Otology

Question 1

What are the common symptoms of otology?

Answer 1

Hearing loss
Tinnitus
Vertigo
Otalgia
Otorrhea
Facial weakness

Question 2

How can otological symptoms be examined?

Answer 2

Otoscopy/microscopy
Rinne's test
Weber's test
Whispered voice test
Pure tone audiogram
Tympanogram

Question 3

When is Rinne’s test positive and negative and what does each of these indicate?

Answer 3

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

Question 4

How does sensorineural and conductive hearing loss present in Weber’s test?

Answer 4

Sensorineural- lateralises (is more audible) away from affected ear
Conductive hearing loss lateralises towards affected ear

Question 5

How is auricular haematoma managed?

Answer 5

Incision and drainage
Pressure dressing
Antibiotics
Possible complication: cauliflower ear

Question 6

How is a foreign body managed?

Answer 6

Removal

Urgency- battery>organic>inorganic

Question 7

What is otitis externa and how is it managed?

Answer 7

Inflammation of external auditory meatus
Management-
Antibiotic/steroid ear drops with potential suction under microscope

Question 8

What is malignant otitis externa, how does it present and how is it managed?

Answer 8

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

Question 9

What is otitis media with effusion, how does it present and how is it managed?

Answer 9

Sterile fluid in the middle ear
Presentation- hearing loss, speech delay
Management- Observation for 3 months, otovent, grommet

Question 10

What is acute suppurative otitis media, how does it present and how is it managed?

Answer 10

Pus in the middle ear
Presentation- otalgia with potential otorrhea
Management- observation, amoxicillin

Question 11

What is tympanosclerosis, how does it present and how is it managed?

Answer 11

Calcification in tympanic membrane +/- middle ear
Presentation- usually asymptomatic
Management- usually none

Question 12

What are the causes of chronic suppurative otitis media?

Answer 12

Can be caused by a perforated tympanic membrane or cholesteatoma

Question 13

What are the possible complications of chronic suppurative otitis media?

Answer 13

“Dead ear”
Facial palsy
Meningitis
Brain abscess

Question 14

What are the causes of a perforated tympanic membrane, how does it present and what is the management?

Answer 14

Causes:
-Infection
-Trauma
-Grommet
Presentaion:
-Recurring infections
-Hearing loss
Management:
-Water precautions
-Potential myringoplasty

Question 15

What are the causes of cholesteatoma, how does it present and what is the management?

Answer 15

Causes:
-Eustachian tube dysfunction
-Impaired skin migration
Presentation:
-Persistent offensive otorrohea
Management:
-Mastoidectomy

Question 16

How does otosclerosis present, what is the underlying pathology and how is it managed?

Answer 16

Presentation:
-Conductive hearing loss
-Normal tympanic membrane
Pathology:
-Fixation of stapes by extra bone
Management:
-Hearing aid
-Stapedectomy

Question 17

What are the causes of sensorineural hearing loss?

Answer 17

Presbyacusis
Head injury
Viral infections
Noise exposure
Ototoxic medications
Acoustic neuroma

Question 18

How is sensorineural hearing loss managed?

Answer 18

Hearing aids

Question 19

What are the clinical features of benign positional vertigo?

Answer 19

Vertigo precipitated by specific changes in head position
Duration: seconds
No associated symptoms
Positional and rotatory nystagmus

Question 20

How is benign positional vertigo investigated and managed?

Answer 20

Investigation- Dix-Hallpike test

Management- Epley manoeuvre

Question 21

What is the underlying pathology of vestibular neuritis/labyrinthitis, what are its clinical features and how is it managed?

Answer 21

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

Question 22

What is the underlying pathology of Meniere’s disease, what are its clinical features and how is it managed?

Answer 22

Pathology:
-Endolymphatic hydrops
Clinical features:
-Spontaneous vertigo
-Associated unilateral hearing loss/tinnitus/aural fullness
-Duration- hours
Management:
-Bendroflumethazide
-Intratympanic dexamethasone
-Intratympanic gentamicin

Question 23

What are the clinical features of a facial nerve palsy and how is it managed?

Answer 23

Clinical features:
-Lower motor neuron facial palsy (forehead involved)
Management:
-Treat underlying cause
-Steroids
-Eye care