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Y2 ENT > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is conductive hearing loss

A

Hearing loss due to sound conduction being blocked / impaired
pathology is in the external or middle ear

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2
Q

What is sensorineural hearing loss

A

Hearing loss due to damage to the neural pathway
Pathology is in the inner ear / brain / nerves

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3
Q

What are the causes of conductive hearing loss

A

Otitis media
Otitis externa
Otosclerosis
Perforation of the tympanic membrane
Choleastoma
Glue ear

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4
Q

What will the audiometry for conductive hearing loss be like

A

Difference in air conduction level and bone conduction level where bone > air

Carhart’s notch in otosclerosis

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5
Q

What will the audiometry for sensorineural hearing loss be like

A

Significant drop in hearing in all frequencies

No difference in air conduction and bone conduction

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6
Q

What clinical examinations can be done to differentiate between conductive and sensorineural hearing loss

A

Rinne’s test
Weber’s test

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7
Q

What is otitis externa

A

Inflammation of the external acoustic canal

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8
Q

Otitis externa is most common in

A

Children and young adults

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9
Q

Risk factors of otitis externa

A

Swimmers
Humid air
Obstruction of the external acoustic canal
Eczema
Psoriasis

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10
Q

What can cause obstruction of the external acoustic canal

A

Use of cotton buds
Foreign bodies

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11
Q

Main cause of otitis externa

A

Bacterial infection

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12
Q

Causes of otitis externa

A

Bacteria
Fungal
Eczema

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13
Q

What skin conditions may lead to otitis externa

A

Contact dermatitis
Seborrheic dermatitis

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14
Q

What is contact dermatitis

A

Dermatological symptoms (pruritus, rash) due to direct contact with a substance

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15
Q

What bacterial pathogens are the main cause of otitis externa

A

S aureus
Pseudomonas aeruginosa

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16
Q

What fungal pathogens can cause otitis externa

A

Candida
Aspergillus

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17
Q

Symptoms of otitis externa

A

Otalgia
Discharge
Itchiness
Swelling
Erythema
Hearing loss (In severe cases)

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18
Q

Management of mild to moderate otitis externa

A

Analgesia
Topical antibiotics +/- topical steroids
Avoid swimming and keep ears dry

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19
Q

Management of severe otitis externa

A

Use Pope wicks to apply topical antibiotics +/- steroids deeper

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20
Q

What should you be aware of in immunocompromised patients with otitis externa

A

Malignant otitis externa

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21
Q

Are oral antibiotics used for otitis externa

A

Not usually used

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22
Q

Indications for used of oral antibiotics for otitis externa

A

Ear canal is occluded by swelling and cannot be treated by Pope wicks
Immunocompromised patients
Infection spreading beyond the external ear

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23
Q

What is malignant otitis externa

A

Invasive infection of the mastoid and temporal bones surrounding the ear canal

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24
Q

Malignant otitis externa is most commonly caused by

A

Pseudomonas aeruginosa

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25
Q

What is otitis media

A

Inflammation of the middle ear

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26
Q

Otitis media is most common in

A

Children especially after URTI

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27
Q

Why may otitis media occur after URTI

A

Pathogens from URTI made their way up to the middle ear through Eustachian tube

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28
Q

Why are children more susceptible to otitis media after URTI

A

Children’s Eustachian tube is shorter and less angled, making it easier for pathogens to enter the middle ear cavity
Children have immature immune system

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29
Q

Otitis media is mostly commonly caused by

A

Bacteria
Virus

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30
Q

What are the bacteria responsible for otitis media

A

Streptococcus pneumoniae
H influenza

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31
Q

Which bacteria is the most common cause of Otitis media

A

Streptococcus pneumonia

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32
Q

What viruses are responsible for Otitis media

A

RSV
Rhinovirus
Adenovirus
Influenza virus

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33
Q

Why may children and infants present otitis media differently from adults

A

Because they cannot express well

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34
Q

Symptoms of otitis media in infants and children

A

Fever
Irritability
Difficulty feeding
Holding / tugging ear

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35
Q

Symptoms of otitis media in adults

A

Fever
otalgia
Hearing loss

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36
Q

Investigations for otitis media

A

Otoscopy

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37
Q

What may be seen through otoscope in a patient with otitis media

A

Erythematous tympanic membrane
Swelling
Bulging tympanic membrane
Perforation of tympanic membrane
Dilated vessels on tympanic membrane

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38
Q

What causes bulging of tympanic membrane

A

Pus filled in the middle ear cavity

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39
Q

Complications of otitis media

A

Facial nerve palsy
Mastoiditis
Meningitis
Labrynthitis
Brain abscess
Sigmoid sinus thrombosis

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40
Q

Patients with facial nerve palsy can present differently. Why is that

A

Because different parts of the nerve are affected - it can be upper or lower motor neurone that is affected

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41
Q

Difference in presentation between upper ad lower motor neurone facial palsy

A

If upper motor neurone is affected - forehead structures are not affected - furrowing of eyebrows, blinking, closing eyes are not affected

If lower motor neurone is affected - all facial muscles are weak

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42
Q

How does otitis media cause mastoiditis

A

Infection may have spread to the mastoid air cells via mastoid antrum which is an opening in posterior wall of middle ear cavity

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43
Q

What are the signs of mastoiditis

A

Postauricular swelling
Auricle pushed outwards and forwards

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44
Q

Mastoiditis tends to affect

A

children

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45
Q

What is labrynthitis

A

Inflammation of the semicircular canals

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46
Q

What can labrynthitis cause

A

Vertigo
Loss of balance
Nausea
Vomiting

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47
Q

Management for acute otitis media

A

Generally self limiting
Analgesia - paracetamol / ibuprofen
Consider antibiotics and admitting the patients under certain conditions

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48
Q

When should you consider delayed prescription of antibiotics (i.e. wait and see before giving) to patients with otitis media

A

If symptoms don’t improve after 3 or 4 days

49
Q

When should you consider immediate prescription of antibiotics to patients with otitis media

A

If systemically very unwell
If at high risk of complications

50
Q

When should you admit a patient with acute otitis media

A

Children under 3 months with > 38 temperatuer
Children with suspected complications

51
Q

What is chronic otitis media

A

A group of conditions that causes inflammation and infection for 3 months or more

52
Q

What conditions are included in chronic otitis media

A

Otitis media + effusion (glue ear)
Cholesteatoma
Perforation

53
Q

What is glue ear

A

Inflammation of the middle ear with accumulation of fluid without the signs and symptoms of acute otitis media

54
Q

Is glue ear an infection

A

No, it is not an infection

55
Q

Cause of glue ear

A

Eustachian tube dysfunction - fluid builds up due to blocked Eustachian tube unable to drain it from middle ear cavity to the nasal cavity

56
Q

Glue ear can occur after certain conditions

A

Recurrent URTI
Recurrent otitis media
Frequent nasal obstruction

57
Q

Risk factors for glue ear

A

Day care
Bottle fed (poor immunity)
Smoking household
Genetic mucociliary disorders (Cystic fibrosis, Primary ciliary dysfunction)
Genetic craniofacial disorders (Down syndrome)

58
Q

Symptoms of glue ear in children

A

Learning or language difficulties
Listening to loud TV or devices
Talk loudly
Lack of concentration
Need to repeat things for them
Ear rubbing

59
Q

Investigations for glue ear

A

Otoscopy
Audiometry / Weber’s / Rinne’s

60
Q

What would be seen on otoscope for glue ear

A

Visible fluid or air bubbles due to fluid
Cloudy tympanic membrane
Immobile tympanic membrane
Retraction of the tympanic membrane

61
Q

Management for glue ear

A

Generally resolves by itself after 3 months
Review at 3 months
Only perform surgery under certain conditions
Hearing aid if surgery is not appropriate

62
Q

When is surgery for glue ear considered

A

If it doesn’t resolve after 3 months
If the child is having learning / language difficulties
If the child is having behavioural problems

63
Q

Surgical options for glue ear

A

Grommet
Grommet + adenoidectomy

64
Q

Hearing aid instead of surgery is mostly offered to

A

Patients with down syndrome because complications from grommet is common

65
Q

What are the complications of grommets

A

Infection
Perforation
Falls out too early / doesn’t fall out

66
Q

What can cause perforated tympanic membrane

A

After acute otitis media
Trauma - sudden negative pressure
Insertion of foreign objects

67
Q

Perforation of the tympanic membrane is most common in

A

Children after acute otitis media

68
Q

Symptoms of perforation

A

Sudden pain
Bleeding
Tinnitus
Hearing loss

69
Q

Management of perforation

A

Generally heals by itself taking up to a year
Keep ears dry to prevent infection
Surgery if there is recurrent discharge

70
Q

What is cholesteatoma

A

Growth of keratinising squamous epithelium in the middle ear and invading other areas such as mastoid bone

71
Q

Causes of cholesteatoma

A

Perforation
Retraction

72
Q

How does retraction of tympanic membrane cause cholesteatoma

A

Negative pressure pulls the tympanic membrane inwards (retraction) and create a pocket of dead epithelial cells. The pocket becomes infected / grow and erode other bones and surrounding structures

73
Q

Most common location of cholesteatoma

A

Anterosuperior quadrant of tympanic membrane

74
Q

Symptoms of cholesteatoma

A

Discharge
Hearing loss
Vertigo
Facial nerve palsy

75
Q

Investigation for cholesteatoma

A

Otoscopy
Audiometry / Rinne / Weber

76
Q

What will you see on otoscope in a patient with cholesteatoma

A

Retraction or perforation of the tympanic membrane
White material usually at anterosuperior quadrant

77
Q

What is otosclerosis

A

Progressive fixation of stapes footplate so it doesn’t function as a piston onto the cochlea
= no movement of perilymph
= no movement of hair cells

78
Q

What does otosclerosis cause

A

Progressive conductive hearing loss

79
Q

Cause of otosclerosis

A

Familial - autosomal dominant condition

80
Q

Management of otosclerosis

A

Hearing aids
Stapedectomy

81
Q

What are the causes of sensorineural hearing loss

A

Presbycusis
Noise induced
Drug induced
Vestibular Schwannoma
Meniere’s
Trauma

82
Q

What is presbycusis

A

Degenerative condition of the cochlea causing progressive sensorineural hearing loss

83
Q

What causes presbycusis

A

Loss of hair cells
Loss of ganglion cells
Strial atrophy

84
Q

What is strial vascularis

A

Capillary loop in in cochlear duct producing endolymph for scala media

85
Q

Risk factors for presbycusis

A

Elderly
High levels of noise exposure

86
Q

Presbycusis is most common in

A

Elderly

87
Q

Management of presbycusis

A

High frequency hearing aid

88
Q

What causes noise induced hearing loss

A

High levels of industrial noises

89
Q

Characteristic of noise included hearing loss in audiometry

A

Dip at 4000Hz

90
Q

What are the drugs that can cause drug induced hearing loss

A

Gentamicin
Cisplatin
Vincristine
Overdose aspirin and NSAID

91
Q

What is Vestibular Schwannoma

A

Benign subarachnoid tumour arising from the vestibular portion of CN VIII in the internal acoustic meatus

92
Q

What is CN VIII

A

vestibulocochlear nerve

93
Q

Symptoms fo vestibular schwannoma

A

Progressive unilateral hearing loss
Progressive tinnitus (only on affected side)
Loss of balance
Facial numbness
Progressive episodes of dizziness
Headaches

94
Q

Management fo vestibular schwannoma

A

If small - monitor every 6 months
If big - surgery

95
Q

What causes facial numbness in vestibular schwannoma

A

Compression of trigeminal nerve

96
Q

What is Ménière’s disease

A

Idiopathic dilatation of the endolymphatic spaces of membranous labyrinth

97
Q

What may be a possible reason for Ménière’s disease

A

Due to increase in endolymphatic pressure caused by dysfunctioning of sodium channels

98
Q

Symptoms of Ménière’s disease

A

Episodes of vertigo - dizziness, nausea, vomiting
Unilateral hearing loss and tinnitus during the episodes of vertigo
Aural fullness on the affected side

99
Q

How long does each vertigo episode last in Meniere’s disease

A

Hours

100
Q

The vertigo in Ménière’s disease is in which direction

A

Rotational vertigo

101
Q

Investigations for Meniere’s

A

Audiometry

102
Q

What is a pattern on audiometry shown in Meniere’s

A

Low frequency hearing loss

103
Q

Management for Ménière’s disease

A

Betahistine for prophylaxis
Prochlorperazine for acute attacks
Reduce salt intake
Avoid chocolate, caffeine, stress

104
Q

What is vertigo

A

A hallucination of movement- spinning, falling ..etc

105
Q

What is dizziness

A

A non-specific term that may include vertigo, disequilibrium, pre syncope ..etc

106
Q

Causes of vertigo

A

Cardiac
Neurological
Vestibular
Visual
Ototoxicity

107
Q

What are the vestibular causes of vertigo

A

BPPV
Meniere’s
Vestibular neuronitis
Acute labyrinthitis
Ototoxicity

108
Q

How do you differentiate between the different types of vertigo

A

Through history
E.g. If present with palpitations - probably cardiac
If present with visual disturbance - probably visual
If present with paraesthesia, weakness, speech problems - probably neurological

109
Q

How do you differentiate between the different otogenic causes of vertigo

A

By duration of episodes and associated symptoms

110
Q

What is the most common otogenic cause of vertigo

A

BPPV

111
Q

What is the vestibulo cochlear reflex

A

When your head turns one way, your eyes will turn to the opposite way to stabilise your gaze during head movement

112
Q

What causes nystagmus

A

Defects in vestibulo cochlear reflex

113
Q

When What causes BPPV

A

Otocania (otoliths) becomes dislodged into the semicircular canals
This causes the otocania to roll around freely in those semircular canals during head movements
As it rolls, hair cells are triggered
So inappropriate signals are sent

114
Q

When can vertigo in BPPV occur -when they

A

Looking up
Rolling in bed
Getting out of bed
Bend forwards
bend backwards

115
Q

Symptoms BPPV

A

Vertigo
Nausea and vomiting
no auditory symptoms

116
Q

How long does vertigo of BPPV usually last

A

30 seconds to 1 minute

117
Q

Investigations for BPPV

A

Dix Hallpike manoeuvre

118
Q

What is a positive Dix Hallpike manoeuvre

A

Torsional geotropic nystagmus
Vertical nystagmus
Nausea and vomiting

119
Q

Management of BPPV

A

Epley manoeuvre
Selmont manoeuvre
Brandt Daroff exercises - 10 reps for 3 time a day

Y2 ENT (7 decks)

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