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Otology Flashcards

1
Q

what frequency shouold tuning forks be at

A

512 Hz - C

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2
Q

when may Rinnes test have a false negative + what does it portray, and how do you fix

A

in profound sensineural hearing loss it may give a false picture of conductive loss - fixed by the use of a masking noise (tragal rub ) on the alternate ear

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3
Q

what is a normal decibel for pure tone audiometry to be heard at

A

up to 20

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4
Q

what is indicative of a conductive hearing loss on a pure tone audiogram

A

air-bone gap of >15DB

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5
Q

what is indicative of a sensorineural hearing loss on a pure tone audiogram

A

increased dB required to hear, air-bone gap <15

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6
Q

what indicates a mixed hearing loss on a pure tone audiogram

A

both are within 20 dB of eachother

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7
Q

what pure tone audiometry picture is seen with otosclerosis

A

air conduction is decreased

bone conduction mostly ok, with a notch of decreased conduction in the middle frequences (0.5-2kHz)

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8
Q

what is indicative of presbyacusis on a pure tone audiometry

A

loss of high frequencies

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9
Q

what is indicative of familial/genetic hearing loss on a pure tone audiometry

A

wide mid frequecy loss - ‘cookie bite’ description

similar to ossicular loss but wider

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10
Q

what is indicative of noise-induced hearing loss on a pure tone audiometry

A

big loss of mid-high (2K-4K) frequency with higher frequencies (8K+) affected but less so

classically there is a 4k notch on a downsloping line

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11
Q

what is indicative of a dead ear on pure tone audiometry

A

sound not heard until 80+ dB

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12
Q

what does tympanometry measure

A

compliance of the ear drum, as long as ear canal volume, and middle ear pressure

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13
Q

when does max sonic energy pass through the ear drum

A

when there is no pressure gradient between external and midde ear

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14
Q

what does a normal tympanogram look like

A

be curve distribution of pressure between -300 and 200 , with the peak aligning above 0

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15
Q

what does a glue ear tympanogram look like

A

completely flat line at a low pressure - no pressure peaks

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16
Q

what does a tympanogram indicating increased middle ear pressure (i.e in eustachean tube dysfunction) look like

A

peak is shifted left nearer the negative pressures with the rest of the distrobution at 0 in a flat line

e.g. type C

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17
Q

what does a tympanogram that indicates ossicular disarticulation look like

A

negative gradient straight line starting on the left at about -3 and slowing down to 0

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18
Q

what does a tympanogram that indicates perforation look like

A

bigger peak than expected , usually with the peak not visualised as it breaks through the -9 upper limit of the scale

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19
Q

what does a tympanogram that indicates otosclerosis (aka decreased compliance) show

A

decreased peak

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20
Q

what is presbyacusis

A

age related hearing loss due to atrophy of the labyrinth and cochlear nerve fibres

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21
Q

Why does presbyacusis tend to affect higher frequencies and why is that an issue for discerning speech

A

because fluid runs up and down the cochlear spiral, with the lower area of the cochlear responsible for the higher freqeuncies

because fluid has to run through the lower part to get to the higher part it is worn down more over time, leading to hearing loss in those areas

speech (particulary consonants) uses high frequencies more

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22
Q

what is the presentation and onset of presbyacusis

A

50+, degenerative, bilateral and symmetrical hearing loss

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23
Q

whats a typical complaint about presbyacusis-caused hearing loss

A

can’t hear people in a crowded room

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24
Q

whats important to reassure patients with prebyacusis

A

hearing won’t go completely

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25
how do you treat presbyacusis
no cure hearing aids can help
26
what is a cholesteatoma
cyst of keratinising squamous epithelium in the attic, which gets trapped and grows bigger, causing recurrent infections and the risk of erosion of bone structures
27
what is a classical presentation of cholesteatoma
frequent, foul smelling discharge from the ear | conductive hearing loss
28
what should you be able to see on examination in cholesteatoma
attic retraction with squamous debris OR attic perforation with discharge OR attic aural polyps
29
what are some important complications to note for cholesteatoma
facial nerve palsy vertigo intracranial sepsis bony erosion of ossicles/cochlear/sigmoid sinus
30
why can a cholesteatoma cause vertigo
erosion into the lateral semicircular canal
31
why can a cholesteatoma cause intracranial sepsis
boney erosion into the middle ear roof
32
how do you treat choestatoma
surgical removal +/- mastoid involvement
33
what is glue ear
poor ventilation of the middle ear causing a non-purulent sticky effusion due to accumulation of mucin
34
what can cause glue ear
a consequence of acute otitis media infection of middle ear mucosa Eustachian tube dysfunction
35
what proportion of patients with glue ear are children
70-80%
36
what are risk factors for the development of glue ear
Large adenoids cleft palate + T21 personal history of otitis media
37
what is the presenting complaint of patients with glue ear
hearing loss - usually affects child functionally in school etc
38
what kind of hearing loss is found in glue ear
10-40dB conductive
39
when do you treat glue ear and with what
after a 3 month history + symptoms grommet surgery
40
when do grommets typically fall out
9 - 24 months
41
what does persistent glue ear cases cause
tympanic membrane thinning
42
what proportion of children require a 2nd grommet
20%
43
what decreases risk of recurrent glue ear
adenoidectomy
44
what is acute otitis media
inflammation of the middle ear
45
what does recurrent attacks of acute otitis media cause
eardrum weakening leading to non-reparing perforations
46
what is chronic suppurative otitis media
chronic/recurrent infection of the middle ear characterised by leakage of pus from a non-healing perforated tympanic membrane for over 6 weeks
47
what types of organisms typically infect cholesteatomas
anaerobic - like pseudomonas
48
what is a typical presentation of acute otitis media
hearing loss with otolagia + pyrexia (probably has a coexistent URTI) pain resolves on perforation and otorrhoea
49
how do you treat acute otitis media
High dose amoxicillin (80-90mg/kg)/ceftriaxone/cefuroxime if pen allergic + analgesia
50
how do you treat an otitis media related perforation
High dose amoxicillin (80-90mg/kg)/ceftriaxone/cefuroxime if pen allergic + steroid ear drops+ analgesia + advice to keep ear dry nasal decongestants may assist in recovery
51
how do you treat chronic supparative otitis media
regular aural toileting, antibiotics and steroid drops
52
what is acute mastoiditis a complication of
acute otitis media (uncommon though)
53
what is acute mastoiditis
infection of the middle ear spreading into the mastoid air cells causing pus accumulation/erosion which may spread into posterior auricular regions
54
what is the typical history of acute mastoiditis
``` persistent acute otitis media otalgia otorrhoea hearing loss UNILATERAL HEADACHE (red flag for intracranial complications) systemically unwel possible polyp tenderness/boggy swelling behind ear (mcewans triangle) ```
55
what might you find on examination for acute mastoiditis
'sagging' (protrusion) of the posterior superior canal wall on otoscopy tenderness/boggy swelling behind ear (mcewans triangle) pinna displacement
56
what is the treatment for acute mastoiditis (early and late)
early = high dose IV antibiotics (ceftriaxone/vancomycin) if no effect after 24 hours or complications occur: late = cortical mastoidectomy
57
what are complications of mastoiditis
subperiosteal abscess CN5/6/7 palsy Labyrinthitis petryosis temporal spread
58
what is otosclerosis
replacement of hard bony labyrinth bone wth a spongier softer bone often affecting the tapes footplate and causing it to become fixed to the oval window - leading to conductive hearing loss
59
how can otosclerosis have coexisting sensorineural loss too
new bone produces toxins to the cochlear which damages it
60
what is the typical presentation of otosclerosis
bilateral hearing loss occuring <30/40
61
when may symptoms of otosclerosis be worse for women
during pregnancy
62
apart from hearing loss, what other symptoms tend to come with otosclerosis
paracussis willisii (hear better with background noise) tinnitus positional vertigo
63
how do you diagnose otosclerosis
the only definite way is an exploratory surgical examination in reality it tends to be a clinical diagnosis when someone presents with conductive hearing loss with an intact eardrum
64
what is the treatment for otosclerosis
mild = observation/hearing aid severe = stapedectomy + teflon replacement
65
what may cause noise induced hearing loss
loud auditory stimuli, usually repeated exposure but a single massive event may cause it e.g. an explosion
66
what kind of hearing loss does noise exposure usually cause
sensorineural hearing loss but always consider conductive via tympanic membrane pathology
67
how do you treat noise induced hearing loss
supportive counselling, prevention most important
68
what is tinnnitus
noise in ears - typically a ringing or wooshing
69
what are the types of tinnitus
subjective tinnitus - not heard by others | objective tinnnitus - heard by others
70
what are examples of objective/extrinsic tinnitus
vascular bruits | soft-palate clicking in palatal myoclonus
71
what causes subjective/intrinsic tinnitus
``` drugs labyrinthitis trauma presbyacusis menieres noise-induced otosclerosis idiopathic temporal lobe epilepsy ```
72
what should be suspected and immediately followed up on if there is unilateral tinnitus
vestibular schwannoma
73
what are options for sleep if tinnitus is bothering someone
white noise machine | sedation
74
what is the classic quartet of menieres disease
hearing loss tinnitus vertigo aural fullness
75
how does menieres present
in disabling attacks of 30mins - 4 hours with all the classical symptoms + N+V and nystagmus
76
what kind of hearing loss does menieres have
low frequency sensorineural
77
what may precede a menieres attack
prodromal tinnitus/aural fullness
78
what is the theory for menieres disease occuring
mixing of endolymph and perilymph due to a rupture in reissners membrane
79
what are differentials for menieres
``` syphillis vascular disease epilepsy MS tumours labyrinthitis BPPV ```
80
Treatment for Menieres
Acute - Vestibular sedatives (prochlorperazine) Chronic - betahistine + diuretics + avoid salt/caffeine (decreases frequency of attacks - not curative) Extremely Severe - chemical destruction of the labyrinth using gentamicin or surgically by drilling out the inner ear/cutting CN8
81
what is an acoustic neuroma/vestibular schwannoma
benign tumour of CN8
82
what are early symptoms of an acoustic neuroma/vestibular schwannoma
unilateral hearing loss and tinnitus
83
what occurs if an acoustic neuroma/vestibular schwannoma gets big enough
removal without damaging the facial nerve and artery is impossible
84
how do you investigate an acoustic neuroma/vestibular schwannoma
pure tone audiometry | MRI/CT
85
how do you treat an acoustic neuroma/vestibular schwannoma
gamma knife/surgery if >3.5cm | watch and wait if <3.5cm
86
what is otitis externa
infection of the external ear canal
87
what are the 3 types of otitis externa
diffuse furuncle malignant
88
what is diffuse otitis externa
a common condition characterised by generalised inflammation of external acoustic meatus
89
what are risk factors for diffuse otitis externa
eczema | trauma
90
what are the signs and symptoms for diffuse otitis externa
pain otorrhoea hearing loss tragal tenderness
91
what are specific signs of bacteria diffuse otitis extern
pus
92
what are specific signs of viral diffuse otitis externa
if herpes zoster - vesices haemorrhagic vesicles indicate bullous myringitis
93
what are specific signs of fungal diffuse otitis externa
dry/wet debris, yellow/black spores
94
treatment for diffuse otitis externa
aural toileting local medication - steroids/antibiotics/antifungal severe = systemic Abx
95
what should you always check for when diffuse otitis externa is improving
otitis media as its a common cause
96
what is malignant otitis externa
a more aggressive form seen in the elderly/diabetics/immunocompromised
97
what causes malignany otitis externa
pseudomonas
98
what is the risk of malignant otitis externa
osteomyelitis of the skull base due to bone spread
99
how do you treat malignant otitis externa
High dose systemic antibiotics - ciprofloxacin/tazocin/a cephalospirin potentially surgical debridement
100
what is a furuncle in otitis externa
painful infection of one of the hair follicles of the outer 1/3 of the EAM
101
what organism causes a furuncle
staph aureus mostly
102
what does a furuncle look like
a red swelling bulging into the EAM
103
how do you treat a furuncle
analgesia astringents - withdraw moisture from EAM (glyceine) antibiotics if required - penicillins work
104
what may occur due to blunt trauma that causes swelling
haemoatoma
105
what is 'cauliflower ear'
bleeding from the vascularised perichondrium
106
whats another name for malignant otitis externa
necrotising otitis externa
107
what must you do with an acute case of cauliflower ear
drain immediately as it may cause ischaemia and become infected
108
what are complications of caluflower ear
peichondritis necrosis cosmetic deformity
109
how is cauliflower ear treated
drained under a local anesthetic with prophylactic antibiotics, pressure is applied afterwards as haemoatomas have the tendency to reform
110
what is chondrodermatitis nodularis helicos
inflammation of the skin and cartilage of the ear causing a benign, tender nodule
111
what usually causes chondrodermatitis nodularis helicos
sleeping on ear sun/cod damage decreased blood supply
112
what is the epidemiology of chondrodermatitis nodularis helicos
40+ M>F
113
what are the characteristics of the lump seen in chondrodermatitis nodularis helicos
lump is usually singular and seen on the outer, upper part of the ear rim (helix)
114
how do you treat chondrodermatitis nodularis helicos
``` avoid direct pressure blister dressings avoid sun/cold exposure corticosteroids surgery - cryotherapy or cut out ```

ENT (8 decks)

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