Otology Flashcards
What is otology?
The study of anatomy and diseases of the ear
What are some examples of some symptoms related to otology?
Hearing loss
Tinnitus
Vertigo
Otalgia (ear pain)
Otorrhoea (discharge)
Facial weakness
What is hearing a sound in the absence of external sounds called?
Tinnitus
What is a sense of spinning dizziness called?
vertigo
What is discharge from the ear called?
Otorrhoea
What is ear pain called?
Otalgia
What are some different methods of ear examination?
Otoscopy
Microscopy
Rinne’s test
Weber’s test
Whispered voice test
What are the 3 possible outcomes from the Rinne’s test?
A (normal ear, air > bone so test is positive)
B (conductive hearing loss, bone > air so test is negative)
C (sensorineural hearing loss, air > bone so test is positive)
What are the 3 possible outcomes of the Weber’s test?
A (normal hearing in both ears, left=right so test is central)
B (sensorineural hearing loss in right ear, left>right so test lateralises to the left)
C (conductive hearing loss right ear, right>left so test lateralises to the right)
What is the Whispered voice test?
Whispered voice at 60cm with the other ear masked and no lip reading
What are different methods of ear investigations?
Pure tone audiogram
Tympanogram
What are the 3 outcomes of pure tone audiogram?
A (normal hearing, better than 20dB)
B (conductive hearing loss, bone conduction better than air condiction)
C (sensorineural hearing loss, bone conduction the same as air conduction)
What are the 3 outcomes of tympanogram?
A (normal middle ear pressure and compliance)
B (low middle ear compliance)
C (low middle ear pressure)
What is pure tone audiogram?
Test to identify hearing thresholds of someone
What is a tympanogram?
Graphic representation of the relationship between air pressure in the ear canal and the movement of the tympanic membrane
What is the tympanic membrane also known as?
Ear drum
What are examples of disorders of the ear?
Auricular haematoma
Foreign body
Otitis externa
Malignant otitis externa
Otitis media with effusion
Acute suppurative otitis media
Tympanosclerosis
Chronic suppurative otitis media
Perforation of tympanic membrane
Cholesteatoma
Otosclerosis
Sensineural hearing loss
Tinnitus
Vertigo
Benign positional vertigo
Vestibular neuritis/labyrinthitis
Meniere’s disease
Migraine
Facial nerve palsy
What is auricular haematoma?
Collection of blood underneath the perichondrium of the ear
What is the management of auricular haematoma?
Incision and drainage
Pressure dressing
Antibiotics
What is a possible complication of auricular haematoma?
Cauliflower ear
What is the management of a forign body in the ear?
Removal
Explain the order of urgency for different kinds of forign bodies in the ear?
Button battery > organic > inorganic
What is otitis externa?
Inflammation of external auditory meatus
What is the management of otitis externa?
Antibiotic/steroid ear drops with or without suction under microscopy
What is the prevention of otitis externa?
No water or cotton buds to be used in the ear
What is malignant otisis externa?
Osteomyelitis of temporal bone
What is the presentation of malignant otitis externa?
Severe pain in elderly diabetic
Granulations in external auditory meatus with or without cranial nerve palsies
What is the management of malignant otitis externa?
Antibiotics for weeks or months
What is otitis media?
Inflammation of the middle ear
What is otitis media with effusion also known as?
Glue ear
What is the presentation of otitis media?
Hearing loss
Speech delay
What is the management of otitis media with effusion?
Observation for 3 months
Otovent
Grommet
What is an otovent?
Autoinflation device used to open up the euchachian tubes
What is grommet?
Tiny tube to be entered into the ear
What is acute suppurative otitis media?
Inflammation of middle ear and mastoid cavity that is characterised by pus in the ear
What is the presentation of acute suppurative otitis media?
Otalgia with or without otorrhoea
What is the management of acute suppurative otitis media?
Observation
Amoxicillin
What is tympanosclerosis?
Calcification in tympanic membrane with or without middle ear involvement
What is the presentation of tympanosclerosis?
Usually asymptomatic
What is the management of tympanosclerosis?
Usually none
What is the pathology of chronic suppurative otitis media?
Perforated tympanic membrane or cholesteatoma (skin in middle ear with or without mastoid bone involvement)
What are possible complications of chronic suppurative otitis media?
Dead ear
Facial palsy
Meningitis
Brain abscess
What are potential causes of perforation of tympanic membrane?
Infection
Trauma
Grommet
What is the presentation of perforation of tympanic membrane?
Recurrent infections
Hearing loss
What is the management of perforation of tympanic membrane?
Water precautions
With or without myrinoplasy
What is myrinoplasy?
Operation to repair a perforation of the tympanic membrane
What is cholesteatoma?
Abnormal, non-cancerous skin growth in the middle ear
What are possible causes of cholesteatoma?
Eustachian tube dysfunction
Impaired skin migration
What is the presentation of cholesteatoma?
Perisistent offensive otorrhoea
What is the management of cholesteatoma?
Mastoidectomy
What is a mastoidectomy?
Surgical procedure to remove diseased mastoid air calls
What is otosclerosis?
One of staples in middle ear gets stuck in place
What is the presentation of otosclerosis?
Conductive hearing loss
Normal tympanic membrane
What is the pathology of otosclerosis?
Fixation of stapes by extra bone
What is the management of otosclerosis?
Heading aid or stapedectomy?
What is a stapedectomy?
Procedure in middle ear where stape is removed
What is sensorineural hearing loss?
Type of hearing loss where the root cause lies in the inner ear or sensory organ (cochlea and associated structures) or the vestibulocochlear nerve (CN VIII)
What are possible causes of sensorineural hearing loss?
Presbyacusis
Head injury
Viral infections
Noise exposure
Ototoxic medications
Acoustic neuroma
What is the management of sensorineural hearing loss?
Hearing aids
What is tinnitus?
Sensation of hearing a sound in the absence of external sounds
What should be investigated with tinnitus?
Unilateral
Pulsatile (pulsating)
What is the management of tinnitus?
Treat underlying cause
Soud enrichment
Stress management
What is vertigo?
Sense of spinning dizziness
What are the differential diagnosis of vertigo?
Benign positional vertigo
Menieres disease
Vestibular neuritis/labyrinthitis
Migraine
What is benign positional vertigo?
Sudden sensation of spinning, feels like from the inside of your head
What is the pathoogy of benign positional vertigo?
Otoconia in semi-circular canals
What are otoconia?
Bio-crystals which couple mechanical forces to the sensory hair cells in the utricle and saccule
What are the clinical features of beign positional vertigo?
Vertigo precipitated by specific changes in head position
Duration in seconds
No associated symptoms
Nystagmus is positional and rotatory
What is Nystagmus?
Vision condition where the eyes make repetative, uncontrolled movements
What investigation is done for benign positional vertigo?
Dix-Hallpike test
What is the management of benign positional vertigo?
Epley manoeuvre
What is vestibular neuritis?
Inflammation of vestibular nerve
What is the pathology of vestibular neuritis/labyrinthitis?
Reactivation of latent HSV infection of vestibular ganglion
What are the clinical features of vestibular neuritis?
Spontaneous vertigo
Associated underlateral hearing loss (labyrinthitis)
Duration is days
Nystagmus is horizontal towards the affected ear
What is the management of vestibular neuritis/labyrinthitis?
Management of acute is vestibular sedatives
Management of chronic is vestibular rehabilitation
What is Maniere’s disease?
Disorder of inner ear that leads to dizziness and hearing loss
What is the pathology of Maniere’s disease?
Endolymphatic hydrops
What are the clinical features of Maniere’s disease?
Spontaneous vertigo
Associated unilateral hearing loss/tinnitus/aural fullness
Duration is hours
What is the management of Maniere’s disease?
Bendoflumethazide
Intratympanic dexamethasone
Intratympanic gentamicin
What is a migraine?
Moderate to severe headache felt as throbbing pain on one side of the head
What is the pathology of a migraine?
Possibly vascular or neural, but is unknown
What are the clinical features of a migraine?
Spontaneous vertigo
Duration is variable
With or without headache, sensory sensitivity
With or without precipitated migraine triggers
With or without past history of migraine
What is the management of migraine?
Avoid migraine triggers
Prophylactic medication
What is facial nerve palsy?
Function of the facial nerve (CN VII) is partly or completely lost
What are the clinical features of facial nerve palsy?
Lower motor neuron facial palsy (forehead involved)
What is the differential diagnosis of facial palsy?
Intratemporal such as cholesteatoma
Extratemporal such as parotid tumour
Idiopathic is called Bell’s palsy
What is idiopathic facial palsy called?
Bell’s palsy
What is the management of facial nerve palsy?
Treat underlying cause (if possible)
Steroids
Eye care