Otology

Question 1

What the 6 common ear symptoms?

Answer 1

• Hearing Loss
• Tinnitus
• Otalgia
• Otorrhoea
• Facial Weakness
• Vertigo

Question 2

How do we examine the ears?

Answer 2

Physical:

• Otoscope
• Microscope

Hearing:

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

Question 3

Explain the tuning fork tests

Answer 3

Rinnes:

• Air vs Bone Conduction
• IF B>A then theres conductive hearing loss in that ear

Webers:

• Tuning fork to forehead
• If its louder in one ear then its either conductive loss in that ear or sensorineural in the opposite

Question 4

What investigations can be done for hearing?

Answer 4

• Pure Tone Audiogram

- Tympanogram

Question 5

How do we interpret the results from a pure tone audiogram

Answer 5

It measures how quiet a sound you can hear at various frequencies
We can also do it with bone vs air conduction

Question 6

What are the result ‘types’ from a tympanogram?

Answer 6

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

Question 7

List the common disorders of the outer ear?

Answer 7

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

Question 8

List some common disorders of the middle ear?

Answer 8

• Otitis Media with effusion (glue ear)
• Acute Otitis Media
• Chronic Suppurative Otitis Media
• Tympanosclerosis
• Otosclerosis

Question 9

Define otitis media with effusion?

Answer 9

Eustachian tube isnt working causing a vaccum in the middle ear that draws out fluid from the lining

Question 10

How do we treat ‘glue ear’?

Answer 10

If the hearing loss is persistant over months or affects their work/school then put in a grommet.
A Grommet is a tube through the ear drum that allows pressure to equalise in the middle ear

Question 11

How does acute otitis media present?

Answer 11

Increasing pain leading to a perforated ear drum

The pain then goes away and the drum heals

Question 12

What are the types of chronic suppurative otitis media?

Answer 12

Either with:

• Perforated Tympanic Membrane
• Cholesteatoma

Question 13

What is a cholesteatoma?

Answer 13

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

Question 14

List some common disorders of the inner ear?

Answer 14

Presbycusis

• Age related hearing loss
• It starts at the higher frequency

Noise Induced Hearing Loss:
- Also starts at higher frequency

Ototoxic Meds e.g. Gentamicin

Meniere’s Disease
Head Injury
Infection
Vestibular Schwannoma (Acoustic Neuroma)

Question 15

What is a vestibular schwannoma?

Answer 15

A benign tumour of the vestibular nerve

Causes sensorineural hearing loss in one ear

Question 16

What causes tinnitus?

Answer 16

Possibly damage to the cochlear hairs

Its associated with presbycusis, noise related hearing loss and stress.

Question 17

How would we investigate tinnitus?

Answer 17

We’d want to test for hearing loss.

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

Question 18

How do we treat tinnitus?

Answer 18

Manage stress to stop exacerbating it

Sound enrichment, e.g. hearing aids

Question 19

What would we want to know about someones vertigo?

Answer 19

• Precipitating Factors such as position
• Associated symptoms
• Frequency
• Duration

Question 20

List some common types/causes of vertigo?

Answer 20

• Benign Paroxysmal Positional vertigo (BPPV)
• Vestibular Neuritis/Labyrinthitis
• Meniere’s Disease
• Migraine

Question 21

What causes benign positional vertigo?

Answer 21

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

Question 22

How do we test for and treat Benign Positional Vertigo?

Answer 22

A Dix-Hallpike test will induce vertigo

The Epley Manoeuvre moves the particles out the canal so they wont stimulate the hair cells

Question 23

What is vestibular neuritis/labyrinthitis?

Answer 23

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

Usually people have a few episodes of decreasing severity as the body fights off the virus better each time

The patient may be left with residual motion-provoked vertigo

Question 24

How do we treat Vestibular Neuritis/Labyrinthitis?

Answer 24

A vestibular sedative acutely

Vestibular rehab afterward

Question 25

What is Meniere’s disease?

Answer 25

Also known as endolymphatic hydrops.

Its thought to stem from unusual fluctuation of endolymph in the vestibular system.

Question 26

How does meniere’s disease present?

Answer 26

Spontaneous vertigo often with:

• Fluctuating & Progressive unilateral hearing loss
• Tinnitus
• Aural Fullness

It can last hours and happen every few days, weeks or months

Question 27

How do we treat meniere’s disease?

Answer 27

Betahistine- antihistamine anti-vertigo medication
Bendrofluazide- diuertic
Intratympanic Dexamethasone
Intratympanic Gentamicin

Question 28

What is a migraine?

Answer 28

Spontaneous Vertigo +/-:

• Headache
• Sensory Sensitivity

It can be precipitated by a migraine trigger such as stress, diet, alcohol or menstruation

Duration & Frequency are very variable

Question 29

How would we treat a migraine?

Answer 29

Avoid the triggers

Prophylactic meds

Question 30

List some sources of Facial Palsy:

Answer 30

Lower Motor Neuron Facial Weakness

Infratemporal (Cholesteatoma) or Extratemporal (Parotid Gland Tumour) pathologies affecting the facial nerve

Bells Palsy
- Acute Idiopathic Facial Palsy