Otology Flashcards
What are some symptoms of otological disorders?
- Hearing loss
- Tinnitus
- Vertigo
- Otalgia
- Otorrhoea (discharge from the ear)
- Facial weakness
What are some methods of physical examination that can be useful in diagnosing otological disorders?
- Otoscopy
- Rinne’s test
- Weber’s test
- Whispered voice test
- Pure tone audiogram (identify hearing threshold levels)
- Tympanogram
What types of hearing loss do the Webers and Rinne’s hearing tests attempt to diagnose?
- Conductive hearing loss
- Sensorineural hearing loss
What is the threshold for normal hearing on a pure tone audiogram? How are conductive and sensorineural hearing loss diagnosed?
- Normal hearing: better than 20dB
- Conductive hearing loss: bone conduction better than air conduction
- Sensorineural hearing loss: bone conduction the same as air conduction
What is a tympanogram?
- Graphic representation of how the eardrum moves in response to the air pressure in the ear canal
- Create variations of air pressure in the tympanic canal and measure the compliance of the TM and mobility of ossicles
What are the possible results from a tympanogram test?
- type A: normal middle ear pressure and
compliance - type B: low middle ear compliance
- type C: low middle ear pressure
What is an auricular haematoma? What is a complication of untreated auricular haematoma?
- A haematoma in the auricle (outer part) of the ear
- Cauliflower ear
How is an auricular haematoma treated?
- incision and drainage
- pressure dressing
- antibiotics
What is otitis externa? How is it treated?
- Inflammation of the external auditory meatus
Management:
- antibiotic/steroid ear drops
- +/- suction under microscope
What is malignant otitis externa? How is it treated?
- Osteomyelitis (infection of bone) in the temporal bone
- Antibiotics (cycle tends to be weeks/months long)
How does malignant otitis externa tend to present?
- pain (severe in elderly diabetic especially)
- Granulation tissue in external auditory meatus
+/- cranial nerve palsies
What is otitis media with effusion? What is it commonly known as?
- Effusion of fluid in the middle ear
- Commonly knowns as “glue ear”
How does otitis media with effusion tend to present? How is it treated?
- Hearing loss
- Speech delay
Management:
- Observation at first (should spontaneously resolve)
- Otovent: pressurized balloon used to open eustachian tubes to allow fluid to drain
What is acute suppurative otitis media? How does it tend to present? How is it treated?
- Otitis media with accumulation of pus in middle ear
- Otalgia +/- otorrhoea
- Management: observation +/- antibiotics (amoxicillin)
What is otitis media?
Inflammation of the middle ear
What is tympanosclerosis? How does it tend to present? How is it managed?
- Calcification in tympanic membrane +/- middle ear
- Usually asymptomatic
- Usually no treatment required
What causes chronic suppurative otitis media?
- Perforated tympanic membrane
- cholesteatoma (growth in middle ear - often a cyst or sac)
What are some complications of chronic suppurative otitis media?
- “dead ear” (hearing loss in one ear)
- facial palsy
- meningitis
- brain abscess
What are some causes of perforated tympanic membrane? How does it tend to present?
- Infection
- Trauma
- Tympanostomy tube (“grommet”)
- Recurrent infections
- Hearing loss
How are perforated tympanic membranes treated?
- Water precautions
- Should heal spontaneously
- myringoplasty if needed (closure of the perforation of pars tensa of the tympanic membrane)
What are some causes of cholesteatomas? How do they tend to present? Management?
- Eustachian tube dysfunction
- Impaired skin migration
- presentation: persistent offensive otorrohoea
- management: mastoidectomy (removal of diseased mastoid air cells)
What is otosclerosis? How does it tend to present?
- Fixation of the stapes bone by the inappropriate proliferation of extra spongy bone
- Conductive hearing loss
- Normal tympanic membrane
How is otosclerosis usually managed?
- Hearing aid
- Stapedectomy (removal of stapes and replacement with a prosthetic)
What is sensorineural hearing loss? What is conductive hearing loss?
- Sensorineural hearing loss: permanent hearing loss that occurs when there is damage to either the cilia of the inner ear or the auditory nerve
- Conductive hearing loss: obstruction or damage to the outer or middle ear that prevents sound from being conducted to the inner ear
What are some causes of sensorineural hearing loss?
- presbyacusis (hearing loss w old age)
- Head injury / noise exposure
- Viral infections
- Acoustic neuroma
- Ototoxic medications
How is sensorineural hearing loss managed?
- Hearing aids
What are some causes of vertigo?
- benign positional vertigo
- Ménières disease
- vestibular neuritis / labyrinthitis
- migraine
Describe the pathophysiology and presentation of Benign positional vertigo?
- otoconia (otoliths) in semicircular canals
- vertigo precipitated by specific changes in head position
duration: seconds - no associated symptoms
- nystagmus: positional and rotatory
How is Benign positional vertigo diagnosed? How is it managed?
- Dix-Hallpike test
- Epley manoeuvre
Describe the pathophysiology and presentation of Vestibular neuritis / labyrinthitis?
- reactivation of latent HSV infection of vestibular ganglion
- spontaneous vertigo
- associated unilateral hearing loss (labyrinthitis)
- duration: days
- nystagmus: horizontal, towards affected ear
How is Vestibular neuritis / labyrinthitis treated?
- acute: vestibular sedatives
- chronic: vestibular rehabilitation
What is the pathophysiology of Ménière’s disease? Clinical features?
- Fluid builds up in the labyrinth of the ear (cause unk.)
- spontaneous vertigo
- associated unilateral hearing loss / tinnitus / aural fullness
- duration: hours
how is Ménière’s disease treated?
- bendroflumethazide
- intratympanic dexamethasone
- intratympanic gentamicin
