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ENT > Otology > Flashcards

Otology Flashcards

1
Q

Definition of otalgia

A

Ear pain

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2
Q

Definition of otorrhea

A

Fluid excreted from ears

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3
Q

If Rinne’s test is positive, what does this mean?

A

AIR > BONE

Normal ear

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4
Q

If Rinne’s test shows a negative test, with bone > air, what does this mean?

A

Conductive hearing loss

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5
Q

If Rinne’s test shows a positive test, with air > bone, what does this show?

A

Sensorineural hearing loss

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6
Q

If in weber’s test there is normal hearing in both ears, what does this mean the test is?

A

Central

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7
Q

In weber’s test, if the sound is louder on the left than the right, and the hearing loss is in the right ear, what does this mean?

A

Test lateralises to the left

- sensorineural loss right ear

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8
Q

In weber’s test, if the sound is louder on the right than the left, and the hearing loss is in the right ear, what does this mean?

A

Test lateralises to the right

- conductive hearing loss right ear

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9
Q

What is conductive hearing loss caused by?

A

Outer or middle ear problems

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10
Q

What is sensorineural hearing loss caused by?

A

Inner ear problems

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11
Q

Investigations of hearing loss

A

Pure tone audiogram

Tympanogram

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12
Q

What is a type A tympanogram result?

A

Normal

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13
Q

What is a type B tympanogram result?

A

Tympanic membrane immobile

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14
Q

What is a type C tympanogram result?

A

Middle ear pressure low

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15
Q

What is the treatment of sensorineural hearing loss?

A

Hearing aids

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16
Q

Causes of vertigo

A

Benign positional vertigo
Menieres disease
Vestibular neuritis / labyrinthiis
Migraine

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17
Q

Pathology of benign positional vertigo

A

Otoconia (particles) in semi-circular canals floating around

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18
Q

In benign positional vertigo, what is the vertigo precipitated by?

A

Specific changes in head position

Not spontaneous

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19
Q

Duration of benign positional vertigo and how often?

A

Seconds, several times a day

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20
Q

What test is positive in benign positional vertigo?

A

Dix-Hallpike test

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21
Q

Treatment of benign positional vertigo

A

Epley manoeuvre

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22
Q

How does the Epley manoeuvre work?

A

Particles are moved to a part of the ear where they will not cause any trouble

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23
Q

Pathology of vestibular neuritis/labyrinthitis

A

Reactivation of latent HSV infection of vestibular ganglion

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24
Q

Presentation of vestibular neuritis

A

Vertigo

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25
Q

Presentation of labyrinthitis

A

Vertigo

Hearing loss in affected ear

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26
Q

Which is more common, vestibular neuritis or labyrinthitis?

A

Vestibular neuritis

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27
Q

What is the duration and how long does the symptoms last in vestibular neuritis / labyrinthitis?

A

Days

Few episodes

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28
Q

What provokes the vertigo in vestibular neuritis / labyrinthitis?

A

Residual motion provoked vertigo

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29
Q

Treatment of acute vestibular neuritis

A

Vestibular sedatives

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30
Q

What do vestibular sedatives do?

A

To promote the central compensation and the brain responding to new signals

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31
Q

Treatment of chronic vestibular sedatives

A

Vestibular rehabilitation

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32
Q

What does vestibular rehabilitation do?

A

Promotes the recovery of benign positional vertigo after an episode of vestibular neuritis

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33
Q

Pathology of Meniere’s disease

A

Endolymphatic hydrops

Raised pressure in the lymphatic compartment of the cochlea and progressive dilatation of the endolymphatic system

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34
Q

Presentation of Menieres disease

A

Spontaneous vertigo
Unilateral hearing loss + tinnitus + aura fullness
Fluctuating, progressive, unilateral hearing loss
Nystagmus
Positive rhomberg test
Typically symptoms are unilateral but bilateral symptoms may result after a number of years

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35
Q

How long do the symptoms of menieres disease last for?

A

Hours

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36
Q

How often do people with menieres disease get there symptoms?

A

Every few days / weeks / months

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37
Q

Treatment of Menieres disease

A 
Betahistine 
Bendrofluazide 
Vestibular rehab exercises 
Intratympanic dexamethasone 
Intratympanic gentamicin (last resort)
Acute attacks may need prochlorperazine

Symptoms resolve in the majority of patients after 5 - 10 years but most left with a degree of hearing loss

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38
Q

What does betahistine do?

A

Improve blood supply to inner ear

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39
Q

What does bendrofluazide do?

A

Diuretic to improve pressure in lymphatic area in ear

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40
Q

Presentation of migraine

A

Spontaneous vertigo
Headache
Sensory sensitivity
Auras

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41
Q

Definition of tinnitus

A

Any perception of sound

42
Q

Treatment of tinnitus

A

Sound enrichment

Stress management

43
Q

Is a facial palsy an UMN or a LMN lesion?

A

LMN

44
Q

What is bells palsy?

A

Acute, idiopathic facial palsy

45
Q

What is otitis externa?

A

Inflammation of the skin of the ear canal

46
Q

What is malignant otitis externa?

A

Aggressive, osteomyelitis of the temporal bone

NOT NEOPLASTIC

47
Q

Who is malignant otitis externa common in?

A

Diabetic patients

48
Q

Treatment of malignant otitis externa

A

Systemic antibiotics

49
Q

Pathology of glue ear

A

Sterile fluid underneath eardrum
Eustachean tube not working
Middle ear lining continues to absorb air
Pressure of middle ear drops which leads to a vacuum which leads to release of fluid

50
Q

What is glue ear?

A

Otitis media with effusion

51
Q

Treatment of glue ear

A

Grommet

52
Q

What is a grommet?

A

Little plastic tube that sits in the eardrum which equalises the pressure in eardrum as air goes in and out of it so fluid doesn’t build up

53
Q

Causes of chronic suppurative otitis media

A

Perforated tympanic membrane

Cholesteatoma

54
Q

Pathology of cholesteatoma

A

Eustachian tube not working so vacuum present
Sucks eardrum inwards
Skin migration does not work well due to pocket in ear so skin builds up

55
Q

Treatment of cholesteatoma

A

Mastoidectomy (take out dead skin)

56
Q

Complications of chronic suppurative otitis media

A

Tympanosclerosis

Otosclerosis

57
Q

What is tympanosclerosis?

A

Calcification of eardrum and middle ear

58
Q

What does otosclerosis present as?

A

Conductive hearing loss

Normal tympanic membrane

59
Q

What hearing loss do you get with presbyacusis?

A

High frequency loss

60
Q

What age do you start to get a bit of presbyacusis?

A

30

61
Q

Pathology of noise induced hearing loss

A

Damaged hair cells in the cochlea

62
Q

What is an example of an ototoxic medication? What does this result in?

A

Gentamicin

High frequency loss

63
Q

What hearing loss comes with Menieres disease?

A

Low frequency sensorineural hearing loss

64
Q

What is a vestibular schwannoma?

A

Benign tumour

65
Q

Another name for vestibular schwannoma

A

Acoustic neuroma

66
Q

What hearing loss comes with vestibular schwannoma?

A

Sensorineural hearing loss in one ear

67
Q

What may menieres disease also have?

A

Sensation of aural fullness

68
Q

What would an elderly patient who gets vertigo on extending their neck indicate?

A

Vertebrobasilar ischaemia

69
Q

What is an important sign of an acoustic neuroma?

A

Absent corneal reflex

70
Q

What is the first line investigation performed when a patient complains of hearing difficulties?

A

Audiogram

71
Q

On an audiogram, anything above the ____ dB line is essentially normal

A

20 dB

72
Q

What is impaired in sensorineural hearing loss on an audiogram?

A

Both air and bone conduction impaired

73
Q

What is impaired in conductive hearing loss on an audiogram?

A

Only air conduction is impaired

74
Q

What is impaired in mixed hearing loss on an audiogram?

A

Air and bone conduction both impaired

Air conduction often ‘worse’ than bone

75
Q

What is seen on otoscopy in cholesteoma?

A

‘Attic crust’ - seen in the uppermost part of the eardrum

76
Q

First line treatment of otitis externa

A

Topical antibiotics (ciprofloxacin) + steriod (dexamethasone)

77
Q

What is strongly suggestive of a cholesteatoma?

A

Offensive discharge and hearing loss

78
Q

Presentation of otitis externa

A

Pain on palpation of the tragus
Itching
Discharge
Hearing loss

79
Q

What is tympanosclerosis?

A

Scarring of the eardrum

80
Q

Causes of tympanosclerosis

A

After surgery

After injury

81
Q

What would be seen on otoscopy in tympanosclerosis?

A

Bright white scarring of the membrane

82
Q

What is exostosis?

A

A benign bony growth in the external auditory canal caused by repeated exposure to cold water and wind

83
Q

What hearing loss does exostosis result in?

A

Conductive hearing loss

84
Q

What would be the resulting complications if a cholesteoma extends posteriorly?

A

Conductive hearing loss (ossicles)
Vertigo (SSCs)
Sensorineural hearing loss (cochlea)

85
Q

What would be the resulting complications if a cholestaeoma extends superiorly?

A

Facial nerve palsy
Meningitis
Cerebellar abscess
Venous sinus thrombosis

86
Q

What may be precipitated in pregnancy if already have a genetic predisposition?

A

Otosclerosis

87
Q

Inheritance of genetic predisposition to otosclerosis

A

Autosomal dominant

88
Q

What is otosclerosis?

A

Sclerosis of the bone and fixation of the stapes to the oval window, leading to conductive hearing loss

89
Q

What type of hearing loss does otosclerosis result in?

A

Conductive

90
Q

What may unilateral middle ear effusion in an adult be a presenting symptom of? How?

A

Nasopharyngeal cancer

Causes an obstruction of the eustachian tube

91
Q

Examples of ototoxic medications

A 
Gentamicin 
Quinine
Furosemide
Aspirin 
Some chemotherapy agents
92
Q

Most common cause of a perforated tympanic membrane

A

Infection

93
Q

Causes of perforated tympanic membrane

A

Infection
Barotrauma
Direct trauma

94
Q

Definition of barotrauma

A

Injury caused by a change in air pressure, affecting typically the ear and lung

95
Q

What does a perforated tympanic membrane lead to?

A

Hearing loss depending on size

Increases risk of otitis media

96
Q

Management of perforated tympanic membrane

A

No treatment in majority
Will heal after 6 - 8 weeks
Avoid getting water in the ear during this healing time
Prescribe antibiotics if perforation is following an episode of acute otitis media
Myringoplasty may be carried out if it does not heal by itself

97
Q

What do aurical haematomas require?

A

Same day ENT assessment

98
Q

What do aurical haematomas if untreated lead to?

A

Cauliflower ear deformity

99
Q

Treatment of aurical haematomas

A

Early incision and drainage

100
Q

In simple terms, what is ramsey hunt syndrome?

A

Shingles affecting the facial nerve

101
Q

First line treatment for impacted ear wax

A

1 week olive oil

102
Q

What may a chronic cough be due to?

A

A post natal drip due to sinusitis

ENT (17 decks)

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