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Otology Flashcards

1
Q

Common symptoms of ear conditions (6)

A

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

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2
Q

Ear investigations (6)

  • examination tests (4)
  • further investigations (2)
A

Otoscopy
Microscopy (+/- suction under microscope at same time)
Tuning fork tests - rinne’s and weber’s
Whispered voice test

Pure tone audiometry
Tympanometry

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3
Q

Air:bone conduction ratio for

  • normal ear
  • conductive hearing loss
  • sensorineural hearing loss

in the rinne’s test

A

Normal ear = air> bone conduction
Conductive hearing loss = bone> air conduction
Sensorineural hearing loss = air> bone conduction

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4
Q

What results in a positive rinne’s test

A

When air> bone conduction so could be a normal ear or ear with sensorineural hearing loss, can’t distinguish between them

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5
Q

Conductive hearing loss is due to problems with which parts of ear

A

External and middle ear

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6
Q

Sensorineural hearing loss is due to problems with which part of the ear

A

Inner ear

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7
Q

Negative rinne’s test indicates what hearing loss

A

When bone> air conduction so in conductive hearing loss

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8
Q

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
A

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

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9
Q

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

A

The right

The left

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10
Q

What is tympanometry

A

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

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11
Q

What can tympanometry detect (2)

A

Fluid in middle ear or perforation of eardrum

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12
Q

Emergency ear disorders that need immediate treatment (5)

A 
Auricular haematoma
Foreign body
Malignant/severe otitis externa
Bell's palsy
Complications of chronic suppurative otitis media - e.g. meningitis or brain abscess
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13
Q

What is an auricular haematoma + cause

A

Collection of blood in the pinna because cartilage of external ear injured so disrupting blood supply

Caused by trauma

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14
Q

Treatment of an auricular haematoma (3)

A

Incision + drainage

Pressure dressing - to stop blood building up again

Antibiotics - to stop cartilage of pinna getting infected

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15
Q

Complication of an auricular haematoma

A

Cauliflower ear (see other flashcard)

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16
Q

What is cauliflower ear

A

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

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17
Q

What is malignant otitis externa

A

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

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18
Q

Major risk factors for malignant otitis externa (2)

A

Diabetes

Immunocompromised - e.g. if receiving chemo

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19
Q

Treatment for malignant otitis externa

A

Antibiotics (ciprofloxacin) for months

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20
Q

What is otitis externa

+ usual causative organism

A

Inflammation of the skin of the EAC/pinna

Usually bacterial - pseudomonas auriginosa

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21
Q

Common term used to describe otitis externa

A

Swimmer’s ear - due to repeated exposure to water

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22
Q

Symptoms (4) + sign (2) of otitis externa

A

Hearing loss
Otalgia
Otorrhoea
Aural fullness

EAC swelling and redness

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23
Q

Specific sign in malignant otitis externa that’s not present in normal otitis externa

A

Granulation tissue in EAC

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24
Q

Treatment of otitis externa (2)

A

Antibiotic/steroid ear drops

Topical/oral antibiotics if ear drops don’t work

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25
What is otitis media with effusion (GLUE EAR)
Inflammation of middle ear with collection of sterile (non-infected) fluid
26
Symptoms of glue ear (2)
Hearing loss | Speech delay
27
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
28
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
29
Otitis media is usually caused by
Viral respiratory infections
30
Acute suppurative otitis media symptoms (2)/ signs (2)
Symptoms - otalgia, - otorrhoea Signs - red bulging tympanic membrane - fever
31
Acute suppurative otitis media treatment (2)
Amoxicillin - once otitis media is confirmed | Analgesia
32
What is chronic suppurative otitis media
Unresolved/recurrent acute otitis media - ongoing inflammation of middle ear with chronic discharge >6 wks and granulation tissue
33
Possible manifestation of chronic suppurative otitis media
Perforated tympanic membrane
34
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
35
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
36
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 ```
37
What is tympanosclerosis
Calcification in the tympanic membrane - white patches
38
Tympanosclerosis symptoms and treatment
Usually no symptoms or treatment
39
What may have preceded tympanosclerosis (middle ear disorder) (2)
Otitis media | Grommet
40
What is otosclerosis
Abnormal bone growth in middle ear which stops stapes (part of ossicle) from moving
41
Symptoms of otosclerosis/ signs
Hearing loss NORMAL tympanic membrane
42
Otosclerosis treatment (2)
Hearing aid | Stapedectomy - removing stapes and replacing with prosthesis
43
Causes of sensorineural hearing loss (5)
``` Old age Excessive loud noise exposure Head injury Ototoxic medications - gentamicin Viral infections ```
44
Name some inner ear disorders (4)
Presbyacusis Acoustic neuroma Meniere's disease Noise induced deafness
45
What is tinnitus
Hearing sounds in the head/ear which have no external source, e.g. ringing or buzzing
46
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
47
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
48
5 commonest causes of vertigo
``` BPPV Meniere's disease Vestibular neuritis Labyrinthitis Migraine ```
49
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
50
How long does the dizziness last in BPPV
Seconds
51
What brings on the vertigo in BPPV
Movement of the head
52
Eye sign of BPPV
Nystagmus
53
BPPV investigation
Dix-hallpike test - positive diagnosis of BPPV if it results in vertigo and nystagmus
54
BPPV treatment
Epley manouvre (continuation of dix-hallpike test) - series of movements that move calcium particles out of the canals
55
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
56
Meniere's disease symptoms (4)
Episodic spontaneous vertigo Hearing loss Tinnitus Aural fullness
57
Meniere's disease treatment (3)
Bendroflumethiazide (thiazide diuretic) Intratympanic dexamethasone (Steroid) Intratympanic gentamicin
58
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
59
Pathology of vestibular neuritis
Reactivation of latent HSV infection of the vestibular ganglion
60
Symptoms of vestibular neuritis (2)
Spontaneous vertigo | Nausea/ vomiting
61
Sign of vestibular neuritis
Horizontal nystagmus - towards affected ear
62
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
63
What is labyrinthitis
Inflammation of both branches of the vestibulocochlear nerve (vestibular and cochlear) so both balance and hearing are affected
64
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
65
What function does the vestibular nerve control
Balance
66
What function does the cochlear nerve control
Hearing
67
What is a migraine
Chronic, genetically determined, episodic neurological disorder
68
Migraine symptoms (6)
Throbbing pain on one side of head Spontaneous vertigo Nausea/vomiting Increased sensitivity to light (photophobia or sound
69
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
70
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
71
What is Bell's palsy
Acute unilateral CN VII palsy usually due to viral infection --> facial paralysis of affected side
72
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

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