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Clinical Anatomy > The Ear > Flashcards

The Ear Flashcards

1
Q

What can cause trauma to the external ear, and what are some possible manifestations?

A

Sport related injuries, result of violence involving a blow to the ear.
Lacerations, bites, pinna haematomas

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2
Q

What can untreated pinna haematoma lead to?

A

Disruption of blood supply to the cartilage, avascular necrosis of cartilage. Risk of associated deformity - Cauliflower ear.
Needs urgent drainage and pressure dressing application to prevent re-accumulation of blood.

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3
Q

Causes, symptoms and treatment of tympanic membrane perforation

A

Direct or indirect trauma, otitis media
Pain, discharge from ear, possible conductive hearing loss
Most heal by themselves, if does not heal in 6 month: surgical intervention = myringoplasty

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4
Q

What is a Haemotympanum and how is it be treated?

A

Blood in the middle ear
Caused by trauma, associated with temporal bone fracture
Can be seen through tympanic membrane, possible conductive hearing loss
Should settle with time, follow up patients to ensure no residual hearing loss from damage to the ossicles

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5
Q

Causes and symptoms of otitis externa

A

Inflammation of the skin lining external canal due to bacterial or fungal infection.
Painful discharging ear, history of an itchy ear, hearing may be muffled from the discharge present

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6
Q

What is malignant otitis externa?

A

Aggressive external ear infection, seen in diabetics or immune compromised patients. Infection spreads from soft tissue into the bone.
Presents with chronic ear discharge, severe ear pain, possible cranial nerve palsies (CNVII)
Mortality rate 10%

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7
Q

Management of otitis externa

A

Topical ear drops empirically eg. Gentamicin
Micro suction of pus/debris
In severe infection use wick to hold canal open
Malignant otitis externa needs IV antibiotics

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8
Q

What epithelium lines the middle ear?

A

Respiratory epithelium - Pseudostratified columnar

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9
Q

Why is acute otitis media more common in children?

A

Shorter, narrower Eustachian tube

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10
Q

Common pathogens of AOM

A

Streptococcus pneumoniae
Haemophilus Influenzae
Moraxella species

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11
Q

Symptoms of AOM

A

Ear pain due to increased pressure in tympanic cavity
Discharge due to rupture of membrane - causes pain to settle
Fever

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12
Q

Management of AOM

A

Conservative - pain relief
Medical - in severe cases give oral antibiotics
Surgery - recurrent AOM may be helped by grommet insertion

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13
Q

What distinguishes active COM from inactive COM?

A

Active - ear is discharging, associated with conductive hearing loss
Inactive - not discharging

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14
Q

How is chronic otitis media classified?

A

Active/inactive

Mucosal/squamous

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15
Q

What is cholesteatoma?

A

Active squamous disease, build up of keratinised squamous cells on tympanic membrane

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16
Q

Treatment of cholesteatoma

A

Surgery is required, mastoidectomy if it has spread to mastoid bone.

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17
Q

What is inactive squamous COM?

A

No cholesteatoma, but a retraction pocket which may develop into active disease

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18
Q

What is mucosal COM?

A

Develops from an episode of AOM where tympanic membrane ruptures and fails to heal

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19
Q

Complications of COM

A

Spread of disease to mastoid bone

Spread of disease intracranially

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20
Q

Risks of mastoidectomy

A 
Facial nerve palsy
Altered taste due to chorda tympani damage
CSF leak
Tinnitus
Vertigo
Hearing loss
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21
Q

What is glue ear?

A

Otitis media with effusion

Due to Eustachian tube dysfunction, negative pressure in middle ear draws transduction fluid, may become infected

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22
Q

What is a possible cause of unilateral Eustachian tube dysfunction in adults?

A

Tumours in the post nasal space

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23
Q

Clinical features of glue ear

A

Ear pain
Conductive hearing loss
Middle ear effusion on otoscopy - tympanic membrane is retracted

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24
Q

Investigations and management of glue ear

A

Investigations: Tympanogram gives flat Type B trace, PTA shows conductive hearing loss (air-bone gap)

Management:
Conservative - most settle in three months
Hearing aid
Surgery - grommets, adenoidectomy

25
Q

What is otosclerosis and who does it affect?

A

Disease affecting ossicles: mature bone is replaced with woven bone and stapes footplate becomes fixed to oval window

Can be genetic (autosomal dominant) or environmental
Occurs in 1-2% population, twice as many females

26
Q

Clinical features of otosclerosis

A

Progressive hearing loss, tinnitus, improved hearing in noisy surroundings during early stages, family history

Pink hue to tympanic membrane on examination - Schwartzes sign

27
Q

Investigations and management of otosclerosis

A

Investigations:
Tympanogram - normal type A trace
PTA - conductive hearing loss, characteristic Carhart notch at 2000Hz

Management:
Conservative - hearing aid
Surgery - stapedectomy

28
Q

Describe the structure and function of the cochlea

A

2.5 turns around a bony core, the modiolus
Responsible for the perception of hearing: stapes articulates with oval window causing movement of perilymph
Vibrations transmitted through endolymph to tectorial membrane
Causes movement of hair cells and depolarisation of neuronal fibres, transmitted via cochlear nerve

29
Q

Where in the cochlear are different frequency sounds heard?

A

Low frequency sounds detected at apex of cochlear

High frequency sounds detected at base of cochlear

30
Q

Name the three semicircular canals

A

Posterior
Lateral
Superior/anterior

31
Q

What movements are detected by different parts of the vestibular system?

A

Semicircular canals - rotational movements
Utricle - linear/horizontal movement
Saccule - vertical movement

32
Q

What makes up good balance?

A

Input from vestibular system
Proprioception
Visual inputs

33
Q

Define vertigo

A

The hallucination of movement

34
Q

Possible causes of vertigo (Central/peripheral)

A

Central = stroke, migraine, neoplasms, demyelination eg. MS, drugs

Peripheral = Ménière’s disease, BPPV, vestibular neuronitis

35
Q

What is BPPV and what is the underlying cause?

A

Benign Paroxysmal Positional Vertigo = vertigo occurring with particular head movements
Caused by displacement of otoliths to semicircular canals (usually posterior) causing abnormal stimulation of hair cells

36
Q

Symptoms, diagnosis and treatment of BPPV

A

Vertigo lasting seconds with particular head movements

Diagnosis: Dix-Hallpike manoeuvre
Treatment: Epley manoeuvre

37
Q

Cause of Ménière’s disease

A

Increased endolymph fluid in the membranous labyrinthe

38
Q

Symptoms of Ménière’s

A 
Tinnitus
Vertigo lasting minutes to hours
Associated nausea and vomiting
Fluctuating sensorineural hearing loss 
Aural fullness
39
Q

What is the burnt out stage of Ménière’s?

A

Over time the vertigo episodes settle, but patient has reduced hearing and may be generally unbalanced

40
Q

Management of Ménière’s

A

Dietary - reduce salt, alcohol, caffeine
Medical - thiazide diuretics, betahistine, vestibular sedatives
Surgical - grommet insertion, dexamethasone middle ear injection, edolymphatic sac decompression, surgical labryrinthectomy

41
Q

What is vestibular neuronitis?

A

Inflammation of the inner ear due to viral infection of vestibular nerve and ganglion

42
Q

Symptoms of vestibular neuronitis

A

Vertigo lasting several days
Associated nausea and vomiting
Horizontal nystagmus
Usually preceded by URTI

43
Q

Treatment of vestibular neuronitis

A

Vestibular sedatives, usually resolves in 3-7 days

Vestibular rehabilitation exercises if there is long term vestibular deficit causing generalised unsteadiness

44
Q

Prognosis of sudden onset sensorineural hearing loss

A

1/3 recovery to normal
1/3 some recovery
1/3 no recovery

45
Q

Investigations and management of sudden onset sensorineural hearing loss

A

Investigations:
PTA
MRI scan to exclude lesion along central auditory pathway eg. Acoustic neuroma

Management:
Steroids, Antivirals,

46
Q

Describe Webers test and typical findings

A

Place tuning fork on patients forehead, ask if noise is heard on left, right or centre

Normal - tone is heard centrally
Sensorineural - tone heard on opposite side
Conductive - tone heard on same side as background noise has been blocked out

47
Q

Describe Rinnes test and typical findings

A

Tuning fork placed on mastoid bone, then external to EAM, ask patient which is louder

Normal - louder when lateral to EAM (Rinne positive)
Sensorineural - Rinne positive
Conductive - louder when placed on temporal bone (Rinne negative)

48
Q

What does a Tympanogram measure?

A

Compliance of the tympanic membrane (y axis), against varying amounts of pressure on the EAM (x axis)

49
Q

What is a Type A trace Tympanogram?

A

Normal result, peak is centred at 0

Extremely high peak can indicate ossicular chain disruption

50
Q

What is a Type B trace Tympanogram?

A

Flat trace

51
Q

What is a type C trace Tympanogram?

A

The peak of the tracing has negative pressure

Suggests Eustachian tube dysfunction

52
Q

What does a pure tone audiogram measure?

A

Air conduction and bone conduction of sound

53
Q

What are the markings used in a PTA?

A

Black line = air conduction (O is right ear, X is left ear)

Red line = bone conduction ( [ is right ear, ] is left ear)

54
Q

Give possible causes of conductive hearing loss

A

Wax
Otitis media with effusion
Otosclerosis

55
Q

Describe a typical PTA in conductive hearing loss

A

Normal bone conduction, but reduced air conduction (black line is lower) i.e. An air bone gap

56
Q

Possible causes of sensorineural hearing loss

A

Caused by a problem anywhere from cochlear to auditory cortex of the brain
Ménière’s disease, acoustic neuroma

57
Q

Describe a typical PTA in sensorineural hearing loss

A

Reduced bone and air conduction

No air bone gap

58
Q

Nerve supply to the pinna

A

Upper lateral surface - Auriculotemporal nerve (CN V3)
Lower lateral and medial surface - Greater auricular nerve (C3)
Superior medial surface - Lesser occipital nerve (C2/3)
EAM - Auricular branch of vagus (CN X)

Clinical Anatomy (6 decks)

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