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HNN > Session 7 > Flashcards

Session 7 Flashcards

1
Q

Symptoms and signs of ear disease

A

Otalgia (ear pain)
Discharge
Hearing loss
Tinnitus
Vertigo
Facial nerve palsy

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2
Q

What makes up the external ear

A
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3
Q

What makes up middle ear

A
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4
Q

What makes up inner ear

A
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5
Q

Which nerves carry general sensation from ear and why is this important

A

Cervical spinal nerves C2/C3
vagus
Trigeminal (Auriculotemporal)
Glossopharyngeal (tyrannical nerve)
Small contribution from facial nerve

Implications for referred pain

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6
Q

The medial surface of the tympanic membrane and middle ear cavity is supplies by the

A

Glossopharyngeal nerve CN 8

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7
Q

Otalgia with a normal ear examination should lead you to suspect an

A

Alternative site of pathology

Non-otological:
TMJ dysfunction (CN Vc)
Diseases of oropharynx (CN IX)
Disease of larynx and pharynx including cancers (Cn IX and CN X)

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8
Q

How long is external auditory meatus in adults

A

2.5cm

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9
Q

What does the external auditory meatus do

A

Collects, transmits and focuses sound waves onto the tympanic membrane

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10
Q

Types of pinna (auricle) abnormalities

A

Congenital
Inflammatory
Infective
Traumatic

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11
Q

Examples of pinna abnormality

A

Facial palsy and red painful ear with vesicles = Ramsay hunt syndrome

Perichondritis = perichondrium infected e.g. piercing or insect bite

pinna haematoma (from injury)

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12
Q

What is pinna haematoma

A

Accumulation of blood between cartilage and it’s overlying perichondrium from blunt injury

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13
Q

Why does pinna haematoma occur

A

Common in contact sports

Subperichondrial haematoma deprives cartilage of blood supply = pressure necrosis of tissue

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14
Q

how do you treat pinna haematoma

A

Drainage and prevent re-accumulation of blood

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15
Q

What happens in untreated pinna haematoma

A

Fibrosis, new asymmetrical cartilage development, cauliflower deformity

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16
Q

External acoustic meatus embryology

A

Arises from cleft between 1st and 2nd pharyngeal arch which is lined with ectoderm (future skin)

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17
Q

Features of external acoustic meatus

A

Lined with keratinising, stratified squamous epithelium

Cartilaginous outer 1/3, bony inner 2/3

Sigmoid shape

Hair, sebaceous and ceruminous glands line cartilage (barrier to foreign objects), bone parts lack these

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18
Q

What are ceruminous glands

A

Produce ear wax

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19
Q

Explain the external acoustic meatus self-cleaning function

A

Desquamation and skin migration laterally off tympanic membrane out of canal- epithelial migration

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20
Q

What is otitis externa

A

INFLAMMATION
Discomfort, pain, itchiness, pain on moving Tragus or pinna

Can be discharge/temporary hearing loss

Could be caused due to malignant otitis externa

Could be swimmers ear due to moisture

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21
Q

Features of malignant otitis externa

A

Rare, serious, can be life threatening, immunocompromised people e.g. diabetes more at risk

Bacteria becomes invasive and erodes through bone

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22
Q

What is this

A

Bulging secondary to bacterial acute otitis media

(Can be viral), build up of pus and exudate

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23
Q

What is this

A

Otitis media with effusion

Underlying cause is not infection

Retracted and evidence of fluid within middle ear cavity

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24
Q

What is this

A

Cholesteatoma

  • Retraction of pars flaccida (TM) forms sac/pocket
  • Traps stratified squamous epithelium and keratin
  • Forming cholesteatoma
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25
Q

Features of cholesteatoma

A

Usually secondary to chronic Eustachian tube dysfunction

Negative pressures pull the pocket into the middle ear

Painless, often smelly otorrhea (ear discharge) plus or minus hearing loss

Not malignant but slowly grows and expands

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26
Q

When can there be more serious consequences to cholesteatoma

A

Due to enzymatic bony destruction, erosion of ossicles, mastoid/petrous bone, cochlea

Can erode into brain

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27
Q

Why is the ear drum sucked in during cholesteatoma

A

Due to negative pressure caused by blockage of Eustachian tube

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28
Q

What is the middle ear

A

Air filled cavity between tympanic membrane and inner ear containing ossicles

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29
Q

Ossicles are connected via

A

Synovial joints

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30
Q

What do ossicles do

A

Amplify and relay vibrations from the TM to the oval window of the cochlea (inner ear)

Transmitting vibration to waves in a fluid medium

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31
Q

What are the ossicles

A

Malleus, Incus, Stapes

32
Q

Ossicle movement is tampered by

A

2 muscles
Tensor tympani and stapedius

Contract if excessive vibration due to loud noise (protective- acoustic reflex)

33
Q

which is Otosclerosis

A
  • One of the most common causes of acquired hearing loss in young adults
  • genetic and environmental causes
  • Ossicles fused at articulations due to abnormal bone growth (often between base plate of stapes and oval window)
  • Sound vibrations can’t be transmitted effectively to cochlea
  • Present with gradual unilateral or bilateral conductive hearing loss
34
Q

What happens in the middle ear

A

Pharyngotympanic tube equilibrates pressure of middle ear with atmospheric pressure

Mucous membrane continuously reabsorbs air causing negative pressure

Allows for ventilation and drainage of mucus

35
Q

What is otitis media with effusion

A

glue ear- not an infection

Due to Eustachian tube dysfunction, fluid and negative pressure in middle ear decreases mobility of TM and ossicles

Most resolve spontaneously within 2-3 months

36
Q

When and how do you treat glue ear

A

Otitis media with effusion

May persist and impede speech and language development or school performance

Require grommets (tympanostomy tube)
Act to maintain equilibration of pressures

37
Q

Features of acute otitis media

A

Acute middle ear infection

Otalgia, temperature, red/bulging TM

Viral mostly

Occasionally bacterial causes- streptococcus pneumoniae, haemophilias influenzae

38
Q

Why do children get more acute otitis media

A

Pharyngotympanic tube is shorter and more horizontal

Adenoids or pharyngeal obstruction to Eustachian tube - compromising ventilation and drainage

Easier passage for infection from nasopharyx to middle ear

39
Q

Complications of acute otitis media

A

Tympanic membrane perforation
Facial nerve involvement
Mastoiditis
Intracranial complications

40
Q

Why can facial nerve involvement occur in acute otitis media

A

Close relationship to middle ear cavity via facial canal

Two intrapetrous branches run through middle ear cavity (chorda tympani, nerve to stapedius)

41
Q

Examples of intracranial complications in acute otitis media

A

Meningitis
Sigmoid sinus thrombosis
Brain abscess

42
Q

What is mastoiditis

A

Middle ear cavity communicates via mastoid antrum with mastoid air cells

Middle ear infections spread into mastoid bone/mastoid air cells

Needs IV antibiotics or surgery

43
Q

What is the role of the inner ear

A

Vestibular apparatus and cochlea: fluid filled tubes

Involved in hearing and position-sense/balance

44
Q

How does the cochlea work

A

Fluid filled tube with specialised hair cells that generate action potentials when moved

Movements at oval window—> movement of cochlear duct fluid —> movement of stereocilia —> generate AP via CN 8 —> brain

45
Q

How do we hear

A
  1. Auricle and external auditory canal focuses and funnels sound waves towards tympanic membrane which vibrates
  2. Vibration of ossicles (stapes at oval window) sets up vibrations in cochlear fluid
  3. Sensed by stereocilia in cochlear duct (spiral organ of Corti)
  4. Movement of stereocilia in organ of Corti triggers AP in cochlear part of CN 8
  5. Primary auditory cortex makes sense of input
46
Q

How does vestibular apparatus work

A

Fluid filled tubes with specialised hair cells that generate AP when moved

Includes semicircular ducts, saccule and utricle (also contain stereocilia)

Moving position or rotation of head moves fluid —> bends stereocilia —> AP generated via CN 8 —> brain

47
Q

What are the different semicircular canals called

A
48
Q

What is Presbycusis

A
  • Affects cochlea
  • Sensorineural hearing loss associated with old age
  • Bilateral and gradual
  • Hearing aids needed
49
Q

What is Benign Paroxysmal Positional Vertigo (BPPV)

A
  • Vertigo only
  • Due to vestibular apparatus
  • Short lived episodes (seconds) triggered by movement of head
  • Crystals in tube of vestibular apparatus
  • Dix-Hallpike and Epley manouvres
50
Q

What is Ménière’s disease

A
  • vertigo, hearing loss and tinnitus (typically unilateral)
  • May also describe aural fullness, Nausea and vomiting
  • 30 mins to 24 hours
  • Recovery in between episodes
  • Hearing may deteriorate over time
  • Problems with too much fluid in cochlear duct
51
Q

What is acute Labrynthitis

A

History of URTI
Involvement of all inner ear structures
Hearing loss/tinnitus, vomiting and vertigo

52
Q

What is acute vestibular Neuronitis

A

usually no hearing disturbances or tinnitus
Sudden onset of vomiting and severe vertigo (lasting days)

53
Q

Sequence of events when a patient presents with hearing loss

A
54
Q

Causes of conductive hearing loss

A
55
Q

Causes of sensorineural hearing loss

A
56
Q

4 components of temporal bone

A

It has 4 components; a squamous part, petromastoid part, tympanic plate and styloid process

57
Q

The petrous part of the temporal part contains the

A

Middle and inner ear

58
Q

the upper surface of the temporal bone forms part of the

A

Floor of the middle and posterior cranial fossae

59
Q

What is found on the surface of the petrous bone

A

Internal acoustic meatus- small opening that transmits the CN VII and CN VIII

Facial nerve and vestibulocochlear

60
Q

the internal and external acoustic meatus are not

A

One continuous bony channel

61
Q

The inferior surface of the petrous bone contains

A

The opening of the carotid canal, through which the internal carotid artery travels,

Downward bony projection called the styloid process

62
Q

What attaches to the mastoid process

A

SCM and posterior belly of disgatric

63
Q

What is within the mastoid process

A

Mastoid air cells- air filled spaces

Communication between mastoid air cells and middle ear cavity via mastoid antrum

64
Q

Middle ear is lined with

A

Pseudostratified columnar epithelium

65
Q

General sensation from within the middle ear and inner surface of tympanic membrane is carried via the

A

Glossopharyngeal nerve (tympanic nerve)

66
Q

Why do ears pop

A

Pharyngotympanic tube is usually closed, being intermittently opened by the pull of attached palate muscles when swallowing or yawning

67
Q

The middle ear communicates with the mastoid air cells via the

A

Mastoid aditus and antrum

68
Q

What is otosclerosis

A

A disease affecting the ossicles causing mature bone to be replaced with woven bone

Footplate of stapes becomes fused to the oval window of the cochlea

Vibrations cannot be transmitted to the inner ear, leading to hearing loss

69
Q

Where does the chorda tympani run

A

Branch of facial nerve

Runs across middle ear cavity over inner surface of tympanic membrane

Carries taste from anterior 2/3 tongue

70
Q

What does nerve to stapedius do

A

Branch of facial nerve which innervates a small muscle called stapedius- dampening XS vibration of the stapes footplate at the oval window (especially in response to loud noises)

71
Q

The inner ear is also known as the

A

Labyrinth

72
Q

The middle ear consists of

A

Semicircular canal, utricle, saccule and cochlea

73
Q

What is tympanosclerosis

A

White plaques present on tympanic membrane

74
Q

What is important about pars flaccida

A

Also referred to as the attic

Common site for cholesteatoma

75
Q

Normal Rinne’s test and Weber’s test

A

Air conduction greater than bone conduction

76
Q

Conductive hearing loss findings

A
77
Q

Sensorineural hearing loss findings

A

HNN (19 decks)

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