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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
Presentation of labyrinthitis
Vertigo | Hearing loss in affected ear
26
Which is more common, vestibular neuritis or labyrinthitis?
Vestibular neuritis
27
What is the duration and how long does the symptoms last in vestibular neuritis / labyrinthitis?
Days | Few episodes
28
What provokes the vertigo in vestibular neuritis / labyrinthitis?
Residual motion provoked vertigo
29
Treatment of acute vestibular neuritis
Vestibular sedatives
30
What do vestibular sedatives do?
To promote the central compensation and the brain responding to new signals
31
Treatment of chronic vestibular sedatives
Vestibular rehabilitation
32
What does vestibular rehabilitation do?
Promotes the recovery of benign positional vertigo after an episode of vestibular neuritis
33
Pathology of Meniere's disease
Endolymphatic hydrops | Raised pressure in the lymphatic compartment of the cochlea and progressive dilatation of the endolymphatic system
34
Presentation of Menieres disease
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
35
How long do the symptoms of menieres disease last for?
Hours
36
How often do people with menieres disease get there symptoms?
Every few days / weeks / months
37
Treatment of Menieres disease
``` 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
38
What does betahistine do?
Improve blood supply to inner ear
39
What does bendrofluazide do?
Diuretic to improve pressure in lymphatic area in ear
40
Presentation of migraine
Spontaneous vertigo Headache Sensory sensitivity Auras
41
Definition of tinnitus
Any perception of sound
42
Treatment of tinnitus
Sound enrichment | Stress management
43
Is a facial palsy an UMN or a LMN lesion?
LMN
44
What is bells palsy?
Acute, idiopathic facial palsy
45
What is otitis externa?
Inflammation of the skin of the ear canal
46
What is malignant otitis externa?
Aggressive, osteomyelitis of the temporal bone | NOT NEOPLASTIC
47
Who is malignant otitis externa common in?
Diabetic patients
48
Treatment of malignant otitis externa
Systemic antibiotics
49
Pathology of glue ear
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
What is glue ear?
Otitis media with effusion
51
Treatment of glue ear
Grommet
52
What is a grommet?
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
Causes of chronic suppurative otitis media
Perforated tympanic membrane | Cholesteatoma
54
Pathology of cholesteatoma
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
Treatment of cholesteatoma
Mastoidectomy (take out dead skin)
56
Complications of chronic suppurative otitis media
Tympanosclerosis | Otosclerosis
57
What is tympanosclerosis?
Calcification of eardrum and middle ear
58
What does otosclerosis present as?
Conductive hearing loss | Normal tympanic membrane
59
What hearing loss do you get with presbyacusis?
High frequency loss
60
What age do you start to get a bit of presbyacusis?
30
61
Pathology of noise induced hearing loss
Damaged hair cells in the cochlea
62
What is an example of an ototoxic medication? What does this result in?
Gentamicin | High frequency loss
63
What hearing loss comes with Menieres disease?
Low frequency sensorineural hearing loss
64
What is a vestibular schwannoma?
Benign tumour
65
Another name for vestibular schwannoma
Acoustic neuroma
66
What hearing loss comes with vestibular schwannoma?
Sensorineural hearing loss in one ear
67
What may menieres disease also have?
Sensation of aural fullness
68
What would an elderly patient who gets vertigo on extending their neck indicate?
Vertebrobasilar ischaemia
69
What is an important sign of an acoustic neuroma?
Absent corneal reflex
70
What is the first line investigation performed when a patient complains of hearing difficulties?
Audiogram
71
On an audiogram, anything above the ____ dB line is essentially normal
20 dB
72
What is impaired in sensorineural hearing loss on an audiogram?
Both air and bone conduction impaired
73
What is impaired in conductive hearing loss on an audiogram?
Only air conduction is impaired
74
What is impaired in mixed hearing loss on an audiogram?
Air and bone conduction both impaired | Air conduction often 'worse' than bone
75
What is seen on otoscopy in cholesteoma?
'Attic crust' - seen in the uppermost part of the eardrum
76
First line treatment of otitis externa
Topical antibiotics (ciprofloxacin) + steriod (dexamethasone)
77
What is strongly suggestive of a cholesteatoma?
Offensive discharge and hearing loss
78
Presentation of otitis externa
Pain on palpation of the tragus Itching Discharge Hearing loss
79
What is tympanosclerosis?
Scarring of the eardrum
80
Causes of tympanosclerosis
After surgery | After injury
81
What would be seen on otoscopy in tympanosclerosis?
Bright white scarring of the membrane
82
What is exostosis?
A benign bony growth in the external auditory canal caused by repeated exposure to cold water and wind
83
What hearing loss does exostosis result in?
Conductive hearing loss
84
What would be the resulting complications if a cholesteoma extends posteriorly?
Conductive hearing loss (ossicles) Vertigo (SSCs) Sensorineural hearing loss (cochlea)
85
What would be the resulting complications if a cholestaeoma extends superiorly?
Facial nerve palsy Meningitis Cerebellar abscess Venous sinus thrombosis
86
What may be precipitated in pregnancy if already have a genetic predisposition?
Otosclerosis
87
Inheritance of genetic predisposition to otosclerosis
Autosomal dominant
88
What is otosclerosis?
Sclerosis of the bone and fixation of the stapes to the oval window, leading to conductive hearing loss
89
What type of hearing loss does otosclerosis result in?
Conductive
90
What may unilateral middle ear effusion in an adult be a presenting symptom of? How?
Nasopharyngeal cancer | Causes an obstruction of the eustachian tube
91
Examples of ototoxic medications
``` Gentamicin Quinine Furosemide Aspirin Some chemotherapy agents ```
92
Most common cause of a perforated tympanic membrane
Infection
93
Causes of perforated tympanic membrane
Infection Barotrauma Direct trauma
94
Definition of barotrauma
Injury caused by a change in air pressure, affecting typically the ear and lung
95
What does a perforated tympanic membrane lead to?
Hearing loss depending on size | Increases risk of otitis media
96
Management of perforated tympanic membrane
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
What do aurical haematomas require?
Same day ENT assessment
98
What do aurical haematomas if untreated lead to?
Cauliflower ear deformity
99
Treatment of aurical haematomas
Early incision and drainage
100
In simple terms, what is ramsey hunt syndrome?
Shingles affecting the facial nerve
101
First line treatment for impacted ear wax
1 week olive oil
102
What may a chronic cough be due to?
A post natal drip due to sinusitis

ENT (17 decks)

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