Week 2 - A - Ear diseases

Question 1

What are the types of hearing loss?

Answer 1

Sensorineural hearing loss Conductive hearing loss Mixed hearing loss

Question 2

What area of the ear is conductive hearing loss?

Answer 2

This is when there is a problem conducting sound waves in the external ear - this could be external audiotry meatus, outer ear canal, tympanic membrane or problem with the middle ear - the ossicles

Question 3

What can the problems in the external ear or middle ear arise due to?

Answer 3

Can arise due to eg infection, build up of infection, otitis media, punctured eardrum or damage to the ossicles (bones of the middle ear)

Question 4

What are the two tests that can be performed using a tuning fork to detect conductive or sensorineural hearing loss? What is the frequency of the tuning fork?

Answer 4

Use rinnie’s test or weber’s test Tuning fork is 512 hertz

Question 5

Which test is uded to detect conductive hearing loss? State how it is carried out

Answer 5

Rinnie’s test Bang the tuning fork off the elbow, then hold the tuning fork in front of the ear to test the patients air conduction hearing Then put the base of the tuning fork against the mastoid process to test the patients hearing with bone conduction If the patient has better hearing on bone conduction then there is a conductive hearing loss, if air conduction is better then this is a normal finding

Question 6

If air conduction is better than bone conduction is this a positive or negative rinnie’s test?

Answer 6

Air conduction should be greater than bone conduction (AC>BC), so the patient should be able to hear the tuning fork next to the pinna (outer ear) after they can no longer hear it when held against the mastoid. This normal result is paradoxically called a positive Rinne test (as a positive medical test usually indicates an abnormality). * Positive rinnie test - AC>BC * Negative rinnie test - BC > AC –> patient has a conductive hearing loss

Question 7

How do you detect a sensorineural hearing loss in a patient? How do you carry this out? describe in a normal patient

Answer 7

Need to carry out a weber’s test in combination with a rinnie’s test If patient tested normal on rinnies and therefore no conductive eharing loss then weber’s will show bang tuning fork then place base of fork in the midline of the forehead Equal sound should be heard in both ears

Question 8

If rinnies test is positive (no condcutive hearing loss), which way would weber’s test have to lateralise to have sensorineural hearing loss in the left hear?

Answer 8

Sound would lateralize to the right to have sensorineural loss in the left ear This is because bone conduction is normal but a problem exists inn the inner ear so sound is not heard as well in the bad side

Question 9

Can you get a positive rinnie test if there is a conductive hearing loss?

Answer 9

NO

Question 10

When would you get a mixed (combined) hearing loss using rinnie’s and weber’s tests? Use the right ear as an example

Answer 10

Rinnie’s test would be negative in the right ear - sound would be heard louder in the right ear when tuning fork on the mastoid process therefore a conductive hearing loss In weber’s test - the tuning fork test in forehead midline would be heard better in the left ear - sensorineural loss in right ear

Question 11

When performing n otoscope eamination of the ear, what position should you pull the ear into?

Answer 11

Adult - lift ear posterosuperiorly Child - lift ear posterioinferiorly

Question 12

In acute otitis media, what is usually seen on an otoscope looking at the tympanic membrane?

Answer 12

Red inflamed, bulging tympanic membrane

Question 13

What are the Ds in the D principle for disease of the ear?

Answer 13

Deafness
Discomfort - due to pain
Discharge - perforation of tympanic membrane or external ear disease
Dizziness - problems with inner ear semicircular canals
Din Din - tinnitus
Defective movement of face - due to damage of the facial nerve

Question 14

What is it known as if rinnies and weber’s test both show no abnormality howver is a false positive as the patient has hearing loss?

Answer 14

Presbycusis (presbyacusis) - age related hearing loss

Question 15

What condition resulting in abnormal bone growth in the ear can cause a severe conductive hearing loss? The abnormal bone growth prevents the ossicles from amplifying sound

Answer 15

Otosclerosis

Question 16

Discomfort - earache in the ear can be due to different nerves What nerves that supply the ear can relay discomfort? (remember this can be due to referred pain)

Answer 16

CN V, VII, IX, X and C2 and 3 spinal accesory nerves

Question 17

What is ear pain/earache known as?

Answer 17

Known as otalgia

Question 18

Otorrhea is discharge from the ear What are causes of otorrhea?

Answer 18

Acute otitis media (AOM) Chronic otitis media (COM) Cerebrospinal fluid (CSF)

Question 19

What are the usual bacterial causes of acute otitis media?

Answer 19

Acute otitis media - H.influenza, strep, moraxella catarrhalis, group a strep

Question 20

What is the treatment of acute otitis media?

Answer 20

Treatment - Wait a few days, usually resolves

> 3 days/discharge:
Amoxicllin first line (5 days)
If pen allergic - clarithromycin (5 days)

Question 21

What is inflammation of the ear that can result in dizziness (vertigo) and potential hearing impairment known as?

Answer 21

Labrynthitis (or otitis interna)

Question 22

In patients with din din (tinnitus), it is useful for the patient to focus on something else as the tinnitus does not stop What is tinnitus?

Answer 22

Tinnitus is the term for hearing sounds that come from inside your body, rather than from an outside source. It’s often described as “ringing in the ears”

Question 23

What is the disease known as that causes inflammation of the external ear canal? (between external auditory meatus and the tympanic membrane)

Answer 23

Otitis externa

Question 24

What is otitis externa also known as?

Answer 24

Swimmer’s disease - ears constantly being wet increases the chance of infection

Question 25

What are some symptoms of otitis externa?

Answer 25

Itching and redness/swelling around the outer ear and ear canal

Question 26

What is this? Picture shows red and inflamed tympanic membrane Can perforate

Answer 26

This shows otitis media

Question 27

What is the presence of fluid behind an intact eardrum in the absence of infection known as?

Answer 27

Otitis media with effusion (OME)

Question 28

Why can otitis media with effusion be known as glue ear?

Answer 28

After a few weeks or months, the fluid behind the tympanic membrane thickens and becomes glue like Sometimes air bubbles are visible behind tympanic membrane on otoscopy

Question 29

What are complications of OME and what can cause the blockage of the eustachian tube leading to a build up fluid?

Answer 29

Complications - infections can occur leading to acute otitis media Enlarged adenoids can block the eustachian tube due to their close anatomy

Question 30

Chronic Otitis Media What are causes of COM? Is there pain?

Answer 30

* Recurrent AOM with perforation
* Cause: pseudomonas, proteus, s. aureus, and mixed anaerobes

* Hallmark: purulent aural discharge
* Pain is uncommon due to the perforation=no more pressure present
* Tx: ear plugs, removal of debris, surgery

Question 31

destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear basically skin in the wrong place What is this known as?

Answer 31

Cholesteatoma - surgery is first line option

Question 32

What is the classification system of the eardrum to rate the degree of cholesteatoma? How is it measured?

Answer 32

Classified by the sade system Measures the degree of retraction of the eardrum (in particular the pars tensa - the thickest part of the eardrum)

Question 33

What is the worst level of retraction of the eardum in the sade classification? What is the thinnest part of the ear drum known as?

Answer 33

Sade IV is the worst

Thinnest part known as pars flaccida - seen on the superiro aspect of the tympanic membrane

Question 34

Congenital cholesteatoma is behind the eardum and from birth Derlacki laid down the following as criteria to diagnose congenital cholesteatoma: ?

Answer 34

1. The patient should not have previous episodes of middle ear disease 2. Ear drum must be intact and normal 3. It is purely an incidental finding 4. If discharge and ear drum perforation is present then it should be construed that congenital cholesteatoma has managed to erode the tympanic membrane.

Question 35

What ear investgation can be carried out to test the tympanic membrane?

Answer 35

Tympanogram - Inject air into ear + record pressure changes