Otology Flashcards
Definition of otalgia
Ear pain
Definition of otorrhea
Fluid excreted from ears
If Rinne’s test is positive, what does this mean?
AIR > BONE
Normal ear
If Rinne’s test shows a negative test, with bone > air, what does this mean?
Conductive hearing loss
If Rinne’s test shows a positive test, with air > bone, what does this show?
Sensorineural hearing loss
If in weber’s test there is normal hearing in both ears, what does this mean the test is?
Central
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?
Test lateralises to the left
- sensorineural loss right ear
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?
Test lateralises to the right
- conductive hearing loss right ear
What is conductive hearing loss caused by?
Outer or middle ear problems
What is sensorineural hearing loss caused by?
Inner ear problems
Investigations of hearing loss
Pure tone audiogram
Tympanogram
What is a type A tympanogram result?
Normal
What is a type B tympanogram result?
Tympanic membrane immobile
What is a type C tympanogram result?
Middle ear pressure low
What is the treatment of sensorineural hearing loss?
Hearing aids
Causes of vertigo
Benign positional vertigo
Menieres disease
Vestibular neuritis / labyrinthiis
Migraine
Pathology of benign positional vertigo
Otoconia (particles) in semi-circular canals floating around
In benign positional vertigo, what is the vertigo precipitated by?
Specific changes in head position
Not spontaneous
Duration of benign positional vertigo and how often?
Seconds, several times a day
What test is positive in benign positional vertigo?
Dix-Hallpike test
Treatment of benign positional vertigo
Epley manoeuvre
How does the Epley manoeuvre work?
Particles are moved to a part of the ear where they will not cause any trouble
Pathology of vestibular neuritis/labyrinthitis
Reactivation of latent HSV infection of vestibular ganglion
Presentation of vestibular neuritis
Vertigo
Presentation of labyrinthitis
Vertigo
Hearing loss in affected ear
Which is more common, vestibular neuritis or labyrinthitis?
Vestibular neuritis
What is the duration and how long does the symptoms last in vestibular neuritis / labyrinthitis?
Days
Few episodes
What provokes the vertigo in vestibular neuritis / labyrinthitis?
Residual motion provoked vertigo
Treatment of acute vestibular neuritis
Vestibular sedatives
What do vestibular sedatives do?
To promote the central compensation and the brain responding to new signals
Treatment of chronic vestibular sedatives
Vestibular rehabilitation
What does vestibular rehabilitation do?
Promotes the recovery of benign positional vertigo after an episode of vestibular neuritis
Pathology of Meniere’s disease
Endolymphatic hydrops
Raised pressure in the lymphatic compartment of the cochlea and progressive dilatation of the endolymphatic system
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
How long do the symptoms of menieres disease last for?
Hours
How often do people with menieres disease get there symptoms?
Every few days / weeks / months
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
What does betahistine do?
Improve blood supply to inner ear
What does bendrofluazide do?
Diuretic to improve pressure in lymphatic area in ear
Presentation of migraine
Spontaneous vertigo
Headache
Sensory sensitivity
Auras
Definition of tinnitus
Any perception of sound
Treatment of tinnitus
Sound enrichment
Stress management
Is a facial palsy an UMN or a LMN lesion?
LMN
What is bells palsy?
Acute, idiopathic facial palsy
What is otitis externa?
Inflammation of the skin of the ear canal
What is malignant otitis externa?
Aggressive, osteomyelitis of the temporal bone
NOT NEOPLASTIC
Who is malignant otitis externa common in?
Diabetic patients
Treatment of malignant otitis externa
Systemic antibiotics
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
What is glue ear?
Otitis media with effusion
Treatment of glue ear
Grommet
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
Causes of chronic suppurative otitis media
Perforated tympanic membrane
Cholesteatoma
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
Treatment of cholesteatoma
Mastoidectomy (take out dead skin)
Complications of chronic suppurative otitis media
Tympanosclerosis
Otosclerosis
What is tympanosclerosis?
Calcification of eardrum and middle ear
What does otosclerosis present as?
Conductive hearing loss
Normal tympanic membrane
What hearing loss do you get with presbyacusis?
High frequency loss
What age do you start to get a bit of presbyacusis?
30
Pathology of noise induced hearing loss
Damaged hair cells in the cochlea
What is an example of an ototoxic medication? What does this result in?
Gentamicin
High frequency loss
What hearing loss comes with Menieres disease?
Low frequency sensorineural hearing loss
What is a vestibular schwannoma?
Benign tumour
Another name for vestibular schwannoma
Acoustic neuroma
What hearing loss comes with vestibular schwannoma?
Sensorineural hearing loss in one ear
What may menieres disease also have?
Sensation of aural fullness
What would an elderly patient who gets vertigo on extending their neck indicate?
Vertebrobasilar ischaemia
What is an important sign of an acoustic neuroma?
Absent corneal reflex
What is the first line investigation performed when a patient complains of hearing difficulties?
Audiogram
On an audiogram, anything above the ____ dB line is essentially normal
20 dB
What is impaired in sensorineural hearing loss on an audiogram?
Both air and bone conduction impaired
What is impaired in conductive hearing loss on an audiogram?
Only air conduction is impaired
What is impaired in mixed hearing loss on an audiogram?
Air and bone conduction both impaired
Air conduction often ‘worse’ than bone
What is seen on otoscopy in cholesteoma?
‘Attic crust’ - seen in the uppermost part of the eardrum
First line treatment of otitis externa
Topical antibiotics (ciprofloxacin) + steriod (dexamethasone)
What is strongly suggestive of a cholesteatoma?
Offensive discharge and hearing loss
Presentation of otitis externa
Pain on palpation of the tragus
Itching
Discharge
Hearing loss
What is tympanosclerosis?
Scarring of the eardrum
Causes of tympanosclerosis
After surgery
After injury
What would be seen on otoscopy in tympanosclerosis?
Bright white scarring of the membrane
What is exostosis?
A benign bony growth in the external auditory canal caused by repeated exposure to cold water and wind
What hearing loss does exostosis result in?
Conductive hearing loss
What would be the resulting complications if a cholesteoma extends posteriorly?
Conductive hearing loss (ossicles)
Vertigo (SSCs)
Sensorineural hearing loss (cochlea)
What would be the resulting complications if a cholestaeoma extends superiorly?
Facial nerve palsy
Meningitis
Cerebellar abscess
Venous sinus thrombosis
What may be precipitated in pregnancy if already have a genetic predisposition?
Otosclerosis
Inheritance of genetic predisposition to otosclerosis
Autosomal dominant
What is otosclerosis?
Sclerosis of the bone and fixation of the stapes to the oval window, leading to conductive hearing loss
What type of hearing loss does otosclerosis result in?
Conductive
What may unilateral middle ear effusion in an adult be a presenting symptom of? How?
Nasopharyngeal cancer
Causes an obstruction of the eustachian tube
Examples of ototoxic medications
Gentamicin Quinine Furosemide Aspirin Some chemotherapy agents
Most common cause of a perforated tympanic membrane
Infection
Causes of perforated tympanic membrane
Infection
Barotrauma
Direct trauma
Definition of barotrauma
Injury caused by a change in air pressure, affecting typically the ear and lung
What does a perforated tympanic membrane lead to?
Hearing loss depending on size
Increases risk of otitis media
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
What do aurical haematomas require?
Same day ENT assessment
What do aurical haematomas if untreated lead to?
Cauliflower ear deformity
Treatment of aurical haematomas
Early incision and drainage
In simple terms, what is ramsey hunt syndrome?
Shingles affecting the facial nerve
First line treatment for impacted ear wax
1 week olive oil
What may a chronic cough be due to?
A post natal drip due to sinusitis
