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MBChB - Y2 - Head and Neck > Otology > Flashcards

Otology Flashcards

1
Q

What is otorrhoea?

A

Ear discharge

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2
Q

When is a Rinne’s test positive and negative?

A

Positive when air conduction is greater than bone conduction

(in the case of a normal ear, or in the case where there is a sensorineural hearing loss)

Negative when there is a conductive hearing loss

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3
Q

What portion of the ear is responsible for sensironeural hearing loss and conductive hearing loss?

A

Sensironeural - problems with the inner ear

Conductive - problems with the middle ear

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4
Q

Which way does the sound lateralise in a webers test with sensorineural hearing loss?

A

Lateralises to the side without the hearing loss

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5
Q

What direction does the sound lateralise in the Weber’s test on a patient with conductive hearing loss?

A

Lateralises to the side with the conductive hearing loss

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6
Q

What do the types A, B and C indicate?

A

A - Normal

B - Tympanic membrane immobile

C - Middle ear pressure is low

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7
Q

What does tympanometry measure?

A

Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum(tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal.

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8
Q

What is tympanometry used to determine?

A

Can be used to establish the difference between conductive hearing loss and sensorineural hearing loss, when results from the weber or Rinne test are unclear.

Can be used to help in the diagnosis of otitis media, used to determine the presence of fluid in the middle ear

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9
Q

What are the common pathologies of the outer ear?

A

Auricular haematoma, foreign body, Otitis externa, malignant otitis externa

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10
Q

What is an auricular haematoma?

A

Shearing forces to the anterior auricle can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage. This may lead to tearing of the perichondrial blood vessels and subsequent hematoma formation.

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11
Q

What is otitis externa?

A

Inflammation of the ear canal

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12
Q

What causes otitis externa?

A

Acute cases are typically due to bacterial infection, and chronic cases are often due to allergies and autoimmune disorders

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13
Q

What is malignant otitis externa?

A

Aggressive otitis externa - The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and swelling may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if it continues to spread.

Involves osteomyelitis of the temporal bone

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14
Q

What are the pathologies of the middle ear?

A

Otitis media

Tympanosclerosis

Osteosclerosis

Cholesteatoma

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15
Q

Why does otits media lead to effusion?

A

Eustachain tube doesn’t work, middle ear lining continues to absorb air, pressure becomes less and therefore secretes fluid to fill the vacuum

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16
Q

What is the purpose of a grommet?

A

Bypasses eustachian tube to equalise pressure.

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17
Q

What are the symptoms of acute otitis media?

A

earache

a high temperature (fever)

being sick

a lack of energy

slight hearing loss – if the middle ear becomes filled with fluid, hearing loss may be a sign of glue ear, also known as otitis media with effusion

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18
Q

What is chronic suppurative otitis media?

A

Chronic suppurative otitis media (CSOM) is middle ear inflammation of greater than two weeks that results in episodes of discharge from the ear.

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19
Q

What can happen to the tympanic membrane as a result of otitis media?

A

Rupture

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20
Q

What is a cholesteatoma?

A

Growth of skin in the middle ear

21
Q

What can the skin of a cholesteatoma erode?

A

May erode the base of the skull (mastoid bone), ossicles, brain and the facial nerve

22
Q

What is typical history for cholesteatoma?

A

Smelly discharge from the ear, hearing loss

23
Q

What is tympanosclerosis?

A

Hyalinization and subsequent calcification of subepithelial connective tissue of TM and middle ear, sometimes resulting in a detrimental effect to hearing

24
Q

What kind of hearing loss does ostosclerosis cause?

A

Conductive hearing loss

Sounds reach the ear drum but are incompletely transferred via the ossicular chain in the middle ear, and thus partly fail to reach the inner ear (cochlea).

On audiometry, the hearing loss is characteristically low-frequency, with higher frequencies being affected later.

25
Q

What are the pathologies associated with the inner ear?

A

Presbyacusis

Noise induced haring loss

Ototoxic medications

Meniere’s disease

Head injury

Infections

Vestibular schwannoma

26
Q

What is presbyacusis?

A

Hearling loss associated with age - begins over the age of 30 - associated with high frequency loss

27
Q

What is Ménière’s disease?

A

A disease of unknown cause affecting the membranous labyrinth of the ear, causing progressive deafness and attacks of tinnitus and vertigo.

Attacks usually last hours

28
Q

What is vestibular schwannoma?

A

A vestibular schwannoma (VS) is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (8th cranial nerve). A type ofschwannoma, this tumor arises from the Schwann cells responsible for the myelin sheath that helps keep peripheral nerves insulated.

29
Q

What are the symptoms of vestibular schwannoma?

A

The primary symptoms of vestibular schwannoma are unexplained progressive unilateral hearing loss and tinnitus, and vestibular (disequilibrium) symptoms.

30
Q

What is the investigation for schwannoma?

A

MRI

31
Q

What is the treatment for vestibular schwannoma?

A

Treatment of the condition is by surgery or radiation, and often results in substantial or complete hearing loss in the affected ear. Observation (non-treatment) over time also usually results in hearing loss in the affected ear.

32
Q

Why is unilateral tinitus on one ear often reffered for an MRI scan?

A

Risk of vestibular schwannoma

33
Q

What are the important factors in the pathology of tinnitus?

A

No directly treatable pathology in vast majority of patients - hearing loss and stress are important in the development of tinnitus

34
Q

What is the treatment of tinnitus?

A

Sound enrichment and sound management

35
Q

What is the differential diagnosis for vertigo?

A

benign positional vertigo

Ménières disease

vestibular neuritis / labyrinthitis

migraine

36
Q

What is vestibular neuritis?

A

Vestibular neuronitis, or neuritis, is an infection of the vestibular nerve in the inner ear. It causes the vestibular nerve to become inflamed, disrupting your sense of balance.

37
Q

What is the difference between vestibular neuritis and labrynthitis?

A

Labrynthitis also has associated hearing loss

38
Q

What are the causes of vestibular neuritis?

A

The vestibular nerve usually becomes inflamed because of a viral infection, which may have started with a sore throat, cold or flu.

Vestibular neuronitis can also be caused by a bacterial infection, such as a middle ear infection or meningitis, although this is much less common. Bacteria can also get into your inner ear if you have a head injury.

39
Q

What are the common symptoms of vestibular neuritis?

A

Dizziness and vertigo

Nystagmus is indicative of the malfunction of the bodies balance system

40
Q

Describe the vertigo present in vestibular neuritis

A

Residual motion - provoked

41
Q

What is treatment for vestibular neuritis?

A

Acute - vestibular sedatives

Chronic - vestibular rehabilitation

42
Q

What is the pathology of Ménière’s disease?

A

Raising pressure in endolymphatic portions of the cochlea

‘endolymphatic hydrops’

43
Q

What is the treatment for Ménière’s disease?

A

betahistine

bendrofluazide

intratympanic dexamethasone

intratympanic gentamicin

44
Q

What are the clinical features of migraine?

A

spontaneous vertigo

duration: variable
frequency: variable

± headache, sensory sensitivity, auras

± precipitated by migraine triggers

± past history of migraine

45
Q

What is the treatment for migraines?

A

Avoid triggers

Prophylactic medication

46
Q

What are the temporal and intratemporal causes of facial palsy?

A

Intratemporal: Cholesteatoma

Extratemporal: Patorid gland tumour

47
Q

What is Bell’s palsy?

A

Facial palsy with no apparent cause

48
Q

What is the onset of bells palsy?

A

Acute

49
Q
A

MBChB - Y2 - Head and Neck (12 decks)

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