Physiology Flashcards
Histology: External Ear - Lined by what?
Stratified squamous epithelium
Histology: External Ear - Dermis contains what? (3)
Hair follicles
Sebaceous glands
Ceruminous glands
Histology: Middle Ear - Cellular structure
Columnar epithelium lined mucosa with a dense fibrous layer
Histology: Inner Ear - Contains what two structures? (2)
Cochlea
Vestibular apparatus
Histology: Nose - Nasal Vestibule cells
Squamous epithelium
Histology: Nose - Nose and Sinuses
Respiratory epithelium (Pseudostratified Ciliated Columnar epithelium) with sero-mucinous glands
Histology: Salivary Gland - Two main components
Acinar component
Ductal component
Histology: Salivary Gland - Serous cells appearance
Dark staining with digestive enzymes inside
Histology: Salivary Gland - Mucinous component appearance
Clear grey staining containing glycoprotein
Histology: Salivary Gland - Ducts are lined by what?
Columnar or cuboidal epithelium
Histology: Salivary Gland - Myoepithelial cell appearance
Flat or cuboidal cells with clear cytoplasm
Pathology of the Ear: Bacterial causes of Otitis Media (3)
Streptococcus pneumonia
Haemophilus influenzae
Moxarella catarrhalis
Pathology of the Ear: Chronic Otitis Media bacterial causes (2)
Pseudomonas aeruginosa
Staphylococcus aureus
Pathology of the Ear: Otitis media has a risk of spreading to what?
Mastoid
Pathology of the Ear: Cholesteatoma
Abnormal collection of skin cells within the ear
Pathology of the Ear: Cholesteatoma - Pathogenesis for acquired causes
Chronic otitis media and perforated tympanic membrane
Pathology of the Ear: Cholesteatoma - Pathogenesis for congenital causes
Proliferation of the embryonic crest
Pathology of the Ear: Cholesteatoma - Macro appearance
Pearly white mass in the middle ear
Pathology of the Ear: Cholesteatoma - Micro appearance
Squamous epithelium with abundant keratin production and inflammation
Pathology of the Ear: Cholesteatoma - Locations (3)
Superior posterior middle ear
Petrous apex
Anterior superior ear
Pathology of the Ear: Cholesteatoma - More common in what sex?
Males
Pathology of the Ear: Vestibular Schwannoma - Pathophysiology
Pathology of the vestibular portion of CN VIII
Pathology of the Ear: Vestibular Schwannoma - Occurs where?
Within the temporal bone
Pathology of the Ear: Vestibular Schwannoma - May be associated with what?
Extensive exposure to excessive loud noise
Pathology of the Ear: Vestibular Schwannoma - If the case is bilateral and present in the young what must be considered?
Neurofibromatosis 2
Pathology of the Ear: Vestibular Schwannoma - Gross appearance
Circumscribed tan/white/yellow mass
Pathology of the Nose: Nasal Polyps - If present in young patients what should be considered?
Cystic Fibrosis
Pathology of the Nose: Nasal Polyps - Pathophysiology
Micro-allergic associations with eosinophils
Pathology of the Nose: Nasal Polyps - Aetiologies (5)
Allergy
Infection
Asthma
Aspirin sensitivity
Nickel exposure
Pathology of the Nose: GPA abbreviation
Granulomatosis with Polyangiitis
Pathology of the Nose: GPA - Pathophysiology
Autoimmune disorder characterised by small vessel vasculitis and necrosis limited to the Respiratory Tract and Kidneys
Pathology of the Nose: GPA - Age of presentation
> 40 years old
Pathology of the Nose: GPA - Presentation (3)
Respiratory Symptoms
Renal Disease
Nasal symptoms of congestion or septal perforation
Pathology of the Nose: GPA - Antibodies (3)
ANCA
PR30-ANCA
MPO-ANCA
Pathology of the Nose: GPA - MPO-ANCA denotes what?
Microscopic polyangiitis and Churg Straus
Pathology of the Nose: Sinonasal Papilloma - 3 types
Inverted
Exophytic
Oncocytic
Pathology of the Nose: Sinonasal Papilloma - Age of onset
> 50 years old
Pathology of the Nose: Sinonasal Papilloma - More common in what sex?
Males
Pathology of the Nose: Sinonasal Papilloma - Aetiologies (2)
HPV
Organic solvents
Pathology of the Nose: Sinonasal Papilloma - Clinical Presentation
Blocked nose
Pathology of the Nose: Sinonasal Papilloma - Exophytic presents where?
Nasal Septum
Pathology of the Nose: Sinonasal Papilloma - Inverted type presents where?
Lateral walls and paranasal sinuses
Pathology of the Nose: Sinonasal Papilloma - Oncocytic type presents where?
Lateral walls and paranasal sinuses
Pathology of the Nose: Nasopharyngeal Carcinoma - Highest incidence where?
Far East
African Countries
Pathology of the Nose: Nasopharyngeal Carcinoma - More common in what sex?
Males
Pathology of the Nose: Nasopharyngeal Carcinoma - Strong association with what risk factors?
EBV
Volatile nitrosamines in food
Pathology of the Nose: Nasopharyngeal Carcinoma - Three types
Keratinising
Non-keratinising
Baseloid
Pathology of the Nose: Nasopharyngeal Carcinoma - Prognosis
Extensive local spread with early nodal metastasis
EBV is associated with what cancers? (3)
Burkitt’s Lymphoma
B Cell Lymphoma
Hodgkins Lymphoma
EBV: LMP-1 acts as what?
Oncogene
EBV: EBNA-2 promotes what?
Transition from G0 to G1
Pathology of the Throat: Laryngeal Polyps - Pathophysiology
Reactive changes in the laryngeal mucosa secondary to vocal abuse, infection or smoking
Pathology of the Throat: Laryngeal Polyps - Nodule location
Bilateral on the middle to posterior third of the vocal cord
Pathology of the Throat: Laryngeal Polyps - Most common patient group
Young women
Pathology of the Throat: Laryngeal Polyps - Common pathology of polyps
Unilateral pedunculated polyps
Pathology of the Throat: Contact Ulcer - Benign response to what?
Injury at the posterior vocal cord
Pathology of the Throat: Contact Ulcer - Clinical Presentation (3)
Chronic throat clearing
Voice abuse
GORD
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Recurrent respiratory papilloma two peaks
<5 years old
20-40 years old
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Risk factors
HPV-6 and -11
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Three types of Macro type
Exophytic
Sessile
Pedunculated
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Presentation of micro type
Finger-like projections with fibrovascular core covered by stratified squamous epithelium
Pathology of the Throat: Paraganglioma - Pathophysiology
Tumours in clusters of neuroendocrine cells throughout the body
Pathology of the Throat: Paraganglioma - May secrete what?
Catecholeamines
Pathology of the Throat: Paraganglioma - Relates to what structures? (5)
Great vessels of the head and neck around the oral cavity
Nose
Nasopharynx
Larynx
Orbit
Pathology of the Throat: Paraganglioma - Most common age
> 50 years old
Pathology of the Throat: Paraganglioma - Associated with what disease?
MEN 2
Pathology of the Throat: Squamous Cell Carcinoma - Mainly located where?
Oropharynx
Pathology of the Throat: Squamous Cell Carcinoma - Risk factors (3)
Smoking
Alcohol
HPV
Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for well-differentiated cases
Epithelial cells with keratinisation and prickle cells
Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for poor differentiated cases
Lack of keratinisation and prickle cells
Pathology of the Throat: Squamous Cell Carcinoma - Linked to what type of HPV?
HPV-16
Pathology of the Throat: Squamous Cell Carcinoma - Cellular immortality due to what?
Increased expression of E6 and E7 disrupt the p53 and Rb pathways
Pathology of the Salivary Glands: Sialothiasis
Stones
Pathology of the Salivary Glands: Pleomorphic Adenoma - Risk of what?
Malignant transformation to a carcinoma
Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what sex?
Females
Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what age?
30-60 years old
Pathology of the Salivary Glands: Pleomorphic Adenoma - Macro histological appearance
Well-circumscribed light tan to grey mass
Pathology of the Salivary Glands: Pleomorphic Adenoma - Micro histological appearance
Variable epithelial and myoepithelial cells in the chondromyxoid stroma
Pathology of the Salivary Glands: Warthin’s Tumour - More common in what sex?
Males
Pathology of the Salivary Glands: Warthin’s Tumour - Most common age
> 50 years old
Pathology of the Salivary Glands: Warthin’s Tumour - Macro histological appearance
Well-circumscribed light grey cystic mass
Pathology of the Salivary Glands: Warthin’s Tumour - Micro histological appearance
Bilayered oncocytic epithelium with lymphoid stroma
Pathology of the Salivary Glands: Most common malignant tumour in the world
Mucoepidermoid Carcinoma
Pathology of the Salivary Glands: Most common malignant tumour in the UK
Adenoid Cystic Carcinoma
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Location
Mainly the parotid gland
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Genetic associations
MECT1-MAML2 Fusion
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Macro histological appearance
Well-circumscribed or infiltrative mass
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Micro histological appearance
Mix of squamous, mucous and intermediate cells with solid and cystic components
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Common age
> 40 years old
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Location in salivary gland and most common location
Parotid
Most common - Palate
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Complications
Perineural invasion causing pain and loss of function
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Macro Histological Appearance
Grey or white infiltrative mass
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Micro Histological Appearance
Small uniform cells with little cytoplasm in solid, tubular or cribiform patterns
Facial Plastic Surgery: Otoplasty
Pinning back of the ears
Facial Plastic Surgery: Otoplasty - Assessment Protocol (3)
1cm from the most superior point of the pinna to the mastoid
2cm from the top of the trague (Frankfort) posterior part of the pinna to the mastoid
30 degrees to the mastoid and helix
Facial Plastic Surgery: Otoplasty - 3 common problems of the ears
Under-developed anti-helical fold
Prominent concha
Protruding lobe
Facial Plastic Surgery: Otoplasty - Mustarde Suturing or Anterior Scoring Method
Open the back of the ear uo and mattress sutures to reform the anti-helical fold
Facial Plastic Surgery: Ageing - What happens to the skin melanocytes with age?
Melanocytes decrease
Facial Plastic Surgery: Ageing - Impact on the dermo-epidermal junction
Flattens by 1/3
Facial Plastic Surgery: Ageing - Impact on collagen
Decreased
Facial Plastic Surgery: Ageing - Impact on elastin
Decreased turnover
Facial Plastic Surgery: Ageing - Impact on subcutaneous fat
Decreased
Facial Plastic Surgery: Ageing - Changes in fat distribution with age
Decreased - Face, Hands, Feet
Increased - Thighs, Waist and Abdomen
Facial Plastic Surgery: Belphroplasty
Removal of excess skin from the eyelids
Facial Plastic Surgery: Ageing Eyelids - Why do people develop deepening creases in the lower lids?
Accumulation of loose skin
Facial Plastic Surgery: Ageing Eyelids - Why does bagginess appear?
Slackening of the muscle beneath the skin allows the fat to cushion the eyes in their sockets to protrude forward
Facial Plastic Surgery: Blephroplasty - Process
Incision into the creases of the upper lids and just below the lashes to remove extra fat, excess skin and sagging muscles
Facial Plastic Surgery: Reconstruction - Primary closure healing
Wound edges are approximated by sutures, staples or glue
Facial Plastic Surgery: Reconstruction - Skin Grafts
Transplantation of the skin covers a large surface area
Facial Plastic Surgery: Reconstruction - Skin Grafts Two Types
Donor section - thin layer of skin from a healthy part of the body
Full thickness skin graft - pinching and cutting skin away from the donor section
Facial Plastic Surgery: Reconstruction - Skin Flaps
Healthy skin and tissue that is partly detached and move to a nearby wound
Airway Obstruction: Neonatal Respiratory System - Obligate … breather
Nasal
Airway Obstruction: Neonatal Respiratory System - Nares are …
Small
Airway Obstruction: Neonatal Respiratory System - Difference with larynx
Small and soft
Airway Obstruction: Neonatal Respiratory System - Difference in tongue
Large tongue
Airway Obstruction: Neonatal Respiratory System - Sub-glottis
Narrow - 3.5mm at the cricoid
Bernoulli Principel OR Venturi Effect
Pressure on the internal wall of the airways occurs due to flow of air
Stridor
High pitched harsh noise due to turbulent airflow resulting from airway obstructions
Stertor
Low pitched sonourous sound arising from the nasopharyngeal airway
Adenotonsillar Hypertrophy: Clinical sign
Breathes with mouth open due to nose blockage
Acute Epiglottitis: Mainly due to what?
Haemophilus Influenza Type B
Acute Epiglottitis: Management
Intubated with resuscitation to secure the airway (24-48 hours) until the inflammation is reduced
Respiratory Papillomatosis: Associated with what?
HPV
Subglottic Stenosis: Management
Division of the stenosis with laser and balloon OR laryngotracheal resection and reconstruction
Subglottic Stenosis: Associated with what condition?
Vasculitis
Subglottic Stenosis: Clinical Presentation
Progressive SOB that is exacerbated by exertion
Burns: How to secure the airway?
Endotracheal intubation or tracheostomy
Airway Endoscopy: General Anaesthetic
Anaesthetic Sevoflurane Gas OR IV Propofol or Remifentanyl
Airway Endoscopy: Pharmacotherapy Anaesthesia (4)
Heliox - 79% Helium + 21% Oxygen
Nebulised Budesonide - 2mg
Dexamethasone - 0.15-0.6 mg/kg
Nebulised Adrenaline
Hearing: Sound Definition
Pressure wave caused by oscillating molecules that are set in motion by vibration
Hearing: Humans can perceive what frequencies?
20-20,000 Hz
The Ear: Tympanic Membrane:Oval Window Ratio
18:1
What is the functional unit of the ear?
Hair cells
The Organ of Corti: Depolarisation of the Organ of Corti has what following pathway?
Stimulates the CN VIII to the Superior Temporal Gyrus Pathways
Oval and Round Windows: High frequency hair cells located where?
At the base
Oval and Round Windows: Low frequency hair cells located where?
At the apex of the curve
Eustachian Tube: Cartilaginous tube opened when?
By the tensor veli palatini and levator palatine muscles to allow air into the middle ear to return to atmospheric pressure
Eustachian Tube: Dysfunction leads to what?
Negative middle ear pressure - progresses to fluid or effusion within the ear
Hearing: Neural Pathway (4 pathways)
- CN VIII
- Cochlear nucleus
- Up the brainstem
- Into the cerebrum - primary auditory complex in the Posterior Superior Temporal Gyrus and Brodman Areas
Hearing: When can the foetus hear?
18 weeks
Hearing: When will the foetus respond to sound or voice?
26 weeks
Balance: Central Pathways - Inputs (4)
Visual
Proprioceptive
Cardiovascular System
Vestibular System
Balance: Central Pathways - Output (2)
Vestibulospinal Tract
Vestibulo-ocular Reflex
Balance: The Inner Ear - Locations of the Superior Vestibulocochlear Nerve (3)
Lateral Semicircular Canal
Anterior Superior Semicircular Canal
Utricle
Balance: The Inner Ear - Locations of the Inferior Vestibulocochlear Nerve (2)
Posterior Semicircular Canal
Saccule
Balance: The Inner Ear - Longest hair cell
Kinocilium
Balance: The Inner Ear - The name for hair cells that are not the Kinocilium
Sterocilia
Balance: The Inner Ear - Deflection towards the hair cells has what impact on action potential?
Increased potential firing rate
Balance: The Inner Ear - Deflection away from the hair cells has what impact on action potential?
Decreased potential firing rate
Balance: The Inner Ear - Two Otolith Organs
Utricle
Saccule
Balance: The Inner Ear - What overlies the hair cells?
Calcium carbonate crystals within a gel membrane
Balance: Semi-Circular Canals - What are the three pairs?
Left and Right Horizontals
Left Posterior and Right Anterior
Left Anterior and Right Posterior
Balance: Vestibulo-Ocular Reflex - Stereocilia Deflection is due to what?
Movement of perilymph
Balance: Vestibulo-Ocular Reflex - Balance is due to the relative process of what?
Relative pushing of the christa caused by the immobility of the perilymph
Balance: Vestibulo-Ocular Reflex - Input
Vestibular input
Balance: Vestibulo-Ocular Reflex - Output
Vestibulo-ocular output
Balance: Vestibulo-Ocular Reflex - Inhibits which side?
Opposite side to movement
Balance: Central Pathways - Vestibulospinal Tract Function
Motor output to the neck, back and leg muscles to ensure posture is maintained
Balance: Central Pathways - Medial Longitudinal Fasciculus and Ocular Muscles Function
Motor output to the eyes gaze stabilisation
Balance: Central Pathways - Medial Lemniscus and Thalamus function
Cerebrum awareness
Taste: Taste Bud - Components
Sensory receptor cells
Support cells
Taste: Taste Bud - Cell life span
10 days
Taste: Taste Bud - Replenished by what?
Basal cells within the Taste Buds
Taste: Taste Bud - Taste receptor cells synapse with what?
Afferent nerve fibres
Taste: Taste Bud - Present mainly where? (4)
Tongue
Palate
Epiglottis
Pharynx
Where do most taste buds sit in the tongue?
Papillae
Taste: Papillae - 4 types
Filliform
Fungiform
Vallate
Folliate
Taste: Papillae - Which type of papillae does not contain taste buds?
Filliform
Taste: Pathway - Binding of tastants to receptor cells has what impact?
Induces a depolarising receptor potential that initiates action potentials in afferent nerve fibres to synapse with receptor cells
Taste: Pathway - Signals from receptor cells are conveyed to where?
Brainstem and Thalamus to eventually reach the Cortical Gustatory Areas
Taste: Pathway - Afferent Taste Fibres reach the brainstem via what three Cranial Nerves?
CN VII - Chorda Tympani Branch of the Facial Nerve
CN IX - Glossopharyngeal Nerve
CN X - Vagus Nerve
Ageusia
Loss of taste function
Hypogeusia
Reduced taste function
Dysgeusia
Distorted taste function
Olfaction: Neural Systems - 4 systems
CN I
CN V
Vomernasal
CN 0
Olfaction: Neural Systems - Main Olfactory System nerve and function
CN I - mediates common odours
Olfaction: Neural Systems - Trigeminal Somatosensory System nerve and function
CN V - chemical and non-chemical sensor with a protective effect of sniffing something harmful
Olfaction: Neural Systems - Accessory Olfactory System Nerve
Vomernasal
Olfaction: Neural Systems - CN 0
Nervus Terminalis
Olfaction: Smell - Olfactory neuroepithelium is located where?
Small region of the nasal mucosa
Olfaction: Smell - Olfactory Cleft consists of what?
Cribiform plate and small parts of the superior and middle turbinate of the septum
Olfaction: Smell - Olfactory Cleft located where?
7cm into the nasal cavity from the nostril
Olfaction: Smell - How is flavour produced from swallowed food?
Retrograde airflow from the nasopharynx during swallowing
Olfaction: Pathway - Physiology during quiet breathing
Odorants reach smell receptors via diffusion as the olfactory neuroepithelium is located above the normal path of airflow
Olfaction: Pathway - Sniffing Process
Drawing air currents upwards within the nasal cavity with force
Olfaction: Pathway - Before neural conduction can occur from the olfactory cleft the brain odourant must do what? (3)
Enter the nose during active or passive processes
Passes to the olfactory cleft
Odourant must move from the air phase to the aqueous phase
Olfaction: Pathway - Role of mucous
Aids the dispersion of odourants to the olfactory receptors and from the mucous to receptors via diffusion or specialised proteins
Olfaction: Pathway - Olfactory neuroepithelium histology
Pseudostratified Columnar Epithelium
Olfaction: Pathway - Function of Bi-polar Sensory Neurones
Extends odourant receptor-containing cilia into the mucous
Olfaction: Pathway - Supporting Cell function
Insulates and protects olfactory neuroepithelium
Olfaction: Pathway - Duct Cell of Bowmans Glands function
Secretes mucous
Olfaction: Olfactory Receptors - Life span
2 months
Olfaction: Olfactory Receptors - Axons of the olfactory receptors go where?
Afferent fibres of the olfactory nerve
Olfaction: Olfactory Receptors - Chemical signals converted to what?
Neural Signals - Glutamate and Dopamine
Anosmia
Inability to smell
Hyposmia
Reduced ability to smell
Dysosmia
Altered sense of smell
Phantosmia
Olfactory hallucination - smell perceived in the absence of stimulation
Olfaction: Conductive Smell Abnormalities Aetiologies (3)
Nasal polyps
Rhinitis
Nasal masses
Olfaction: Sensorineural Smell Abnormalities Aetiologies (5)
Viral
Head Trauma
Neurological Conditions - Parkinsons or Alzheimers
Brain tumours
Medication
Signs of Ear Disease: How to know if it is upper motor damage inducing facial weakness?
Forehead will still move
Signs of Ear Disease: How to know if it is lower motor damage inducing facial weakness?
Whole face moves
Dizziness
Non-specific term covering vertigo, pre-syncope and disequilbrium
Vertigo
Sensation of movement - normally movement
Dizziness: Aetiologies within the Visual System? (2)
Cataracts
Diabetes Mellitus
Dizziness: Aetiologies within Proprioceptive System (3)
Diabetes Mellitus
Arthritis
Neurology
Dizziness: Aetiologies within Central Pathways (3)
Stress
Migraine
Multiple Sclerosis
Dizziness: Aetiologies within Cardiovascular Pathways (2)
Arrhythrmias
Postural Hypotension
Dizziness: Aetiologies within Vestibular System (3)
BPPV
Menieres
Vestibular Neuronitis
Benign Positional Paroxysmal Vertigo: Most common cause of what?
Vertigo on looking upwards
Benign Positional Paroxysmal Vertigo: Aetiologies (2)
Head trauma
Ear Surgery
Benign Positional Paroxysmal Vertigo: Pathophysiology
Otoconia from the utricle is displaced within the semicircular canals
Benign Positional Paroxysmal Vertigo: Most commonly in what canal
Posterior Semicircular Canal
Benign Positional Paroxysmal Vertigo: Clinical Presentation
Vertigo on:
- Looking up
- Turning in bed
- First lying down
- First getting out of bed
- Bending forward
- Rising from bending
- Moving the head quickly
Benign Positional Paroxysmal Vertigo: Diagnostic Test
Dix Hallpike Test - patient is sat on the bed and moves into lying down with the head turned 45 degrees to the impacted side
Benign Positional Paroxysmal Vertigo: Dix Hallpike Test Positive Result
Torsional and Upbeating Nystagmus
Benign Positional Paroxysmal Vertigo: Management - Options (3)
Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercise
Benign Positional Paroxysmal Vertigo: Management - Epley Manoeuvre
Sat on the bed with the head turned to 45 degrees to the affected side and quickly lie back
Wait 30 seconds
Turn your head 90 degrees to the other side
Wait 30 seconds
Turn your head another 90 degrees to the normal side
Wait 30 seconds
Sit up on opposite side to impacted side
Benign Positional Paroxysmal Vertigo: Management - Brandt Daroff Exercise Mechanism
Repositions the otoconia
Vestibular Neuronitis
Inflammation of the vestibular nerve
Labyrinthitis
Inflammation of the labyrinth
Vestibular Neuronitis or Labyrinthitis: Viral causes
Viral is most likely
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - First severe attack
Lasts hours with nausea and vomiting
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation (4)
Prolonged vertigo - for days
Malaise
Headache
Nausea and Vomiting
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Labyrinthitis is associated with what? (2)
Tinnitus
Hearing loss
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Management
Supportive management with vestibular sedatives
Menieres Disease
Idiopathic disorder causing vertigo
Menieres Disease: Pathophysiology
Excess endolymph within the membranous labyrinth
Menieres Disease: Symptoms present why?
Increase endolymphatic pressure due to dysfunctional sodium channels
Menieres Disease: Clinical Presentation - Triad
Severe Paroxysmal Vertigo
Sensorineural hearing loss
Tinnitus
Menieres Disease: Clinical Presentation - Vertigo
Recurrent spontaneous rotational vertigo with at least 2 episodes lasting >20 minutes
Menieres Disease: Clinical Presentation - Ear symptoms (2)
Change in hearing or tinnitus around the time of dizzy spell
Sensation of ear being full
Menieres Disease: Lifestyle Advice
Reduce salt
Avoid chocolate and caffeine
Avoid stress
Dizziness: Timing - Most likely if Seconds
BPPV
Dizziness: Timing - Most likely if Hours
Menieres
Dizziness: Timing - Most likely if Days
Vestibular Neuronitis
Dizziness: Timing - Most likely if variable timing
Migraine-associated Vertigo
Dizziness: Most likely if associated with rolling over in bed
BPPV
Dizziness: Most likely if associated with Nausea and Vomiting
Vestibular Neuritis
Dizziness: Most likely if associated with light sensitivity during dizzy spells
Vestibular migraine
Dizziness: Most likely if ear feels full or changes in hearing present
Menieres Disease
Hearing Aid
Sound amplifier
Hearing Aids: Mechanism of action
Passes from the microphone through an electronic processer to amplify the sound and pass them to the receiver
Hearing Aids: Types of fitting (3)
Behind the ear
In the ear
In the canal
Hearing Aids: 4 parts of the hearing aid
Body
Elbow
Tubing
Ear mould
Hearing Aids: Open Fitting Hearing Aid - Benefit
Do not occlude the ear canal completely to allow natural sound
Hearing Aids: Indication
Patients with any auditory difficulty with demonstrable hearing loss
Hearing Aids: Open Fitting Hearing Aid - Concern with cochlear or retro-cochlear hearing loss
Sound can become distorted
Hearing Aids: Telecoil - Function
Telecoil induction loop systems have telephone receivers that are fitted in public locations
Hearing Aids: Telecoil - Mechanism of Action
Sound causes distortion in a magnetic field that is picked up by the hearing aid and converted back into sound
Hearing Aids: Telecoil - Problem
Hearing aid microphone is switched off so cannot hear anything else
Hearing Aids: Problems (3)
No or Insufficient Sound
Excessive amplification of sound
Pain or discomfort
Hearing Aids: Causes of pain or discomfort (3)
Ear mould poorly inserted or fitted
Allergy to the ear mould material
Otitis externa secondary to occlusion of the ear canal
Hearing Aids: Problems - Feedback definition
Whistling noise caused by amplified sound being picked up by the microphone
Hearing Aids: Problems - Feedback may be caused by what? (4)
Wax in the external acoustic meatus
Earmould not inserted correctly
Misfitting earmould
Leakage of sound through a hole in the tubing or elbow
Hearing Aids: Problems - Why may patients be unable to wear conventional hearing aids?
Recurrent discharge
Absence of stenosis of the ear canal
Hearing Aids: Problems - What can be used for patients that cannot use conventional hearing aids?
Bone anchored hearing aids
Hearing Aids: Bone Anchored Hearing Aids - How are they fitted?
Pure titanium screw is placed in the skull and a metal abutment screws into this and passes through the skin - the hearing aid is attached to the abutment to give amplification without occluding the ear canal or requiring air conduction to the cochlea
Hearing Aids: Vibrant Soundbridge - Mechanism
Works by direct stimulation of the ossicles and round window - converts sound into electrical signals which are transmitted around the skin to the implant via induction
Hearing Aids: Vibrant Soundbridge - Indications (2)
Unable to wear conventional hearing airs
Do not wish to wear a device in their ear
Hearing Aids: Vibrant Soundbridge - Disadvantages (2)
Risk of middle ear and mastoid surgery
Risks of anaesthesia
Hearing Aids: Cochlear Implants - Mechanism of action
Electrical stimulation of neural structures in the cochlea and is transmitted to the brain where it is perceived as sound
Hearing Aids: Cochlear Implants - Indicated when?
Severe to profound sensorineural hearing loss when conventional hearing aids do not benefit the patient
Ear Drops: Applications
Anti-inflammatory
Antibiotics
Wax solvents
Bacterial Infection: Most common pathogenic bacteria in Otitis externa (3)
Pseudomonas aeruginosa
Proteus species
Staphylococcus aureus
Ear Drops: Options for bacterial infections (4)
Neomycin
Gentamicin
Polymyxin B
Framycetin - used in Otitis Externa with a steroid
Common fungal causes of Otitis Media (2)
Aspergillus niger
Candida albicans
Ear Drops: Options for fungal Otitis Externa (2)
Clotrimazole
Nystatin
Ear Drops: Wax Solvents - Options (3)
Sodium Bicarbonate
Olive Oil
Almond Oil
Ear Drops: Application method
Turn the recipients ear upwards
Straighten the ear canal by pulling the pinna upwards and backwards in an adult or directly upwards in a child
Instil the drops
Press the tragus repeatedly over the introitus of. theear canal to encourage passage down the canal
Ear Drops: Disadvantage of Gentamicin
Ototoxic
Ear Drops: Side Effects (2)
Dizziness
Ototoxic
Ear Drops: Side Effects - When may dizziness occur?
When the temperature of the drops is not close to the ear - Lateral Semi-circular canal is stimulated by temperature difference in the Caloric Effect
Ear Drops: Side Effects - What increases the risk of Ototoxicity?
Use of aminoglycoside
Pure Tone Audiometry
Painless non-invasive hearing test that measures a persons ability to process different sounds, pitches or frequencies
Pure Tone Audiometry: Aim
Find the hearing threshold - the quietest sound that an individual can hear across a range of different frequencies
Pure Tone Audiometry: Pure Tone
Single specific frequency determined by frequency, amplitude, phase and duration
Pure Tone Audiometry: When are Warble Tones used?
In patients with Tinnitus or children <5 years old
Pure Tone Audiometry: Audiometers - Calibrated to what?
Measure air conduction thresholds between 125-8000 Hz and bone conduction thresholds between 250-6000 Hz
Measure air conduction thresholds of 120dB and bone conduction of 70dB maximum
Pure Tone Audiometry: Audiometers - What happens if set to 70dB for conduction?
Produce distortions
Pure Tone Audiometry: Audiometers - 3 main transducers that are used to present tones (3)
Headphones
Insert headphones
Bone conductor
Pure Tone Audiometry: Audiometers - Air conduction thresholds assessed by what? (2)
Headphones or Insert Earphones
Assess the entire auditory pathway
Pure Tone Audiometry: Audiometers - Bone conduction thresholds assessed by what?
Bone conductor
Pure Tone Audiometry: Masking - Function
Ensures a true threshold of the worse ear is gained by preventing the working ear from picking up any tone
Pure Tone Audiometry: Masking - 3 rules
1 - Masking is required at any frequency where the difference between the left and right not masked AC thresholds is >40 dB when using headphones or 55 dB when using insert earphones
2 - Masking is required at any frequency where the not masked BC threshold is better than the AC threshold of either ear by >10 dB - the worse ear would be the test ear and better ear would be the non-test ear and BC cannot be below the AC threshold
3 - Masking will be required where rule 1 hasn’t been applied but where BC threshold of one ear is more acute by 40 dB or 55 dB than not masked AC threshold attributed to the other ear
Pure Tone Audiometry: Masking - Consequences of not masking (5)
Inaccurate measure of threshold
Incorrect diagnosis
May lead to inappropriate treatment options
Difficulty in later interpretation of test results
Pure Tone Audiometry: Audiogram - Symbol for right ear
Circle
Pure Tone Audiometry: Audiogram - Symbol for left ear
Cross
Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the right ear
Triangle
Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the left ear
Square
Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the right ear
<
Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the left ear
>
Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the right ear
[
Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the left ear
]
Pure Tone Audiometry: Audiogram - Symbol for no response
Arrow down
Pure Tone Audiometry: Audiogram - Normal hearing in dB
20 to -10 dB
Pure Tone Audiometry: Audiogram - Pitch relationship with Frequency
Low pitch has a lower Hz frequency
High pitch has a higher Hz frequency
Pure Tone Audiometry: Audiogram - Loudness relationship with dB
Loud has higher dB
Pure Tone Audiometry: Audiogram - Mild Hearing Loss Threshold
20-40 dB
Pure Tone Audiometry: Audiogram - Moderate Hearing Loss Threshold
41-70 dB
Pure Tone Audiometry: Audiogram - Severe Hearing Loss Threshold
71-95 dB
Pure Tone Audiometry: Audiogram - Profound hearing loss Threshold
> 95 dB
Pure Tone Audiometry: Audiogram - For sensorineural hearing loss
No significant air-bone gap on audiogram - trend decreases with increased frequency
Pure Tone Audiometry: Audiogram - For conductive hearing loss
Significant air-bone gap - the bone conduction is within normal limits
Pure Tone Audiometry: Audiogram - For Mixed Hearing Loss
Parts of significant air-bone gap and others that bone conduction suggest a sensorineural hearing loss
Sensorineural Hearing Loss: Pathophysiology
Damage to the hair cells within the cochlear or hearing nerve, or both
Presbycusis
Age-related hearing loss
Sensorineural Hearing Loss: Aetiologies (5)
Regular and prolonged exposure to loud sounds
Ototoxic drugs
Rubella - and other infections
Complications at birth
Benign tumours on the auditory nerve
Conductive Hearing Loss: Pathophysiology
Sound not being able to pass freely into the inner ear usually due to an abnormality in the outer and middle ear
Conductive Hearing Loss: Aetiologies (3)
Ear infections
Middle ear fluid - Glue ear
Perforated ear drums
Mixed Hearing Loss: Pathophysiology
Combination due. todamage in both the outer or middle ear and the inner ear
Mixed Hearing Loss: What disease may cause mixed hearing loss?
Otosclerosis
Mixed Hearing Loss: Characteristic feature of Otosclerosis
Carharts Notch at 2 kHz
Tympanometry: Objective test of what?
Middle ear function - tests the condition of the middle ear, mobility of the ear drum and conduction of the ossicular chain
Tympanometry: Enables a distinction between what?
Sensorineural and conductive hearing loss
Tympanometry: Important in the diagnosis of what?
Otitis media