Tinnitus and Otalgia

Question 1

key investigation for tinnitus

Answer 1

Audiogram

Imaging only in very select cases: localization to one specific ear with pulsatile tinnitus, focal neurological abnormalities,significant asymmetric hearing loss.

Question 2

Tinnitus is divided into subjective and objective.

Objective tinnitus is caused by an ____ abnormality. what is the DDX?

Answer 2

ANATOMICAL ABNORMALITY. More pulsatile in sound

Vascular: arterial bruit, venous hum, AV malformation, vascular tumors (glomus tumours, a pulsating red mass behind the ear drum)

Neurologic; palatal myoclonus, stapedial muscle spasm.

Question 3

Tinnitus is divided into subjective and objective.

Subjective tinnitus is more common, what are the chief causes?

Answer 3

Otolgic: hearing loss

Ototoxic medications

Neurologic: MS, head injury

Metabolic: thyroid disorders, hyperlipidemia, vitamin deficiencies

Psychogenic: depression, anxiety, fibromyalgia

Question 4

Key Otitis Externa infections

Answer 4

S. aureus

Pseudomonas

Herpes zoster oticus

Varicella zoster; if vesicles are present and there is a CNVII palsy, then this is considered Ramsay Hunt Syndrome

Generally, Otitis Externa infections are an inflammation or infection of the external auditory canal, auricle or both.

Symptoms of Otitis Externa: otalgia, hearing loss, otorrhea, ear fullness or pressure, pain with movement or auricle.

Question 5

Otitis externa infections can extend into the mastoid/termporal bone and exert a form of osteomyelitis. Most common in __ populations infected with ____ bacteria.

Answer 5

Extension of otitis externa into the mastoid/termporal bone (osteomyelitis).

Most common organism is P. aeruginosa. Common in diabetc patients or the immunocompromised.

Mortality rate up to 53%

Suspect if symptoms are disproportionately more severe than clinical signs. MUST REFER.

Complications of Acute Mastoiditis:

Intracranial: meningitis, epidural abscess, sigmoid sinus thrombosis, brain abscess

Otologic: labyrinthitis, facial nerve paralysis, petrous apicitis

Question 6

Neuralgias can cause ear pain: ___, __, geniculate, or sphenopalatine nerves converge around the ear.

Results in __, ___, electric otalgia

PE: normal otologic exam, may have a trigger point.

Answer 6

Neuralgias can cause ear pain: trigeminal, glossopharyngeal, geniculate, or sphenopalatine nerves converge around the ear.

Results in severe, sharp, electric otalgia

PE: normal otologic exam, may have a trigger point.

Question 7

3 key diagnostic requirements for acute otitis media (middle ear)

Answer 7

Diagnosis requires:

Acute onset of signs and symptoms

Presence of middle ear effusion

Signs and symptoms of middle ear inflammation

Question 8

middle ear otitis media (acute) treatment

Answer 8

Risk Factors for AOM: family history, day care, bottle fed, male, not immunized, ethnicity-native american.

all children under 6 moths treated with amoxicillin. over 2 is observation +/- amoxicillin