perforated tympanic membrane, how does it present and what is the management?
Causes: -Infection -Trauma -Grommet Presentaion: -Recurring infections -Hearing loss Management: -Water precautions -Potential myringoplasty
What are the causes of cholesteatoma, how does it present and what is the management?
Causes: -Eustachian tube dysfunction -Impaired skin migration Presentation: -Persistent offensive otorrohea Management: -Mastoidectomy
How does otosclerosis present, what is the underlying pathology and how is it managed?
Presentation: -Conductive hearing loss -Normal tympanic membrane Pathology: -Fixation of stapes by extra bone Management: -Hearing aid -Stapedectomy
What are the causes of sensorineural hearing loss?
Presbyacusis Head injury Viral infections Noise exposure Ototoxic medications Acoustic neuroma
How is sensorineural hearing loss managed?
Hearing aids
What are the clinical features of benign positional vertigo?
Vertigo precipitated by specific changes in head position
Duration: seconds
No associated symptoms
Positional and rotatory nystagmus
How is benign positional vertigo investigated and managed?
Investigation- Dix-Hallpike test
Management- Epley manoeuvre
What is the underlying pathology of vestibular neuritis/labyrinthitis, what are its clinical features and how is it managed?
Pathology: -Reactivation of latent HSV infection of vestibular ganglion Clinical features: -Spontaneous vertigo -Associated unilateral hearing loss -Duration: days -Nystagmus- horizontal and towards affected ear Management: -Acute- vestibular sedatives -Chronic- vestibular rehabilitation
What is the underlying pathology of Meniere’s disease, what are its clinical features and how is it managed?
Pathology: -Endolymphatic hydrops Clinical features: -Spontaneous vertigo -Associated unilateral hearing loss/tinnitus/aural fullness -Duration- hours Management: -Bendroflumethazide -Intratympanic dexamethasone -Intratympanic gentamicin
What are the clinical features of a facial nerve palsy and how is it managed?
Clinical features: -Lower motor neuron facial palsy (forehead involved) Management: -Treat underlying cause -Steroids -Eye care
