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ENT > Otology > Flashcards

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
Q

how do you treat presbyacusis

A

no cure

hearing aids can help

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26
Q

what is a cholesteatoma

A

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

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27
Q

what is a classical presentation of cholesteatoma

A

frequent, foul smelling discharge from the ear

conductive hearing loss

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28
Q

what should you be able to see on examination in cholesteatoma

A

attic retraction with squamous debris OR
attic perforation with discharge OR
attic aural polyps

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29
Q

what are some important complications to note for cholesteatoma

A

facial nerve palsy
vertigo
intracranial sepsis
bony erosion of ossicles/cochlear/sigmoid sinus

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30
Q

why can a cholesteatoma cause vertigo

A

erosion into the lateral semicircular canal

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31
Q

why can a cholesteatoma cause intracranial sepsis

A

boney erosion into the middle ear roof

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32
Q

how do you treat choestatoma

A

surgical removal +/- mastoid involvement

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33
Q

what is glue ear

A

poor ventilation of the middle ear causing a non-purulent sticky effusion due to accumulation of mucin

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34
Q

what can cause glue ear

A

a consequence of acute otitis media
infection of middle ear mucosa
Eustachian tube dysfunction

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35
Q

what proportion of patients with glue ear are children

A

70-80%

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36
Q

what are risk factors for the development of glue ear

A

Large adenoids
cleft palate + T21
personal history of otitis media

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37
Q

what is the presenting complaint of patients with glue ear

A

hearing loss - usually affects child functionally in school etc

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38
Q

what kind of hearing loss is found in glue ear

A

10-40dB conductive

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39
Q

when do you treat glue ear and with what

A

after a 3 month history + symptoms

grommet surgery

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40
Q

when do grommets typically fall out

A

9 - 24 months

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41
Q

what does persistent glue ear cases cause

A

tympanic membrane thinning

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42
Q

what proportion of children require a 2nd grommet

A

20%

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43
Q

what decreases risk of recurrent glue ear

A

adenoidectomy

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44
Q

what is acute otitis media

A

inflammation of the middle ear

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45
Q

what does recurrent attacks of acute otitis media cause

A

eardrum weakening leading to non-reparing perforations

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46
Q

what is chronic suppurative otitis media

A

chronic/recurrent infection of the middle ear characterised by leakage of pus from a non-healing perforated tympanic membrane for over 6 weeks

47
Q

what types of organisms typically infect cholesteatomas

A

anaerobic - like pseudomonas

48
Q

what is a typical presentation of acute otitis media

A

hearing loss with otolagia + pyrexia (probably has a coexistent URTI)

pain resolves on perforation and otorrhoea

49
Q

how do you treat acute otitis media

A

High dose amoxicillin (80-90mg/kg)/ceftriaxone/cefuroxime if pen allergic + analgesia

50
Q

how do you treat an otitis media related perforation

A

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
Q

how do you treat chronic supparative otitis media

A

regular aural toileting, antibiotics and steroid drops

52
Q

what is acute mastoiditis a complication of

A

acute otitis media (uncommon though)

53
Q

what is acute mastoiditis

A

infection of the middle ear spreading into the mastoid air cells causing pus accumulation/erosion which may spread into posterior auricular regions

54
Q

what is the typical history of acute mastoiditis

A 
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
Q

what might you find on examination for acute mastoiditis

A

‘sagging’ (protrusion) of the posterior superior canal wall on otoscopy

tenderness/boggy swelling behind ear (mcewans triangle)

pinna displacement

56
Q

what is the treatment for acute mastoiditis (early and late)

A

early = high dose IV antibiotics (ceftriaxone/vancomycin)

if no effect after 24 hours or complications occur:

late = cortical mastoidectomy

57
Q

what are complications of mastoiditis

A

subperiosteal abscess
CN5/6/7 palsy
Labyrinthitis petryosis
temporal spread

58
Q

what is otosclerosis

A

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
Q

how can otosclerosis have coexisting sensorineural loss too

A

new bone produces toxins to the cochlear which damages it

60
Q

what is the typical presentation of otosclerosis

A

bilateral hearing loss occuring <30/40

61
Q

when may symptoms of otosclerosis be worse for women

A

during pregnancy

62
Q

apart from hearing loss, what other symptoms tend to come with otosclerosis

A

paracussis willisii (hear better with background noise)
tinnitus
positional vertigo

63
Q

how do you diagnose otosclerosis

A

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
Q

what is the treatment for otosclerosis

A

mild = observation/hearing aid

severe = stapedectomy + teflon replacement

65
Q

what may cause noise induced hearing loss

A

loud auditory stimuli, usually repeated exposure but a single massive event may cause it e.g. an explosion

66
Q

what kind of hearing loss does noise exposure usually cause

A

sensorineural hearing loss but always consider conductive via tympanic membrane pathology

67
Q

how do you treat noise induced hearing loss

A

supportive counselling, prevention most important

68
Q

what is tinnnitus

A

noise in ears - typically a ringing or wooshing

69
Q

what are the types of tinnitus

A

subjective tinnitus - not heard by others

objective tinnnitus - heard by others

70
Q

what are examples of objective/extrinsic tinnitus

A

vascular bruits

soft-palate clicking in palatal myoclonus

71
Q

what causes subjective/intrinsic tinnitus

A 
drugs
labyrinthitis
trauma
presbyacusis
menieres
noise-induced
otosclerosis
idiopathic 
temporal lobe epilepsy
72
Q

what should be suspected and immediately followed up on if there is unilateral tinnitus

A

vestibular schwannoma

73
Q

what are options for sleep if tinnitus is bothering someone

A

white noise machine

sedation

74
Q

what is the classic quartet of menieres disease

A

hearing loss
tinnitus
vertigo
aural fullness

75
Q

how does menieres present

A

in disabling attacks of 30mins - 4 hours with all the classical symptoms + N+V and nystagmus

76
Q

what kind of hearing loss does menieres have

A

low frequency sensorineural

77
Q

what may precede a menieres attack

A

prodromal tinnitus/aural fullness

78
Q

what is the theory for menieres disease occuring

A

mixing of endolymph and perilymph due to a rupture in reissners membrane

79
Q

what are differentials for menieres

A 
syphillis
vascular disease
epilepsy
MS
tumours
labyrinthitis 
BPPV
80
Q

Treatment for Menieres

A

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
Q

what is an acoustic neuroma/vestibular schwannoma

A

benign tumour of CN8

82
Q

what are early symptoms of an acoustic neuroma/vestibular schwannoma

A

unilateral hearing loss and tinnitus

83
Q

what occurs if an acoustic neuroma/vestibular schwannoma gets big enough

A

removal without damaging the facial nerve and artery is impossible

84
Q

how do you investigate an acoustic neuroma/vestibular schwannoma

A

pure tone audiometry

MRI/CT

85
Q

how do you treat an acoustic neuroma/vestibular schwannoma

A

gamma knife/surgery if >3.5cm

watch and wait if <3.5cm

86
Q

what is otitis externa

A

infection of the external ear canal

87
Q

what are the 3 types of otitis externa

A

diffuse
furuncle
malignant

88
Q

what is diffuse otitis externa

A

a common condition characterised by generalised inflammation of external acoustic meatus

89
Q

what are risk factors for diffuse otitis externa

A

eczema

trauma

90
Q

what are the signs and symptoms for diffuse otitis externa

A

pain
otorrhoea
hearing loss
tragal tenderness

91
Q

what are specific signs of bacteria diffuse otitis extern

A

pus

92
Q

what are specific signs of viral diffuse otitis externa

A

if herpes zoster - vesices

haemorrhagic vesicles indicate bullous myringitis

93
Q

what are specific signs of fungal diffuse otitis externa

A

dry/wet debris, yellow/black spores

94
Q

treatment for diffuse otitis externa

A

aural toileting
local medication - steroids/antibiotics/antifungal
severe = systemic Abx

95
Q

what should you always check for when diffuse otitis externa is improving

A

otitis media as its a common cause

96
Q

what is malignant otitis externa

A

a more aggressive form seen in the elderly/diabetics/immunocompromised

97
Q

what causes malignany otitis externa

A

pseudomonas

98
Q

what is the risk of malignant otitis externa

A

osteomyelitis of the skull base due to bone spread

99
Q

how do you treat malignant otitis externa

A

High dose systemic antibiotics - ciprofloxacin/tazocin/a cephalospirin

potentially surgical debridement

100
Q

what is a furuncle in otitis externa

A

painful infection of one of the hair follicles of the outer 1/3 of the EAM

101
Q

what organism causes a furuncle

A

staph aureus mostly

102
Q

what does a furuncle look like

A

a red swelling bulging into the EAM

103
Q

how do you treat a furuncle

A

analgesia
astringents - withdraw moisture from EAM (glyceine)
antibiotics if required - penicillins work

104
Q

what may occur due to blunt trauma that causes swelling

A

haemoatoma

105
Q

what is ‘cauliflower ear’

A

bleeding from the vascularised perichondrium

106
Q

whats another name for malignant otitis externa

A

necrotising otitis externa

107
Q

what must you do with an acute case of cauliflower ear

A

drain immediately as it may cause ischaemia and become infected

108
Q

what are complications of caluflower ear

A

peichondritis
necrosis
cosmetic deformity

109
Q

how is cauliflower ear treated

A

drained under a local anesthetic with prophylactic antibiotics, pressure is applied afterwards as haemoatomas have the tendency to reform

110
Q

what is chondrodermatitis nodularis helicos

A

inflammation of the skin and cartilage of the ear causing a benign, tender nodule

111
Q

what usually causes chondrodermatitis nodularis helicos

A

sleeping on ear
sun/cod damage
decreased blood supply

112
Q

what is the epidemiology of chondrodermatitis nodularis helicos

A

40+ M>F

113
Q

what are the characteristics of the lump seen in chondrodermatitis nodularis helicos

A

lump is usually singular and seen on the outer, upper part of the ear rim (helix)

114
Q

how do you treat chondrodermatitis nodularis helicos

A 
avoid direct pressure
blister dressings
avoid sun/cold exposure
corticosteroids
surgery - cryotherapy or cut out

ENT (8 decks)

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