Otology Flashcards
What are some otology symptoms?
Hearing loss Tinnitus Vertigo Otalgia Otorrhoea Facial weakness
What happens in Rinne’s test for a normal ear?
Air > bone
Test = positive
What happens in Rinne’s test for conductive hearing loss?
Bone > air
Test = negative
What happens in Rinne’s test for sensorineural hearing loss?
Air > bone
Test = positive
What happens in Weber’s test for normal hearing in both ears?
Left = right Test = central
What happens in Weber’s test for sensorineural hearing loss in right ear?
Left > right
Test = lateralises to left
What happens in Weber’s test for conductive hearing loss in right ear?
Right > left
Test = lateralises to right
What is involved in the whispered voice test?
Whispered voice at 60cm
Mask other ear
No lip reading
What happens in a pure tone audiogram for normal hearing?
Better than 20dB
What happens in a pure tone audiogram for conductive hearing loss?
Bone conduction better than air conduction
What happens in a pure tone audiogram for sensorineural hearing loss?
Bone conduction the same as air conduction
What is type A in a tympanogram?
Normal middle ear pressure and compliance
What is type B in a tympanogram?
Low middle ear compliance
What is type C in a tympanogram?
Low middle ear pressure
What is responsible for equalising pressure around the ear drum?
Eustachian tube
What is the management for auricular haematoma?
Incision and drainage
Pressure dressing
Antibiotics
What is a complication of auricular haematoma?
Cauliflower ear
Blood becomes infected and destroys connective tissue in pinna
What is the management for a foreign body in the ear?
Removal
Urgent if button battery > organic > inorganic
What is otitis externa?
Inflammation of external auditory meatus
What is the management for otitis externa?
Antibiotic/steroid ear drops
+/- suction under microscope (required if ear canal obstructed as ear drops won’t work
How do you prevent otitis externa?
No water or cotton buds
What is malignant otitis externa?
Osteomyelitis of temporal bone
What is the presentation of malignant otitis externa?
Severe pain in elderly diabetic
Granulations in external auditory meatus
+/- cranial nerve palsies
What is the management for malignant otitis externa?
Antibiotics for weeks or months
What is otitis media with effusion?
Sterile fluid in middle ear
Caused by eustachian tube blockage - pressure builds around ear drum
What is the presentation for otitis media with effusion?
Hearing loss
Speech delay
What is the management for otitis media with effusion?
Observe for 3 months
Otovent
GROMMET
What is acute suppurative otitis media?
Pus in middle ear
What is the presentation for acute suppurative otitis media?
Otalgia +/- otorrhoea
Painful and discharge if ear drum ruptures
What is the management for acute suppurative otitis media?
Observation
Amoxicillin (only if persistent)
What is tympanosclerosis?
Calcification in tympanic membrane +/- middle ear
What is the presentation for tympanosclerosis?
Usually asymptomatic
What is the management for tympanosclerosis?
Usually none
What are the complications of chronic suppurative otitis media?
‘Dead ear’ - complete loss of hearing
Facial palsy
Meningitis
Brain abscess
What are the causes of a perforation of the tympanic membrane?
Infection
Trauma
GROMMET
What is the presentation of a perforated tympanic membrane?
Recurrent infections
Hearing loss
What is the management for perforation of the tympanic membrane?
Water precautions +/- myringoplasty
Myringoplasty - operation to repair hole in eardrum
What are the causes of cholesteatoma?
Eustachian tube dysfunction
Impaired skin migration
What is the presentation for cholesteatoma?
Persistent offensive otorrhoea
What is the management for cholesteatoma?
Mastoidectomy
What is the presentation for otosclerosis?
Conductive hearing loss
Normal tympanic membrane
What is the pathology for otosclerosis?
Fixation of stapes by extra bone
What is the management for otosclerosis?
Hearing aid or stapedectomy
What are the causes for sensorineural hearing loss?
Presbyacusis Head injury Viral infections Noise exposure Ototoxic medications Acoustic neuroma
What is the management for sensorineural hearing loss?
Hearing aids
What occurs in investigation of tinnitus?
Unilateral
Pulsatile
What is the management for tinnitus?
Treat underlying cause
Sound enrichment
Stress management
What is the differential diagnosis for vertigo?
Benign positional vertigo
Meniere’s disease
Vestibular neuritis/labyrinthitis
Migraine
What is the pathology of benign positional vertigo?
Otoconia in semicircular canals
What are the clinical features of benign positional vertigo?
Precipitated by specific changes in head position
Lasts seconds
No associated symptoms
Nystagmus: positional and rotatory
What is the investigation for benign positional vertigo?
Dix-Hallpike test
What is the management for benign positional vertigo?
Epley manoeuvre
What is the pathology for vestibular neuritis?
Reactivation of latent HSV infection of vestibular ganglion
What are the clinical features of vestibular neuritis?
Spontaneous vertigo
Associated unilateral hearing loss
Lasts days
Nystagmus - horizontal, towards affected ear
What is the management for vestibular neuritis?
Acute = vestibular sedatives Chronic = vestibular rehabilitation
What is the pathology for meniere’s disease?
Endolymphatic hydrops
What are the clinical features of meniere’s disease?
Spontaneous vertigo
Associated unlateral hearing loss/tinnitus/aural fullness
Lasts hours
What is the management for meniere’s disease?
Bendroflumethazide
Intratympanic dexamethasone
Intratympanic gentamicin
What are the clinical features of migraine?
Spontaneous vertigo variable duration \+/- headache, sensory sensitivity \+/- precipitated by migraine triggers \+/- past history of migraine
What is the management for migraines?
Avoid migraine triggers
Prophylactic medication
What are the clinical features of facial nerve palsy?
Lower motor neuron facial palsy
Forehead involved
What is the differential diagnosis for facial nerve palsy?
Intratemporal (e.g. cholesteatoma)
Extratemporal (e.g. parotid tumour)
Idiopathic = Bell’s palsy
What is the management for facial nerve palsy?
Treat underlying cause
Steroids
Eye care
