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Head and Neck > Otology > Flashcards

Otology Flashcards

1
Q

Name six common presenting symptoms in otology cases

A
  • Hearing loss
  • Tinnitus
  • Vertigo
  • Otalgia (pain)
  • Otorrhoea (discharge)
  • Facial weakness
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2
Q

What is otoscopy?

A

Inspection of the ear canal with an otoscope

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3
Q

What are the benefits of microscopic examination of the ear?

A
  • Magnification
  • Three dimensions
  • Suction (wax or debris to improve visualisation)
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4
Q

Name three examination techniques to determine hearing loss?

A
  • Rinne’s test
  • Weber’s test
  • Whispered voice test
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5
Q

What is the process of the rinne’s test?

A

Tuning fork places on mastoid process and then exterior ear, important for patient to distinguish which is heard loudest

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6
Q

Explain a postive result of a Rinne’s test

A
  • Normal ear: AC > BC
  • Sensorineural hearing loss: inner ear not working, but as outer and middle ear is working so AC and BC is reduced in proportion so will still be positive
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7
Q

Explain a negative Rinne’s test result

A

Conductive hearing loss: BC louder than AC as sound waves are not conducted through outer or middle ear, but bypasses middle ear and travels to inner ear

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8
Q

What is the process of a Weber’s test?

A

Tuning fork placed on the middle of the forehead and sound travels through the skull to the inner ear

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9
Q

Explain a ‘central’ result of a Weber’s test?

A

Hearing is symmetrical (R ear = L ear)

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10
Q

Explain a ‘lateralises to left’ result of a Weber’s test with right ear hearing loss?

A

If there is hearing loss in the R ear, sound lateralises to the left

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11
Q

Explain a ‘lateralises to right’ result of a Weber’s test with right ear hearing loss?

A

Conductive hearing loss in right ear but hear is better in right ear as no other sound waves are travelling through ear compared to left to distract signal from tuning fork

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12
Q

Describe the process of the whispered voice test

A
  • Whispered voice at 60cm
  • Mask other ear
  • No lip reading
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13
Q

Describe the process of a pure tone audiogram?

A

Hearing test used to identify hearing threshold levels of an individual

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14
Q

What indicates normal hearing from a pure tone audiogram?

A

Hearing better than 20dB

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15
Q

What indicates conductive hearing loss from a pure tone audiogram?

A

Bone conduction better than air conduction

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16
Q

What indicates sensorineural hearing loss from a pure tone audiogram?

A

Bone conduction is the same as air conduction

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17
Q

What is sensorihearing loss?

A

Damage to the hair cells in the inner ear or to the nerve pathways that lead from the inner ear to the brain

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18
Q

Name two investigations for hearing loss?

A
  • Pure tone audiogram

* Tympanogram

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19
Q

What is a tympanogram?

A

Investigation to determine the relationship between the air pressure in the ear canal and the movement of the ear drum

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20
Q

Describe a normal tympanogram reading

A

Normal middle ear pressure and compliance

On graph: peak pressure under the ear drum is 0 (equal to atmospheric pressure)

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21
Q

Describe a low compliant tympanogram reading

A

Low middle ear compliance - no movement in ear drum due to perforation or fluid in the ear drum

On graph: line is flat

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22
Q

Describe a low pressure tympanogram reading

A

Low middle ear pressure - usually due to malfunction of Eustachian tube

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23
Q

Name three management strategies for auricular haematoma?

A
  • Incision and drainage
  • Pressure dressing
  • Antibiotics

Need to prevent cartilage becoming infected and necrosing as difficult to correct

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24
Q

Name a complication of an auricular haematoma

A

Cauliflower ear

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25
Q

Describe the management of foreign body in the ear canal

A

Urgent removal as can affect nasal/oral cavity if infection is prolonged

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26
Q

What are Otitis Externa?

A

Inflammation of external auditory meatus

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27
Q

Name three symptoms of otitis external

A
  • Hearing loss (debris blockage)
  • Pain
  • Discharge
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28
Q

Describe the management of otitis externa

A
  • Antibiotic/steroid ear drops

* +/- suction under microscope

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29
Q

What is suggested to prevent otitis externa?

A

No water or cotton buds in ear

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30
Q

What is malignant otitis externa?

A

Osteomyelitis of temporal bone

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31
Q

Name symptoms of malignant otitis externa

A
  • Severe pain in elderly or diabetic
  • Granulations in external auditory meatus
  • +/- cranial nerve palsies
32
Q

What is the management of malignant otitis externa?

A

Antibiotics for weeks or months

33
Q

What is ‘dead’ ear?

A

Spread of infection to inner ear –> dead ear where there is no hearing or auditory function in that ear

34
Q

What are two causes of chronic suppurative otitis media?

A
  • Perforated tympanic membrane

* Cholesteatoma (skin in middle ear +/- mastoid bone)

35
Q

What are four complications of chronic suppurative otitis media?

A
  • Dead ear
  • Facial palsy
  • Meningitis
  • Brain abscess
36
Q

What is myringoplasty?

A

Surgery to repair holes in ear drums

37
Q

What are six causes of sensorineural hearing loss?

A
  • Presbyacusis
  • Head injury
  • Viral infections
  • Noise exposure
  • Ototoxic meds (gentamicin)
  • Acoustic neuroma
38
Q

What is acoustic neuroma?

A

Benign tumour that presents as hearing loss in one ear

39
Q

What is vertigo?

A

Any perception of movement

40
Q

What is tinnitus?

A

Any perception of sound

41
Q

Name differential diagnoses for vertigo

A
  • Benign positional vertigo
  • Menieres disease
  • Vestibular neuritis/labyrinthitis
  • Migraine
42
Q

Why use bendroflumethazide to treat meniere’s disease?

A

To reduce endolymph pressure

43
Q

Why use Intratympanic gentamicin to treat meniere’s disease?

A

Use ototoxic properties to destroy hair cells (will make hearing worse)

44
Q

What are differential diagnoses for facial nerve palsy?

A
  • Intratemporal i.e. choesteatoma
  • Extratemporal i.e. parotid tumour
  • Idiopathic = bell’s palsy
45
Q

What is otitis media with effusion?

A

Sterile fluid in middle ear (“glue ear”)

46
Q

What is the presentation of OM with effusion?

A
  • Hearing loss

* Speech delay as a result of hearing loss

47
Q

What is the management for OM with effusion?

A
  • Usually self limiting
  • Otovent - child blows balloons with nose to open eustacian tube
  • Grommet - if it doesn’t heal, use tube in ear drum to equalise pressure
48
Q

What is acute suppurative OM?

A

Pus in the middle ear

49
Q

What is the presentation o acute suppurative OM?

A
  • Otalgia

* +/- otorrhoea

50
Q

What is the treatment for acute suppurative OM?

A
  • Observation

* Amoxycillin

51
Q

What is tympanosclerosis?

A

Calcification in tympanic membrane +/- middle ear

52
Q

What can cause tympanosclerosis?

A

Bleeding between the layers of the ear drum which is caused by infection, trauma or grommet

53
Q

What is the presentation and management for tympanosclerosis?

A

Usually asymptomatic and usually no treatment

54
Q

What are three causes of a perforated tympanic membrane?

A
  • Infection
  • Trauma
  • Grommet
55
Q

What is the presentation of a perforated tympanic membrane?

A
  • Recurrent infection

* Hearing loss

56
Q

What is the treatment of a perforated tympanic membrane?

A
  • Water precautions

* +/- myringoplasty

57
Q

What are causes of a Cholesteatoma?

A
  • Eustacian tub dysfunction - low pressure in ear drum and eventually gets sucked inwards
  • Impaired skin migration causing it to build up
58
Q

What is the presentation and treatment for Cholesteatoma?

A

Persistent offensive otorrhoea and treated with mastoidectomy

59
Q

What is otosclerosis?

A

Fixation of stapes by extra bone - stoping it from movement and thus unable to conduct sound waves

60
Q

What is the presentation of otosclerosis?

A
  • Conductive hearing loss

* Normal tympanic membrane

61
Q

What is the treatment of otosclerosis?

A
  • Hearing aid

* Stapedetomy

62
Q

When to refer cases of tinnitus?

A

If it is unilateral or pulsatile - could be acoustic neuroma

63
Q

What is the management of tinnitus?

A
  • Treat underlying cause (if possible)
  • Sound enrichment
  • Stress management
64
Q

What is benign positional vertigo?

A

Otoconia in semicircular canals

65
Q

What is the presentation of benign positional vertigo?

A
  • Vertigo precipitated by specific changes in head position
  • Duration: seconds
  • No associated symptoms
  • Nyastagmus: positional and rotatory
66
Q

What is nyastagmus?

A

A condition of involuntary eye movement

67
Q

What is the investigation used for benign positional vertigo?

A

Dix-Hallpike test

68
Q

What is the treatment of benign positional vertigo?

A

Epley manoeuvre

69
Q

What is Meniere’s Disease?

A

Endolymphatic hydros - raised pressure in the endolymph

Increased pressure —> dizziness

70
Q

What is the presentation of Meniere’s Disease?

A
  • Spontaneous vertigo
  • Associated unilateral hearing loss / tinnitus / aural fullness
  • Duration: hours
71
Q

What is the management of Meniere’s Disease?

A
  • Bendroflumethazide (reduce pressure)
  • Intratympanic dexamethasone
  • Intratympanic gentamicin
72
Q

What is the presentation of a migraine?

A 
Spontaneous vertigo
\+/-:
• Headache, sensory sensitivity
• Precipitated by migraine triggers
• Past history of migraine
73
Q

What is the management of a migraine?

A
  • Avoid triggers

* Prophylactic medication

74
Q

What is the presentation of facial nerve palsy?

A

Lower motor neurone facial palsy (forehead involved)

75
Q

What is the management of facial nerve palsy?

A
  • Treat underlying cause
  • Steroid
  • Eye care

Head and Neck (12 decks)

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