Visual and auditory conditions Flashcards

Question

How many older people in the UK are living with glaucoma, either detected or undetected (EpiVision/RNIB)?

Answer 1

``` healthy diet quit smoking maintain a healthy weight avoid exposure to UV light avoid digital eye strain using 20-20-20 rule book an eye test every two years ```

Answer 2

``` leafy greens (e.g. kale, spinach) brightly coloured fruit and vegetables (e.g. corn, carrots, orange sweet peppers, oranges) oily fish (e.g. salmon, tuna, mackerel) broccoli eggs ```

Answer 3

``` optometrist - 73% GP - 59% internet - 20% pharmacist/chemist - 11% walk-in clinic - 10% family member - 9% friend - 5% don't know - 2% none of these - 1% ```

Answer 4

glasses - 69% contact lenses - 13% laser eye surgery - 13% none of these - 25%

Answer 5

BAME - increased risk of leading causes of sight loss | people with a learning disability - 10 times more at risk of blindness or partial sight loss than the general population

Answer 6

intrinsic factors (genetics) and extrinsic factors (environmental)

Answer 7

caused by impaired conduction of sound waves from the outer ear through the middle ear (tympanic membrane) to reach the inner ear the inner ear cannot transduce sound waves into nerve impulses in the cochlea which pass to the auditory cortex

Answer 8

``` wax or foreign body otitis media (acute, serious, chronic) otitis externa otosclerosis damaged tympanic membrane ear barotrauma ```

Answer 9

caused by disease of the cochlea, the cochlear branch of the vestibular nerve (inner ear), or within the auditory cortex sound waves are not processed correctly and they are hard to discriminate/distinguish

Answer 10

``` presbycusis noise pollution congenital Meniere's disease ototoxic drugs (e.g. aspirin, cisplatin, quinine, antibiotics, diuretics, chemotherapy) infections (e.g. mumps, syphilis) ```

Answer 11

to eliminate other possible causes | to ensure appropriate onward referral

Answer 12

if hearing loss is accompanied by any facial weakness or other symptoms

Answer 13

wash hands introduce yourself explain procedure obtain patient consent

Answer 14

Which is your better hearing ear? Have you got any pain or tenderness? Can you give me a smile? - Look for facial weakness (1 of 5 cardinal symptoms of ear disease); facial nerve passes in the medial wall of the middle ear and may be affected by pathology in the ear)

Answer 15

examine the better hearing ear inspect external ear using light of otoscope inspect skin colour and shape of pinna look for other abnormalities (e.g. tophi, congenital defects) look for surgical scars (endaural, postauricular)

Answer 16

perform otoscopy to visualise the external auditory meatus and tympanic membrane two sizes of speculum for the otoscope (choose the largest size speculum possible for the patient's ear canal)

Answer 17

when examining the right ear, hold the otoscope in the right hand hold it like a pen, balanced between the thumb and index finger extend the little finger and use this to rest against the patient's face

Answer 18

with the free left hand, pull the pinna gently upwards, outwards, and backwards to straighten the external ear canal and allow better view of the tympanic membrane in children, pull the pinna down and back instead

Answer 19

insert the otoscope into the external auditory meatus and inspect the canal for wax, discharge, inflammation, and other abnormalities gently precede down the canal until the tympanic membrane is seen

Answer 20

move the speculum around to examine the whole of the tympanic membrane and identify the normal landmarks (handle of the malleus, light reflex, pars tensa, pars flaccida)

Answer 21

gently remove the otoscope, continuing to observe the ear canal for any pathology that may have been missed repeat the examination on the other ear

Answer 22

assess hearing using the tuning fork tests and audiometry

Answer 23

``` impacted wax acute infections (e.g. otitis externa) ```

Answer 24

bulging tympanic membrane | dull or absent light reflex

Answer 25

skin cyst visible behind tympanic membrane

Answer 26

inflammation of external auditory meatus

Answer 27

if alternative causes are excluded | if there is a sudden or rapid onset of hearing loss and/or with specific additional signs/symptoms

Answer 28

if the hearing loss developed suddenly (over a period of 3 days or less)

Answer 29

if the hearing loss developed suddenly more than 30 days ago | if the hearing loss worsened rapidly (over a period of 4-90 days)

Answer 30

professional will ask questions relating to the patient's hearing How do you experience your hearing? Have you been subjected to loud noise or other incidents? Do people in your family suffer from hearing loss? Do you hear better in one ear or the other?

Answer 31

ear examination using otoscope

Answer 32

hearing test in a quiet room without background noise or in a special soundproof room pure tone test - tests the ability to hear a number of different pure tones, using a pair of soundproof headphones bone conduction test - place a small bone conductor behind the ear to measure the ability to hear pure tones; will reveal a problem in the middle ear cavity

Answer 33

test the ability to understand speech performed to identify problems with auditory nerve by sending signals from the ear to the brain performed to identify problems understanding speech and sounds in the brain itself

Answer 34

tympanometry - tests the condition of the middle ear and mobility of the tympanic membrane performed to identify specific hearing conditions

Answer 35

test results are presented in an audiogram | this shows the degree of hearing loss and whether the patient could benefit from hearing aids

Answer 36

electronic irrigator microsuction manual removal using a probe

Answer 37

olive oil or almond oil drops 3-4 times daily for 3-5 days (do not prescribe almond oil ear drops to anyone who is allergic to almonds)

Answer 38

to soften wax and aid removal

Answer 39

history of previous problem with irrigation (pain, perforation, severe vertigo) current perforation of tympanic membrane history of perforated tympanic membrane in the last 12 months (controversial) history of ear surgery (except extruded grommets in the last 18 months, with subsequent discharge from an ENT department) mucus discharge from the ear (may indicate an undiagnosed perforation) in the last 12 months history of otitis media in the last 6 weeks acute otitis externa with an oedematous ear canal and painful pinna

Answer 40

grommets in place cleft palate, whether repaired or not hearing in only one ear if it is the ear to be treated, as there is a remote chance that irrigation could cause permanent deafness presence of a foreign body, including vegetable matter, in the ear (hygroscopic matter, e.g. peas or lentils, will expand on contact with water making removal more difficult) confusion or agitation, as unable to sit still inability to cooperate (e.g. young children, some people with LDs)

Answer 41

sit at the same level as the patient apply the waterproof shoulder cape around the patient's neck to ensure they will be kept dry from water and debris use a headlight to ensure full visibility of the ear canal during the procedure

Answer 42

use tap water and ensure the temperature is at 40°C after 20 secs of running the tap water, insert approx. 700 mls of warm water into the reservoir pour water onto your finger to ensure the water is warm enough for the procedure to be performed

Answer 43

remove a new single-use QrX tip from the packaging, push the collar back, and ensure the tip is securely held in place when the collar is released turn on the machine and set the pressure control to minimum

Answer 44

using the foot pedal to start the flow of water, you and the patient use your finger to ensure both are comfortable with the water temperature and noise of the machine ask the patient to sit sideways on the chair so they can lean on the chair to be able to comfortably hold the newt tank in place under the earlobe

Answer 45

using the headlight to aid the visibility of the ear canal, hold the irrigation handle across the palm of your hand and introduce it to the entrance of the ear canal

Answer 46

after irrigating the ear for 10 secs, stop and question the patient that they remain comfortable and do not feel any water at the back of the nose or throat as the patient is comfortable, continue the procedure and straighten the ear canal by holding the pinna up and out

Answer 47

continue irrigation with the handle pressed against the tragus and water flowing along the posterior wall of the ear canal

Answer 48

using the headlight, see that the wax is coming towards the entrance of the ear canal you can now appropriately use the wax scoop to remove the wax

Answer 49

using a tissue to dry the entrance of the ear canal, remove a new disposable scoop from the bag straightening the ear canal, and with the headlight for visibility, insert the wax scoop into the ear canal and remove wax this has reduced the length of the irrigation procedure and improves patient comfort

Answer 50

drying the entrance of the ear canal, perform oral toilet to remove all the water from the ear canal using cotton wool, tease the cotton wool apart and insert the serrated end of the wax scoop onto the cotton wool

Answer 51

insert cotton wool to the entrance of the ear canal and using a gentle rotary motion of the scoop, water left pooling within the ear canal will be absorbed back by the cotton wool

Answer 52

once the cotton wool is wet, it should be discarded from the scoop re-examine the ear to ensure all the water has been removed from the ear canal, there is no wax or debris left in the ear canal, and the patient has a normal tympanic membrane

Answer 53

advise patient to keep ears dry from the entry of water for a minimum of five days after irrigation (a small amount of cotton wool coated in petroleum jelly) advise patient not to insert any implement in their ear which could damage ear canal or tympanic membrane advised to return for ear care and examination in one year document the results of procedure according to local policy

Answer 54

a long-term vestibular condition caused by an accumulation of endolymph within the membranous labyrinth this leads to increased pressure and distension, and the destruction of sensory cells within the ampulla/cochlea can start unilaterally and progress to bilateral both sexes are equally affected and it can occur at any age

Answer 55

1:1000-1:2000 of the population (depends on the source)

Answer 56

acute attacks of vertigo (severe dizziness) fluctuating tinnitus increasing deafness feeling of pressure in the ear

Answer 57

unpredictable attacks of vertigo which can last from a few minutes to hours this can accompany hearing loss with a sensation of fullness in the affected ear and tinnitus the hearing and sensation in the ear return to normal between attacks

Answer 58

attacks of vertigo; tinnitus; hearing loss attacks of vertigo continue with variable remissions, though may be less severe before/after the attack the person may experience a period of imbalance and movement-induced giddiness tinnitus becomes more prominent and often fluctuates or increases with the attacks

Answer 59

hearing loss; balance difficulties; tinnitus hearing loss increases and often the attacks of vertigo diminish/stop hearing loss can be severe and distortion loudness, discomfort and recruitment can occur permanent damage to the balance organ in the ear and significant general balance problems are common, especially in the dark

Answer 60

(nausea and vomiting) - buccal prochlorperazine or cyclizine (examples)

Answer 61

complementary therapy vestibular rehabilitation surgery

Answer 62

this may include acupuncture or counselling

Answer 63

a programme of head, eye and neck movements, usually led by a physiotherapist, to assess balance function and re-educate the balance system so the person becomes more stable

Answer 64

``` intratympanic steroids (injection into the inner ear) intratympanic gentamicin (injected through the tympanic membrane) endolymphatic sac surgery (bone removed around the sac) labyrinthectomy (95-98% success rate) vestibular neurectomy (cuts the nerve), grommets (tympanstomy) ```

Answer 65

ageing changes without any other obvious cause that affects the central area of the retina (macula) painless condition that generally leads to the gradual impairment of vision, but it can sometimes cause a rapid reduction in vision it mainly affects the central vision, which is responsible for reading and recognising faces.

Answer 66

``` older age presence of AMD in the other eye family history of AMD smoking hypertension BMI of 30 kg/m2 or higher diet low in omega 3 and 6, vitamins, carotenoid and minerals diet high in fat lack of exercise ```

Answer 67

accounts for 90% of all AMD cases layers of the macula (including photoreceptors and retinal pigment epithelium) get progressively thinner, and lead to reduced function, due to atrophy

Answer 68

``` causes pigment discolouration within the macula tiny drusen (waste products) appear on the retina, and may lead to deterioration and atrophy of the retinad dry AMD often does not progress further than pigment discoloration and the presence of drusen ```

Answer 69

large sections of the retina that are well demarcated (geographies) stop functioning this is called geographic atrophy (GA)

Answer 70

accounts for 10% of all AMD cases new blood vessels grow in the choroid layer behind the retina - choroidal neovascularization (CNV) the new vessels are weak, and leak fluid, lipids and blood the leaking gets into the layers of the retina (including the layers of the macula) and can cause scar tissue to form and retinal cells to stop functioning

Answer 71

no signs of age-related macular degeneration (AMD) | small ('hard') drusen (less than 63 micrometres) only

Answer 72

medium drusen (63 micrometres or more and less than 125 micrometres) or pigmentary abnormalities

Answer 73

large drusen (125 micrometres or more) or reticular drusen or medium drusen with pigmentary abnormalities

Answer 74

large drusen (125 micrometres or more) with pigmentary abnormalities or reticular drusen with pigmentary abnormalities or vitelliform lesion without significant visual loss (best-corrected acuity better than 6/18) or atrophy smaller than 175 micrometres and not involving the fovea

Answer 75

retinal pigment epithelial (RPE) degeneration and dysfunction (presence of degenerative AMD changes with subretinal or intraretinal fluid in the absence of neovascularisation) serous pigment epithelial detachment (PED) without neovascularisation

Answer 76

classic choroidal neovascularisation (CNV) occult (fibrovascular PED and serous PED with neovascularisation) mixed (predominantly or minimally classic CNV with occult CNV) retinal angiomatous proliferation (RAP) polypoidal choroidal vasculopathy (PCV)

Answer 77

geographic atrophy (in the absence of neovascular AMD) significant visual loss (6/18 or worse) associated with: dense or confluent drusen or advanced pigmentary changes and/or atrophy or vitelliform lesion

Answer 78

fibrous scar sub-foveal atrophy or fibrosis secondary to an RPE tear atrophy (absence or thinning of RPE and/or retina) cystic degeneration (persistent intraretinal fluid or tubulations unresponsive to treatment) NB eyes may still develop or have a recurrence of late AMD (wet active)

Answer 79

to determine the cause of the visual disturbance and what type of treatment, if any are available in terms of AMD dry or wet, there are options available to reduce the impact of the condition

Answer 80

dry AMD - limited treatment options, or ability to reduce visual loss (despite making up 90% of cases) most treatments are aimed at patients with wet AMD or late-stage wet AMD

Answer 81

antiangiogenic therapies - a group of medication that was traditionally used to treat metastatic kidney cancer the medication slows down tumour growth by preventing the formation of new blood vessels this is beneficial in wet AMD, due the formation of new and fragile vessels ranibizumab

Answer 82

intravitreal anti-vascular endothelial growth factor (VEGF) treatment photodynamic therapy is offered as an adjunct to anti-VEGF in second-line treatment for late wet AMD only monitoring is only seen as beneficial in those with late AMD (wet active)

Answer 83

certification of visual impairment to enable people to access necessary benefits and services group-based rehabilitation programme in addition to a low-vision service to promote independent living for people with AMD counselling - as needed to support individuals and significant others

Answer 84

27% (33% in 2006)