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H and N > Otology > Flashcards

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
Q

What is otitis media with effusion (GLUE EAR)

A

Inflammation of middle ear with collection of sterile (non-infected) fluid

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26
Q

Symptoms of glue ear (2)

A

Hearing loss

Speech delay

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27
Q

Treatment of otitis media with effusion (3)

A

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

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28
Q

What is acute suppurative otitis media + usual causative organisms of otitis media if bacterial (3)

A

Middle ear infection with pus

Streptococcus pneumoniae, Moraxella catarrhalis, or Haemophilus influenzae

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29
Q

Otitis media is usually caused by

A

Viral respiratory infections

30
Q

Acute suppurative otitis media symptoms (2)/ signs (2)

A

Symptoms

  • otalgia,
  • otorrhoea

Signs

  • red bulging tympanic membrane
  • fever
31
Q

Acute suppurative otitis media treatment (2)

A

Amoxicillin - once otitis media is confirmed

Analgesia

32
Q

What is chronic suppurative otitis media

A

Unresolved/recurrent acute otitis media - ongoing inflammation of middle ear with chronic discharge >6 wks and granulation tissue

33
Q

Possible manifestation of chronic suppurative otitis media

A

Perforated tympanic membrane

34
Q

Chronic suppurative otitis media symptoms (1)/ signs (1)

+ a symptom and sign that is not present but would be present in acute form

A

Hearing loss
Perforation of tympanic membrane

NO OTALGIA
NO FEVER

35
Q

Chronic suppurative otitis media treatment (3)

A

Aural toilet - cleaning EAC
Topical antibiotics/steroids
If TM perforation is large then may need Myringoplasty but if small then will heal itself

36
Q

Disorders of the middle ear (7)

A 
Otitis media with effusion
Acute suppurative otitis media
Chronic suppurative otitis media
Tympanosclerosis
Perforation of tympanic membrane
Cholesteatoma
Otosclerosis
37
Q

What is tympanosclerosis

A

Calcification in the tympanic membrane - white patches

38
Q

Tympanosclerosis symptoms and treatment

A

Usually no symptoms or treatment

39
Q

What may have preceded tympanosclerosis (middle ear disorder) (2)

A

Otitis media

Grommet

40
Q

What is otosclerosis

A

Abnormal bone growth in middle ear which stops stapes (part of ossicle) from moving

41
Q

Symptoms of otosclerosis/ signs

A

Hearing loss

NORMAL tympanic membrane

42
Q

Otosclerosis treatment (2)

A

Hearing aid

Stapedectomy - removing stapes and replacing with prosthesis

43
Q

Causes of sensorineural hearing loss (5)

A 
Old age
Excessive loud noise exposure
Head injury
Ototoxic medications - gentamicin
Viral infections
44
Q

Name some inner ear disorders (4)

A

Presbyacusis
Acoustic neuroma
Meniere’s disease
Noise induced deafness

45
Q

What is tinnitus

A

Hearing sounds in the head/ear which have no external source, e.g. ringing or buzzing

46
Q

Treatment of tinnitus (3)

A

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
Q

Examination test to assess a dizzy patient that would positively diagnose BPPV

A

Dix-hallpike test - positively diagnoses BPPV if test results in vertigo and nystagmus

48
Q

5 commonest causes of vertigo

A 
BPPV
Meniere's disease
Vestibular neuritis
Labyrinthitis
Migraine
49
Q

What is benign paroxysmal positional vertigo (BPPV) + pathophysiology

A

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
Q

How long does the dizziness last in BPPV

A

Seconds

51
Q

What brings on the vertigo in BPPV

A

Movement of the head

52
Q

Eye sign of BPPV

A

Nystagmus

53
Q

BPPV investigation

A

Dix-hallpike test - positive diagnosis of BPPV if it results in vertigo and nystagmus

54
Q

BPPV treatment

A

Epley manouvre (continuation of dix-hallpike test) - series of movements that move calcium particles out of the canals

55
Q

Pathophysiology of meniere’s disease

A

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
Q

Meniere’s disease symptoms (4)

A

Episodic spontaneous vertigo
Hearing loss
Tinnitus
Aural fullness

57
Q

Meniere’s disease treatment (3)

A

Bendroflumethiazide (thiazide diuretic)
Intratympanic dexamethasone (Steroid)
Intratympanic gentamicin

58
Q

What is vestibular neuritis

A

Inflammation of the vestibular nerve (branch of vestibulocochlear nerve) in the inner ear usually due to a viral infection –> disrupting sense of balance

59
Q

Pathology of vestibular neuritis

A

Reactivation of latent HSV infection of the vestibular ganglion

60
Q

Symptoms of vestibular neuritis (2)

A

Spontaneous vertigo

Nausea/ vomiting

61
Q

Sign of vestibular neuritis

A

Horizontal nystagmus - towards affected ear

62
Q

Vestibular neuritis treatment (acute + chronic vestibular neuritis)

A

Acute - vestibular sedatives, e.g. diazepam (a benzodiazepine)

Chronic - vestibular rehabilitation (retraining brain to get used to abnormal signals

63
Q

What is labyrinthitis

A

Inflammation of both branches of the vestibulocochlear nerve (vestibular and cochlear) so both balance and hearing are affected

64
Q

Difference between vestibular neuritis and labrynthitis

A

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
Q

What function does the vestibular nerve control

A

Balance

66
Q

What function does the cochlear nerve control

A

Hearing

67
Q

What is a migraine

A

Chronic, genetically determined, episodic neurological disorder

68
Q

Migraine symptoms (6)

A

Throbbing pain on one side of head
Spontaneous vertigo
Nausea/vomiting
Increased sensitivity to light (photophobia or sound

69
Q

Migraine treatment

  • general measure
  • mild/moderate (pharmacological)
  • severe (pharmacological)
A

Avoid trigger, e.g. light
Mild/moderate migraine - NSAIDs or aspirin, anti-emetics
Severe migraine - triptan, anti-emetics

70
Q

How do triptans work in treating severe migraines

A

They’re serotonin receptor agonists - stimulate serotonin, (neurotransmitter found in the brain) which reduces inflammation and constricts blood vessels –> stopping the migraine

71
Q

What is Bell’s palsy

A

Acute unilateral CN VII palsy usually due to viral infection –> facial paralysis of affected side

72
Q

Bell’s palsy treatment (4)

A

High dose oral steroids - prednisolone

Antiviral if Ramsay hunt syndrome suspected to be the viral cause

Eye protection - eyedrops, eyelid tape overnight

H and N (14 decks)

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