Week 2 - I - ISS Ear stuff

Question 1

What covers the elastic cartilage of the ear before the skin?

Answer 1

The perichodnrium

Question 2

Label the ear

Answer 2

A - tragus B - anti-tragus C - lobule D - Anti-helix E - helix F - external acoustic meatus

Question 3

What are the three layers of the tympanic membrane? Which ossicle connects to it?

Answer 3

The outer epithelial layer is skin - CN V and X Inner mucosal layer is supplied by CN IX

Question 4

What is the nerve supply to the outer layer of tympanic membrane?

Answer 4

Superior 2/3rds is via the trigeminal nerve (mandibulaar division) The inferior 1/3rd is via the vagus nerve

Question 5

What gland of the ear produces wax? What is the other gland in the ear?

Answer 5

Ceruminous glands produce wax The other gland is the sebaceous glands

Question 6

reactivation of Varicella Zoster Virus in geniculate ganglion of CN7. What is this and what is the first feature?

Answer 6

This is Ramsay Hunt Syndrome First feature is auricular pain

Question 7

What are other features of ramsay hunt syndrome?

Answer 7

facial nerve palsy, vesicular rash around ear, vertigo & tinnitus.

Question 8

How is Ramsay hunt syndrome treated?

Answer 8

Treated with oral acyclovir and corticosteroids

Question 9

What can ramsay hunt syndrome cause due to the involvement of the facial nerve?

Answer 9

Can reduce taste on anterior 2/3rds of the tongue - chorda tympani branch Can decrease lacrimation - greater petrosal branch Can cause paralysis/loss of sensation in the face

Question 10

occurs when there are painful vesicles on the tympanic membrane. This condition is associated with mycoplasma or viral respiratory infections. A similar clinical can occur with herpes zoster of the eardrum which may be associated with facial palsy in Ramsay Hunt syndrome. What is this condition?

Answer 10

This is myringitis bullosa

Question 11

What is the most common type of cancer of the ear?

Answer 11

Squamous cell carcinoma of the ear canal

Question 12

Which cranial nerves may cause referred ear pain?

Answer 12

CN V CN VII CN IX CN X

Question 13

Which cranial nerve supplies the parotid gland?

Answer 13

The glossopharyngeal nerve

Question 14

What is compression of the facial nerve in the facial canal? Can also happen due to herpes virus causing damage to the facial nerve Which herpes virus causes it?

Answer 14

Bell’s palsy - caused by herpes simplex

Question 15

What is the difference between bell’s palsy and ramsay hunt syndrome?

Answer 15

Ramsay hunt is due to reactivation of varicella zoster in the geniculate ganglion (it is now shingles aka herpes zoster) causing facial paralysis and vesicular rash on the ear Bell’s palsy is due to herpes simplex affecting the facial nerve -can cause symptoms of facial nerve palsy

Question 16

The virus causing Chickenpox (varicella) is herpes simplex The virus causing shingles (zoster) is what? Shingles is the reactivation of varicella zoster

Answer 16

Virus is herpes zoster

Question 17

What is the C2 and 3 nerve joining known as? What part of the ear does this supply

Answer 17

Known as the greater auricular nerve Supplies the helix and antihelix and the lobule of ear Also supplies posterior surface of the ear

Question 18

The curvature of the top of the helix is called the crus of the helix What supplies the crus and the tragus with sensory innervation?

Answer 18

The auricolotemporal branch of the mandibular nerve CN V3

Question 19

What is a red flag symptom in an elderly patient or smoker that can be indicative of malignancy?

Answer 19

Otalgia - ear pain

Question 20

A 55 year old man, Bill, presents to you, his doctor with an acutely painful left ear and says “I’ve just flown back from holiday in Spain doctor and I’ve got dreadful earache – it’s killing me – can you take a look” What do you askbefore thinking referred pain?

Answer 20

Any discharge Tinnitus Vertigo Hearing loss Ds - Discharge, din din, dizziness, deafness

Question 21

A 55 year old man, Bill, presents to you, his doctor with an acutely painful left ear and says “I’ve just flown back from holiday in Spain doctor and I’ve got dreadful earache – it’s killing me – can you take a look” In spain you will swim a lot so what diagnosis may you think?

Answer 21

may think otitis externa