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ENT > Otology > Flashcards

Otology Flashcards

1
Q

What the 6 common ear symptoms? [6]

A
  • Hearing Loss
  • Tinnitus
  • Otalgia
  • Otorrhoea
  • Facial Weakness
  • Vertigo
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2
Q

Clinical examination of the ears include: [4]

A

Physical:

  • Otoscope
  • Microscope

Hearing:

  • Tuning fork (Rinne’s & Weber’s)
  • Whispered Voice Tests
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3
Q

Rinnes test - explain what it demonstrates [1]
If BC>AC in Rinne’s test - clinical significance? [1]

Webers test - explain the clinical significance if the sound was lateralized ie the test was abnormal [2]

Explain why in conductive hearing loss, Webers test will show lateralization to same ear [2]

A

Rinnes:

  • Tells us if Air conduction vs Bone Conduction - which one is better/louder
  • IF B>A then theres conductive hearing loss in that ear

Webers:
- If its louder in one ear then its either conductive loss in that ear or sensorineural in the opposite

BC>AC in affected ear so the cochlea is more sensitized. [1] Both cochlea are working but it will be heard louder in the affected ear. [1]

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4
Q

What investigations can be done for hearing? [2]

A
  • Pure Tone Audiogram

- Tympanogram

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5
Q

What are the result ‘types’ from a tympanogram? [3]

A

Type A - normal
Type B - Immobile Tympanic membrane
Type C - Low Middle Ear pressure

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6
Q

Common disorders of outer ear [4]

A

Auricular Haematoma

  • ‘Cauliflower ear’
  • Needs to be drained

Foreign Body

Otitis Externa

  • Itching, pain, discharge & hearing loss
  • Abx/steroid eardrops

Malignant Otitis Externa

  • Osteomyelitis of the temporal bone
  • Months of systemic Abx
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7
Q

List some common disorders of the middle ear? [5]

A
  • Otitis Media with effusion (glue ear)
  • Acute Otitis Media
  • Chronic Suppurative Otitis Media
  • Tympanosclerosis
  • Otosclerosis
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8
Q 
Otitis Externa
Causes [5]
Name 2 most common bugs 
Sequelae if untreated [2]
Treatment [2]
Appearance on examination of chronic otitis external [1]
A

Causes:

  • Generalised skin conditions eg eczema, psoriasis
  • Generalised skin infections eg impetigo
  • Trauma eg dirty fingernail
  • Local infection
  • Middle ear discharge

Pseudomonas, staphylococcus - are common bugs if local infection was cause

Hearing loss and canal stenosis can occur

OE:

  • Tenderness of auricle, trigs, behind ear if LN involvement
  • EAM swollen, full of debris
  • Skin cracked, crusting
  • Fungal, hyphae and spores seen

Treatment:

  • Aural toilet ie remove all debris with suction
  • Local medication - abx or steroid drops, glycerine, aluminum acetate

Chronic otitis externa - skin of EAM thickened, fissured, moist

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9
Q 
Glue ear or Otitis media with effusion
Presentation [3]
Otoscope appearance [3]
Investigations [2]
Course [1]
Mx [3]
A

Presentation
- hearing loss eg poor listening, speech, lang delay, inattention, poor behaviour
- repeat ear infections/URTI
- balance problems
Otoscope:
- +/- retracted/bulging drum, looking dull grey or yellow, fluid level

Audiogram

  • conductive defects
  • Flat tympanogram on impedance audiometry - ddx from eustachian malfx and otosclerosis

Course: usually resolves over time

Management:

  • Review in 3m
  • Hearing aids
  • Surgery ie grommets
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10
Q 
Acute otitis media
Presentation [4]
Common organisms [3]
Course [3]
Treatment [3]
Continuing discharge - possible sequelae [3]
A

Presentation

  • Rapid onset
  • Fever, ear pain, irritability (children)
  • Anorexia, vomiting
  • ppt by viral infection

Common organisms
- Pneumococcus, haemopilus, moraxella

Course: drum bulging causes pain > purulent discharge > perforation alleviates pain

Treatment: amoxicillin +/- clavulanate, analgesia

Sequelae:

  • mastoiditis, petrositis
  • labyrinthitis, facial palsy
  • meningitis, intracranial abscess
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11
Q

What are the types of chronic suppurative otitis media? [2]

A

Either with:

  • Perforated Tympanic Membrane
  • Cholesteatoma
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12
Q

What is a cholesteatoma? [3]
Presentation [5]
Serious rare complications [2]
Treatment [1]

A

Abnormal skin growth in the middle ear. [1]
The skin forms a pouch so it doesnt shed, instead it builds up. [1] Eroding structures of the ear, facial nerve and into the brain [1]

Presentation

  • Foul discharge
  • Deafness
  • Headache, otalgia
  • Facial paralysis
  • Vertigo

Serious rare complications:

  • Meningitis
  • Cerebral abscess

Treatment:
- Mastoid surgery needed to make a safe dry ear

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13
Q

List some common disorders of the inner ear [8]

A 
Presbycusis
Noise Induced Hearing Loss:
Ototoxic Meds e.g. Gentamicin
Meniere's Disease
Head Injury
Infection
Vestibular Schwannoma (Acoustic Neuroma)
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14
Q

What is a vestibular schwannoma? [2]

A

A benign tumour of the vestibular nerve [1]

Causes sensorineural hearing loss in one ear [1]

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15
Q 
Tinnitus
Definition [2]
Age of onset [1]
Describe nature of noise heard and their respective clinical significance [2]
Cause [1]
A

Sensation of non-verbal sound not due to stimuli outside body
Age of onset: 50-60y
Ringing, hissing, buzzing - inner ear
Popping, clicking - external/middle ear
Cause: ?damage to the cochlear hairs
Its associated with presbycusis, noise related hearing loss and stress.

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16
Q

How would we investigate tinnitus? [3]

When would you investigate further for acoustic neuroma [1]

A

We’d want to test for hearing loss. Tuning fork, audiogram

If its unilateral hearing loss or pulsatile we would want to do a MRI scan

17
Q

Tinnitus treatment
Treatment approach [1]
Describe 5 modes of treatment
What is the role of surgery in tinnitus [1]

A

Treat the whole person not just a malfunctioning ear - avoid saying its untreatable

  • Aids: if hearing loss >35 dB
  • Psychological support
  • Music, massage
  • Intratympanic dexa + oral alprazolam
  • Drugs: melatonin, betahistine for Meniere’s, Baclofen
  • Surgery - limited role
18
Q

Vertigo
Associated symptoms [3]
How can duration differentiate the type of vertigo [3]

A

Associated symptoms:

  • nausea, vomiting
  • hearing loss, tinnitus
  • nystagmus

Duration:

  • seconds to minutes BPPV
  • 30 min to 30h Menieres/migraine
  • 30h to a week - acute vestibular failure
19
Q

List some common types/causes of vertigo

  1. Peripheral vertigo [5]
  2. Central vertigo [3]
  3. Drugs [4]
A

Peripheral vertigo

  • Meniere’s disease
  • BPPV
  • Vestibular failure
  • Labyrinthitis
  • Cholesteatoma

Central vertigo

  • Acoustic neuroma
  • MS
  • Head injury

Drugs

  • Gentamicin
  • Diuretics
  • Cotrimoxazole
  • Metronidazole
20
Q

Pathogenesis of BPPV [3]

Causes of BPPV [5]

A

Otoconia (small crystals) in the semi-circular canals of the inner ear [1]
Its precipitated by changes in head position [1] causing the stones to stimulate the hair cells [1]
It only lasts a few seconds and occurs a few times a day

Causes:

  • Middle ear disease
  • Head injury
  • Otosclerosis
  • Postviral illness
  • Stapes surgery
21
Q

Benign Positional Vertigo
Investigations [2]
Treatment [3]
Describe last resort treatment for BPPV [1]

A

A Dix-Hallpike test will induce vertigo
The Epley Manoeuvre moves the particles out the canal so they wont stimulate the hair cells

Treatment

  • Vestibular habituation exercises
  • Reassurance, reduce alcohol intake
  • Drugs - betahistine, prochlorperazine, antidepressants
  • Last resort: posterior semicircular canal denervation or obliteration
22
Q

What is vestibular neuritis/labyrinthitis?

A

A reactivation of a latent HSV infection [1] in the vestibular gangion. [1]

23
Q

How do we treat Vestibular Neuritis/Labyrinthitis? [3]

A
  1. Vestibular sedative eg diazepam
  2. Anti-emetic eg prochlorperazine
  3. CCS
24
Q 
Meniere's disease
Also known as endolymphatic hydrops
Define [1]
Clinical features [5]
Ix [2]
A

Dilation of the endolymph spaces of membranous labyrinth [1]
Clinical features
- Vertigo with nausea/vomiting
- Aural fullness
- Uni/bilateral tinnitus
- Sensorineural hearing loss (fluctuates)
- Attacks occur in clusters >20 per month
Investigation:
- Electrocochleography
- Endolymphatic space MRI

25
Q

How do we treat meniere’s disease? [1]

Surgical [2]

A

Betahistine or prochlorperazine

Surgical

  • Endolymphatic shunts
  • Labyrinthectomy
26
Q

Migraine

Clinical features [3]

A

Spontaneous Vertigo +/-:

  • Headache
  • Sensory Sensitivity
27
Q 
Facial palsy
Intracranial causes [4]
Intratemporal causes [3]
Infratemporal causes [1]
One main cause
A

Intracranial

  • Brainstem tumors
  • Strokes
  • Polio, MS
  • Cerebropontine angle lesions eg acoustic neuroma

Intratemporal

  • OM
  • Ramsay Hunt syndrome
  • Cholesteatoma

Infratemporal
- Parotid tumours

Bells palsy - idiopathic

28
Q

Otitis Media management
Explain when you should offer surgery [4]
Steps [3]
Describe grommet [1]

A

Offer surgery if persistent bilateral OME + hearing level in better ear is <25-30 DBL
Confirmed over 3m, affecting ADL.

Myringotomy
Suction of fluid
Insert grommet
+/- adenoidectomy (tonsillectomy doesn’t help)

A Grommet is a tube through the ear drum that allows pressure to equalise in the middle ear

29
Q

Otitis Media management
Complication of grommet [2]
Advice on living with grommets [3]
Long term plan [2]

A

Complications infections, tympanosclerosis

  • OK to swim with grommets but diving is a no, use ear plug eg cotton wool and Vaseline
  • Avoid forcing water into middle ear
  • 25% need re-insertion

Long term plan
Grommets extrude after 3-12m
Recheck hearing then

30
Q

Bells palsy treatment [3]

A

Protect eye with glasses, tape closed eyes during sleep, artificial tears
Lateral tarsorrhaphy
Prednisolone early

ENT (15 decks)

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