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Conditions Of The Ear Flashcards

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1
Q

What conditions can affect the pinna?

A
  • Perichondritis
  • Ramsay Hunt Syndrome
  • Cauliflower ear
  • Pinna Haematoma
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2
Q

Presentation of Ramsay Hunt Syndrome

A

Facial nerve palsy
Painful red ear with vesicles

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3
Q

What is a pinna haematoma?

A

Accumulation of blood between cartilage and overlying perichondrium

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4
Q

What is a pinna haematoma due to?

A

Blunt trauma
eg. Contact sport

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5
Q

What happens to an untreated pinna haematoma?

A
  • cartilage is deprived of blood + pressure necrosis
  • fibrosis of cartilage > new asymmetrical cartilage development (cauliflower ear)
  • hearing not impaired but cosmetic implications
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6
Q

Treatment of pinna haematoma

A
  • Drainage + aspirate
  • Prevent re-accumulation using a dressing between the two layers
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7
Q

What conditions affect the external auditory meatus?

A
  • acute otitis externa
  • necrotising otitis externa
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8
Q

What is acute otitis externa?

A

Inflammation of external acoustic meatus usually due to infection (staph aureus or pseudomonas aeruginosa)

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9
Q

What organism normally causes otitis externa?

A

staphylococcus aureus
pseudomonas aeruginosa

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10
Q

Presentation of acute otitis externa

A

Otalgia
Custard like discharge
+/- hearing loss

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11
Q

Risk factors of acute otitis externa

A
  • injury to EAM e.g. scratch from itching
  • swimming
  • warm weather
  • skin problems e.g. eczema
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12
Q

Treatment of acute otitis externa

A

Ear drops
(Topical antibiotics +/- steroids)

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13
Q

Presentation of necrotising otitis externa

A
  • severe otalgia (may keep them up at night)
  • purulent discharge
  • non resolving acute otitis externa
  • hearing loss
  • CN involvement
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14
Q

What is the main organism that causes necrotising otitis externa?

A

Pseudomonas aeruginosa

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15
Q

Risk factors of necrotising otitis externa

A
  • male
  • diabetic
  • immunocompromised
  • > 65 years old
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16
Q

What is necrotising otitis externa?

A
  • complication of otitis externa
  • infection spreads deeper > osteomyelitis of temporal bone + skull base
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17
Q

Treatment of necrotising otitis externa

A
  • IV antibiotics
  • Analgesia
  • Discharged with oral antibiotics (+ topical drops)
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18
Q

What is the best imagining if suspecting necrotising otitis externa?

A

CT of temporal bone

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19
Q

Why are middle ear infections more common in children?

A

Shorter, more horizontal pharyngotympanic tube

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20
Q

Conditions affecting the middle ear

A

Acute otitis media (+/- effusion)
Mastoiditis
Cholesteatoma

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21
Q

What is acute otitis media?

A

Middle ear infection

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22
Q

Presentation of acute otitis media

A
  • infants
  • otalgia (child pulling ear as can’t communicate)
  • fever
  • red +/- bulging tympanic membrane
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23
Q

Treatment of acute otitis media

A
  • most will resolve in 3-7 days
  • analgesia e.g. calpol, paracetamol
  • back up antibiotic prescription if doesn’t self resolve - amoxicillin
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24
Q

Complications of acute otitis media

A
  • tympanic membrane perforation
  • facial nerve involvement
  • mastoiditis
  • intracranial complications e.g. meningitis, sigmoid sinus thrombosis, brain abscess
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25
Presentation of mastoiditis
- sharp angle behind hear lost (boggy oedema) - pinna pushed down and forward - unwell + fever - signs + symptoms of acute otitis media
26
How can infection spread from the middle ear to the mastoid bone?
Middle ear > mastoid antrum > mastoid air cell (mastoid bone)
27
Presentation of otitis media with effusion
Well child Hearing loss (like turning up the tv)
28
What is otitis media with effusion due to?
- due to pharyngotympanic dysfunction - negative pressure in middle ear + inflammatory fluid activation - decreased mobility of TM + ossicles > affecting hearing
29
What is another name for otitis media with effusion?
Glue ear
30
Treatment of otitis media with effusion
- most resolve in 2-3 months - grommets to maintain equilibration of pressures
31
Function of grommets
Act to maintain equilibration of pressures
32
What is cholesteatoma?
- congenital or acquired - retraction pocket in tympanic membrane > dead skin accumulates - grows into middle ear and beyond
33
Presentation of cholesteatoma
- foul smelling discharge from ear - +/- progressive hearing loss
34
Treatment of cholesteatoma
Surgical treatment (Mastoidectomy)
35
Conditions that affect the inner ear
- age related hearing loss (presbycusis) - Benign paroxysmal positional vertigo - Meniere’ disease - acute labyrinthitis + acute vestibular neuronitis
36
What is presbycusis?
Age related hearing loss Bilateral + gradual
37
Presentation of Ménière’s disease
- 40-60 years - Unilateral - Vertigo (potentially associated with aural fullness, N+V) - Tinnitus - Hearing loss - between 20 mins to several hours
38
Typical history of a patient with BPPV
- older - episodes of short lived vertigo in response to change in position
39
Treatment of BPPV How does it work?
**Epley manoeuvre** Moves the otoliths back into the utricle + saccule
40
How does BPPV happen?
Otoliths in semicircular canals move due to change in position which is perceived by the body as movement > vertigo
41
Diagnosis of BPPV
Dix-Hallpike manoeuvre
42
Where are otoliths normally located?
Utricle Saccule
43
Triad of Ménière’s disease
Vertigo Tinnitus Hearing loss
44
Describe acute labyrinthitis
- prior history of URTI - involvement of all inner ear structures - hearing loss - tinnitus - vomiting - vertigo
45
Presentation of acute labyrinthitis
Hearing loss Tinnitus Vomiting Vertigo Prior history of URTI
46
Presentation of acute vestibular neuronitis
- Sudden onset vomiting - Severe vertigo lasting days - No hearing loss or tinnitus
47
Compare the presentation of acute labyrinthitis + acute vascular neuronitis
- both present with vomiting + vertigo (more severe in AVN) - only hearing loss + tinnitus in AL
48
What is needed if a patient presents with sudden onset unilateral hearing loss with no explanation?
- immediate referral to ENT - need to rule out **sudden sensorineural hearing loss** + **acosutic neuroma/vestibular shwannoma**
49
Describe conductive hearing loss Examples
Pathology involving the external or middle ear *e.g. wax, acute otitis media, otitis media with effusion, otosclerosis*
50
Presentation of otosclerosis
Gradual hearing loss Unilateral > bilateral overtime Otherwise well Tinnitus Young female
51
What is otosclerosis?
Gradual hearing loss over years Due to bony growth on stapes
52
Treatment of otosclerosis
Hearing aids Surgical (replacing stapes with prosthesis)
53
Describe sensorineural hearing loss Examples
Pathology involving inner ear structures or vestibulocochlear nerve *e.g. age related hearing loss, noise related hearing loss, Meinere’s disease, ototoxic meds, acoustic neuroma, suddent sensorineural hearing loss*
54
What is an acoustic neuroma/vestibular schwannoma?
- Benign slow growing posterior cranial fossa tumour - Involves Schwann cells of vestibular component of CN VIII
55
Presentation of acoustic neuroma
Unilateral hearing loss Tinnitus Vertigo Facial nerve palsy
56
What is needed to diagnose acoustic neuroma?
MRI
57
Treatment of acoustic neuroma
Observe if small Surgery Radiation
58
Parts of the surface anatomy of the external ear
Helix Antihelix Concha Tragus Antitragus Lobule
59
Is air or bone conduction better normally?
Air conduction is better
60
In conductive hearing loss, is air or bone conduction better?
Bone conduction
61
In sensorineural hearing loss is air or bone conduction better?
Air conduction
62
Normal findings of a Weber’s test
Centre (Equal in both ears)
63
Findings of a Weber’s test in conductive hearing loss
Sound lateralises **towards pathology**
64
Findings of Weber’s test in sensorineural hearing loss
Sound lateralises away from pathology
65
A patient come to the GP complaining of a foul smelling discharge coming from their ear, what is the most likely diagnosis?
Cholesteatoma
66
What organism causes Ramsay Hunt syndrome?
Varicella zoster
67
Tympanic membrane pathologies
- perforations (wet vs dry) - cholesteatoma - tympano sclerosis
68
Wet vs dry tympanic membrane perforation
-
69
Types of tympanic membrane perforation related to location
- **peripheral** - at the edge - **central** - in pars tense - **attic** - upper part of TM (pars flaccida) | associated with cholesteatoma
70
Describe what you would see during an otoscope exam in a child with otitis media with effusion?
- TM is retracted due to negative pressure - loss of cone of light - straw coloured fluid
71
Describe what you would see during an otoscope exam in a child with otitis media without perforation or effusion
Bulging, red + inflamed tympanic membrane
72
Describe what you would see during an otoscope exam in a child with otitis externa
Oedematous, inflamed EAM +/- discharge
73
What is vestibulopathy?
It includes many disorders of the inner ear: - bilateral vestibulopathy - central vestibulopathy - post traumatic vestibulopathy - peripheral vestibulopathy - recurrent vestibulopathy - visual vestibulopathy - neurotoxic vestibulopathy
74
Causes of bilateral vestibulopathy
- inner ear damage *e.g. medications - macrolide abx, loop diuretics, chemo drugs* - autoimmune disease that cause inflammation to inner ear over time - Ménière’s disease - acoustic neuroma - meningitis - genetic or Congential abnormalities - idiopathic
75
Presentation of bilateral vestibulopathy
- reduced balance function - unsteadiness/disorientation - blurred/jumpy vision - fatigue - neck ache - brain fog - gait and balance problems are worse if dark or on uneven surfaces
76
What is oscilloscia?
A vision problem which causes still objects to jump, jiggle or vibrate due to misalignment of eyes or balance system issue
77
Examples of vestibular function tests
- video-nystagmography - rotational chair test - caloric test
78
Management of bilateral vestibulopathy
- avoid trigger situations - vestibular rehabilitation - treat underlying cause if possible - walking aids if severe - avoid/stop too toxic medications - stop medications which can cause dizziness *e.g. antiemetics, benzodiazepines, CCBs*
79
What is vestibular rehabilitation?
- type of exercise based therapy to help the brain re-learn how to balance + how to respond to signals rom the visual, vestibular and proprioceptive systems
80
What test can you use to assess balance?
Romberg test Standing up with eyes closed
81
Presentation of vestibular migraine
Migraine in combination with vertigo, imbalance, nausea + vomiting
82
What can trigger vestibular migraines?
- stress - bright lights - strong smells - certain foods - menstruation - abnormal sleep patterns
83
Central vs peripheral vertigo
- **central**: pathology related to the cerebellum or brainstem - **peripheral**: pathology in the inner ear
84
Common pathology causing central vertigo
- posterior circulation infarction (stroke) - tumour - multiple sclerosis - vestibular migrainene
85
Common causes of peripheral vertigo
- BPPV - Meniere's disease - Labyrinthitis - Vestibular neuronitis
86
What examinations may you want to do on a person presenting with vertigo?
- cerebellar exam - DANISH - romberg's test - dix-hallpike manoeurve
87
Drug management of peripheral vertigo
- prochlorperazine - antihistamines
88
What is audiometry?
- Testing a patient’s hearing by playing a variety of tones + volumes using headphones (air conduction) + a bone conduction device (oscillator) - the quietest a person can hear different frequencies
89
Outline the lay out of audiogram chart
- frequency (Hz) on x axis: left lower pitch > right higher pitch - volume (dB) on y axis: higher up quiet > lower down louder - X left sided air conduction - ] left sided bone condition - O right sided air condition - [ right sided bone conduction
90
How is air conduction measured?
Using headphones
91
How is bone condition measured?
A bone conduction device (An oscillatory)
92
What is masking?
Presenting noise to the non-test ear to prevent it from participating in the hearing
93
Results of on audiogram in: - normal hearing - sensorineural hearing loss - conductive hearing loss - mixed hearing loss
- **normal hearing: all readings will be 0-20dB - **sensorineural hearing loss**: air + bone readings will be >20dB - **conductive hearing loss**: bone readings normal 0-20dB | air conduction >20dB - **mixed hearing loss**: air + bone >20dB but >15dB between the two | bone>air
94
Results of audiogram in normal hearing
All readings between 0-20dB
95
Results of audiogram in sensorineural hearing loss
Both bone + air readings will be <20dB
96
Results of audiogram in conductive hearing loss
Bone conduction normal 0-20dB Air condition >20dB
97
Results of audiogram in mixed hearing loss
Both air + bone <20dB Difference of >15dB between the two Bone > air

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