Otology Flashcards
Common symptoms of ear conditions (6)
Hearing loss (conductive or sensorineural)
Tinnitus (hearing sounds that have no external source), e.g. ringing
Vertigo (dizziness)
Otalgia (ear pain)
Otorrhoea (ear discharge)
Facial weakness
Ear investigations (6)
- examination tests (4)
- further investigations (2)
Otoscopy
Microscopy (+/- suction under microscope at same time)
Tuning fork tests - rinne’s and weber’s
Whispered voice test
Pure tone audiometry
Tympanometry
Air:bone conduction ratio for
- normal ear
- conductive hearing loss
- sensorineural hearing loss
in the rinne’s test
Normal ear = air> bone conduction
Conductive hearing loss = bone> air conduction
Sensorineural hearing loss = air> bone conduction
What results in a positive rinne’s test
When air> bone conduction so could be a normal ear or ear with sensorineural hearing loss, can’t distinguish between them
Conductive hearing loss is due to problems with which parts of ear
External and middle ear
Sensorineural hearing loss is due to problems with which part of the ear
Inner ear
Negative rinne’s test indicates what hearing loss
When bone> air conduction so in conductive hearing loss
3 possible results of the weber’s test
- normal hear
- sensorineural hearing loss - which side do you hear it better
- conductive hearing loss - which side do you hear it better
Equal lateralisation to both ears = test central
Sensorineural hearing loss = sound heard best in NORMAL EAR = test lateralises to normal ear
Conductive hearing loss = sound heard best in ABNORMAL EAR = test lateralises to abnormal ear
If there’s conductive hearing loss in the right ear, the weber’s test lateralises to which ear
If there’s sensorineural hearing loss in the right ear, the weber’s test lateralises to which side
The right
The left
What is tympanometry
Tests condition of the middle ear by testing the MOBILITY OF THE TYMPANIC MEMBRANE
Tympanometer probe inserted into ear canal and generates a pure tone (sound) then measures the response of the tympanic membrane to the sound at different pressures
What can tympanometry detect (2)
Fluid in middle ear or perforation of eardrum
Emergency ear disorders that need immediate treatment (5)
Auricular haematoma Foreign body Malignant/severe otitis externa Bell's palsy Complications of chronic suppurative otitis media - e.g. meningitis or brain abscess
What is an auricular haematoma + cause
Collection of blood in the pinna because cartilage of external ear injured so disrupting blood supply
Caused by trauma
Treatment of an auricular haematoma (3)
Incision + drainage
Pressure dressing - to stop blood building up again
Antibiotics - to stop cartilage of pinna getting infected
Complication of an auricular haematoma
Cauliflower ear (see other flashcard)
What is cauliflower ear
Degeneration of the cartilage of the pinna because it loses its blood supply –> fibrous tissue forms under the skin of the pinna –> swollen + deformed external ear
What is malignant otitis externa
A severe form of otitis externa that spreads to the surrounding bones of the jaw and face (osteomyelitis of the temporal bone)
Isn’t a malignancy, just an AGGRESSIVE INFECTION
Major risk factors for malignant otitis externa (2)
Diabetes
Immunocompromised - e.g. if receiving chemo
Treatment for malignant otitis externa
Antibiotics (ciprofloxacin) for months
What is otitis externa
+ usual causative organism
Inflammation of the skin of the EAC/pinna
Usually bacterial - pseudomonas auriginosa
Common term used to describe otitis externa
Swimmer’s ear - due to repeated exposure to water
Symptoms (4) + sign (2) of otitis externa
Hearing loss
Otalgia
Otorrhoea
Aural fullness
EAC swelling and redness
Specific sign in malignant otitis externa that’s not present in normal otitis externa
Granulation tissue in EAC
Treatment of otitis externa (2)
Antibiotic/steroid ear drops
Topical/oral antibiotics if ear drops don’t work
What is otitis media with effusion (GLUE EAR)
Inflammation of middle ear with collection of sterile (non-infected) fluid
Symptoms of glue ear (2)
Hearing loss
Speech delay
Treatment of otitis media with effusion (3)
Observe for 3 months - usually heals itself
Otovent - blowing up a special balloon with one nostril to open up Eustachian tube and allow fluid to drain down back of throat
Grommet - small plastic tube put in tympanic membrane so air can flow through, keeping pressure on either side of ear drum equal
What is acute suppurative otitis media + usual causative organisms of otitis media if bacterial (3)
Middle ear infection with pus
Streptococcus pneumoniae, Moraxella catarrhalis, or Haemophilus influenzae
Otitis media is usually caused by
Viral respiratory infections
Acute suppurative otitis media symptoms (2)/ signs (2)
Symptoms
- otalgia,
- otorrhoea
Signs
- red bulging tympanic membrane
- fever
Acute suppurative otitis media treatment (2)
Amoxicillin - once otitis media is confirmed
Analgesia
What is chronic suppurative otitis media
Unresolved/recurrent acute otitis media - ongoing inflammation of middle ear with chronic discharge >6 wks and granulation tissue
Possible manifestation of chronic suppurative otitis media
Perforated tympanic membrane
Chronic suppurative otitis media symptoms (1)/ signs (1)
+ a symptom and sign that is not present but would be present in acute form
Hearing loss
Perforation of tympanic membrane
NO OTALGIA
NO FEVER
Chronic suppurative otitis media treatment (3)
Aural toilet - cleaning EAC
Topical antibiotics/steroids
If TM perforation is large then may need Myringoplasty but if small then will heal itself
Disorders of the middle ear (7)
Otitis media with effusion Acute suppurative otitis media Chronic suppurative otitis media Tympanosclerosis Perforation of tympanic membrane Cholesteatoma Otosclerosis
What is tympanosclerosis
Calcification in the tympanic membrane - white patches
Tympanosclerosis symptoms and treatment
Usually no symptoms or treatment
What may have preceded tympanosclerosis (middle ear disorder) (2)
Otitis media
Grommet
What is otosclerosis
Abnormal bone growth in middle ear which stops stapes (part of ossicle) from moving
Symptoms of otosclerosis/ signs
Hearing loss
NORMAL tympanic membrane
Otosclerosis treatment (2)
Hearing aid
Stapedectomy - removing stapes and replacing with prosthesis
Causes of sensorineural hearing loss (5)
Old age Excessive loud noise exposure Head injury Ototoxic medications - gentamicin Viral infections
Name some inner ear disorders (4)
Presbyacusis
Acoustic neuroma
Meniere’s disease
Noise induced deafness
What is tinnitus
Hearing sounds in the head/ear which have no external source, e.g. ringing or buzzing
Treatment of tinnitus (3)
Treat underlying cause (e.g. if it’s caused by an ear infection then treat the infection)
Sound enrichment - sound therapy retraining brain to tune out of the tinnitus
Cognitive behavioural therapy - changing mindset about the tinnitus + reducing anxiety
Examination test to assess a dizzy patient that would positively diagnose BPPV
Dix-hallpike test - positively diagnoses BPPV if test results in vertigo and nystagmus
5 commonest causes of vertigo
BPPV Meniere's disease Vestibular neuritis Labyrinthitis Migraine
What is benign paroxysmal positional vertigo (BPPV) + pathophysiology
Inner ear disorder that causes vertigo and imbalance
Otoconia (calcium carbonate particles) abnormally present in semi-circular canals causes endolymph to move when you move your head –> causing dizziness
How long does the dizziness last in BPPV
Seconds
What brings on the vertigo in BPPV
Movement of the head
Eye sign of BPPV
Nystagmus
BPPV investigation
Dix-hallpike test - positive diagnosis of BPPV if it results in vertigo and nystagmus
BPPV treatment
Epley manouvre (continuation of dix-hallpike test) - series of movements that move calcium particles out of the canals
Pathophysiology of meniere’s disease
Over production of endolymph –> raised pressure in the semi-circular canals and the cochlea –> causing distended endolymphatic space which is referred to as ENDOLYMPHATIC HYDROPS
Meniere’s disease symptoms (4)
Episodic spontaneous vertigo
Hearing loss
Tinnitus
Aural fullness
Meniere’s disease treatment (3)
Bendroflumethiazide (thiazide diuretic)
Intratympanic dexamethasone (Steroid)
Intratympanic gentamicin
What is vestibular neuritis
Inflammation of the vestibular nerve (branch of vestibulocochlear nerve) in the inner ear usually due to a viral infection –> disrupting sense of balance
Pathology of vestibular neuritis
Reactivation of latent HSV infection of the vestibular ganglion
Symptoms of vestibular neuritis (2)
Spontaneous vertigo
Nausea/ vomiting
Sign of vestibular neuritis
Horizontal nystagmus - towards affected ear
Vestibular neuritis treatment (acute + chronic vestibular neuritis)
Acute - vestibular sedatives, e.g. diazepam (a benzodiazepine)
Chronic - vestibular rehabilitation (retraining brain to get used to abnormal signals
What is labyrinthitis
Inflammation of both branches of the vestibulocochlear nerve (vestibular and cochlear) so both balance and hearing are affected
Difference between vestibular neuritis and labrynthitis
Only the vestibular nerve is inflamed in vestibular neuritis so only balance is affected whereas both vestibular and cochlear nerve are inflamed in labyrnthitis so both hearing and balance affected
What function does the vestibular nerve control
Balance
What function does the cochlear nerve control
Hearing
What is a migraine
Chronic, genetically determined, episodic neurological disorder
Migraine symptoms (6)
Throbbing pain on one side of head
Spontaneous vertigo
Nausea/vomiting
Increased sensitivity to light (photophobia or sound
Migraine treatment
- general measure
- mild/moderate (pharmacological)
- severe (pharmacological)
Avoid trigger, e.g. light
Mild/moderate migraine - NSAIDs or aspirin, anti-emetics
Severe migraine - triptan, anti-emetics
How do triptans work in treating severe migraines
They’re serotonin receptor agonists - stimulate serotonin, (neurotransmitter found in the brain) which reduces inflammation and constricts blood vessels –> stopping the migraine
What is Bell’s palsy
Acute unilateral CN VII palsy usually due to viral infection –> facial paralysis of affected side
Bell’s palsy treatment (4)
High dose oral steroids - prednisolone
Antiviral if Ramsay hunt syndrome suspected to be the viral cause
Eye protection - eyedrops, eyelid tape overnight
