Ear Flashcards

(132 cards)

1
Q

What is the sensory supply to the pinna?

A

Upper lateral surface - CN V3 auriculotemporal
Lower lateral/medial - C3 - greater auricular
Superior medial - C2/C3 lesser occipital nerve
External auditory meatus - auricular branch of vagus

So can perform regional nerve blocks

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2
Q

What is the anatomy of the external ear?

A

Auricle/pinna and external acoustic meatus

Lateral third of external acoustic meatus is cartilage, medial two thirds are bony from temporal bone
Contains keratinised squamous epithelium

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3
Q

What is the vascular supply to the auricle?

A

External carotid artery, superficial temporal, occipital

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4
Q

What is the innervation of the external acoustic meatus?

A

Auriculotemporal nerve branch of trigeminal

Auricular nerve - branch of vagus CN X

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5
Q

What is the tympanic membrane?

A

Middle layer of connective tissue
Oblique angle to maximise sound localisation
At centre - umbo attaches to handle of malleus

Transmits sound waves from external ear to ossicles of the middle ear

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6
Q

What is the innervation of the middle ear?

A

Vagus nerve and glossopharyngeal nerve

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7
Q

What is the anatomy of the middle ear?

A

Auditory ossicles - malleus, incus, stapes form oval window and transmit and amplify sound vibrations

Tensor tympani, stapedius muscles

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8
Q

What is the function of the Eustachian tube?

A

Aerates the middle ear to equalise pressure

For optimum movement of the tympanic membrane

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9
Q

What is the anatomy of the inner ear?

A

Vestibulocochlear organs, receives sound waves to convert into electrical signals

Bony labyrinth - vestibule, three semi circular canals and the cochlea. Vestibule contains saccule and utricle to detect linear motion.

Semicircular canals - rotatory movements
Cochlear contains organ of corti containing epithelial cells converting sound waves to electrical impulses

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10
Q

What is ear trauma commonly related to?

A

Sports injuries

Violence

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11
Q

How severe is ear trauma normally?

A

Normally uncomplicated and treatable under local anaesthetic

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12
Q

How should a laceration with exposed cartilage be managed?

A

Cover any exposed cartilage with skin

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13
Q

What may be done if there is skin loss or a skin laceration can’t be closed by primary closure?

A

Plastic reconstructive surgery

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14
Q

What is the main risks with bites to the ear?

A

Infection from skin commensal or oral commensal of offending creature/person
Staph epidermis and S hominid are most prevalent coagulase negative commensals

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15
Q

How would you manage a patient with an ear bite?

A

Take a good history - work out likely organism

Leave wound open

Irrigate wound thoroughly

Antibiotics

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16
Q

Why are pinna haematoma’s dangerous?

A

Disrupt blood supply to cartilage as it normally obtains nutrients via diffusion from vessels in the perichondrium.

Can lead to avascular necrosis

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17
Q

What is cauliflower ear?

A

Cartilage undergoes avascular necrosis which stimulates the formation of new cartilage but it grows asymmetrically

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18
Q

What can cause a tympanic membrane perforation?

A

Blunt force - trauma to side of head
Penetrating trauma - e.g. cotton bud
Otitis media
Barotrauma - explosion/scuba diving

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19
Q

How does a tympanic membrane perforation present?

A

Pain
Conductive hearing loss (possibly)

Can get tinnitus and serosanguineous discharge

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20
Q

How can tympanic membrane perforation be managed?

A

Most heal within 8 weeks- monitoring
Antibiotics if contamination
Keep clean and cry

Not healing after 6 months or hearing loss/recurrent infection - myringoplasty

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21
Q

What can cause haemotympanum?

A

Basal skull fracture - most common
Nasal packing
Bleeding disorders/anticoagulants
Recurrent ear infections

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22
Q

How does haemotympanum present?

A

Seen through tympanic membrane

Associated with conductive hearing loss

Sense of fullness in ear

Pain

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23
Q

How is haemotympanum managed?

A

Treat conservatively but follow up to ensure no residual hearing loss

However commonly associated with other issues - head trauma

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24
Q

What is otitis externa and causes?

A

Inflammation of the skin of the external ear canal
Acute - less than three weeks, chronic >3
Swimmer’s ear - water causes inflammation in ear

Bacterial infection, fungal, eczema, seborrhoeic dermatitis, contact dermatitis

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25
When is it important to think about fungal infection as a cause for otitis externa?
Patients who have had multiple courses of topical antibiotics - kills friendly bacteria that have protective function against fungal infections
26
What are the two most common bacterial causes of otitis externa?
Pseudomonas aeruginosa - gram neg aerobic rod shaped bacteria, grows in moist oxygenated environments e.g. CF Staphylococcus aureus
27
What is the presentation of otitis externa?
Ear pain, discharge, itchiness, conductive hearing loss if becomes blocked On examination - erythema, swelling, tenderness of canal Pus or discharge, lymphadenopathy
28
What is the management of otitis externa?
Mild - acetic acid 2% antifungal and antibacterial (Otomize ear spray) Moderate - topical antibiotic and steroid e.g. Neomycin, dexamethasone, acetic acid Neomycin and bethamethasone Fungal infections with - clotrimazole ear drops
29
What is it important to exclude before prescribing aminoglycosides?
e.g. gentamicin or neomycin Potentially ototoxic, if get past tympanic membrane So exclude perforated tympanic membrane
30
What is malignant otitis externa?
Severe and life threatening form of otitis externa Infection spreads to bones of ear canal Progresses to osteomyelitis of temporal bone Risk factors e.g. diabetes, immunosuppressants, HIV Causes persistent headache, severe pain and fever Granulation tissue at junction between bone and cartilage
31
What is the treatment for malignant otitis externa?
Admission to hospital, ENT treatment IV antibiotics Imaging - CT or MRI head
32
What complications can malignant otitis externa lead to?
``` Facial nerve damage and palsy Other cranial nerve involvement Meningitis Intracranial thrombosis Death ```
33
What is otitis media?
Infection of middle ear, often preceded by viral upper respiratory tract infection
34
What is the cause of otitis media?
Strep pneumoniae most common cause Haemophilus influenzae Moraxella catarrhalis Staph aureus
35
What is the presentation of otitis media?
Ear pain Reduced hearing in affected ear Generally feeling unwell, symptoms of upper airway infection Can cause issues in balance and vertigo if affecting vestibular system Discharge if tympanic membrane perforated
36
What is seen on examination of the ear in otitis media?
Bulging red inflamed looking membrane (as opposed to pearly grey translucent and shiny) If perforation, may see discharge and hole in membrane
37
What is the management of otitis media?
Most cases resolve without antibiotics after 3 days-wk Simple analgesia for pain and fever Immediate abx if significant co-morbidities, systematically unwell or immunocompromised. Delayed prescription - collected after 3 days if still bad Amoxicillin for 5-7 days, clarithromycin if allergic, erythromycin in penicillin allergic women
38
What are the complications of otitis media?
``` Otitis media with effusion Temporary hearing loss Perforated tympanic membrane Labyrinthitis, mastoiditis, abscess Facial nerve palsy Meningitis ```
39
What is chronic suppurative otitis media?
Chronic inflammation of the middle ear and mastoid | Presents with recurrent ear discharges through a tympanic perforation
40
What are the causes of chronic suppurative otitis media?
``` Pseudomonas aerugonisa Staph aureus Proteus species Aspergillus Candida albicans ```
41
What are the risk factors for chronic suppurative otitis media?
``` Younger age - under five Allergy/atopy URTI Acute or recurrent otitis media Exposure to second hand smoke Social deprivation Snoring ```
42
What is the management of chronic suppurative otitis media?
Appropriate antibiotic given topically - careful use of aminoglycosides Intensive microsuction to remove debris Control of granulation tissue
43
What are the types of chronic otitis media?
Active or inactive depending on whether the ear is discharging or not Can be subdivided into mucosal disease or squamous Active - chronic discharge from the middle ear through a tympanic perforation Inactive mucosal disease - tympanic perforation Inactive mucosal - dry perforation Inactive squamous - retraction pocket which has potential to become active with retained debris (keratin) Active mucosal - wet perforation with inflamed middle ear mucosa and discharge Active squamous - cholesteatoma
44
What is active squamous disease in chronic otitis media?
Cholesteatoma | If this is present, surgery is required
45
What is otitis media with effusion?
Middle ear effusion without the signs of infection | Glue ear
46
What are the causes of OME?
Eustachian tube dysfunction - in children smaller and more horizontal, impairing middle ear ventilation Cleft palate Beware of nasopharyngeal tumours in adults which can block drainage
47
What is the presentation of OME?
Conductive hearing loss, behavioural changes May be asymptomatic in an infant Poor speech development Otoscopy - tympanic membrane is dull, visible fluid level
48
What are the investigations for OME?
Pure tone audiogram - conductive hearing loss Tympanometry will show flat trace due to reduced compliance of the tympanic membrane - type b curve In an adult with unilateral effusion, flexible nasoendoscopy FNE to rule out nasopharyngeal tumour
49
What is the treatment for OME?
Antibiotics have no benefit Watch and wait - 50% of OME will resolve spontaneously within 3 months Hearing aids may be useful while waiting to resolve Myringotomy and ventilation tube insertion - grommets that will self extrude after 9 months
50
What common bacterial pathogens can cause an infection/ottorhoea?
``` Pseudomonas aeruginosa Staph aureus Proteus spp. Strep pneumonia Haemophilus influenza Moraxella catarrhalis ```
51
What are the differentials for otorrhoea?
Fungal otitis externa - itchy ear canal, fluffy white discharge/coating of the canal Acute otitis media +- perforation - recent URTI, deep severe ear pain, mucoid ear discahrge Otitis externa - thin watery discharge Necrotising otitis externa/malignant - foul smelling discharge, cranial nerve palsies, unilateral severe pain Cholesteatoma - ear drum retraction, perforation, keratin accumulation, unilateral chronic offensive smelling ear CSF otorrhoea - clear watery discharge, history of trauma or skull base injury
52
What is otosclerosis?
Remodelling of the small bones of the middle ear Leads to conductive hearing loss Usually presents before age 40 Base of stapes attaches to oval window, causing stiffening and fixation and preventing it from transmitting sound correctly Autosomal dominant
53
What is the presentation of otosclerosis?
Patient under 40 Unilateral or bilateral hearing loss, or tinnitus Tends to affect hearing of lower pitched sounds more than higher pitched sounds There is intact sensory hearing, so patient can experience voice being loud - talks quietly
54
What is seen on examination of otosclerosis?
Otoscopy is normal Weber's - normal if otosclerosis is bilateral Unilateral - sound louder in the more affected ear Rinne's - conductive hearing loss
55
What are the investigations for otosclerosis?
Audiometry - conductive hearing loss Bone conduction readings will be normal Hearing loss greater at lower frequencies Tympanometry will show generally reduced admittance (absorption) of sound Tympanic membrane stiff, non compliant, non-absorbant reflects the sound back High resolution CT can detect boney changes
56
What is the management of otosclerosis?
Conservative - use of hearing aids Surgery - successful, can restore to normal Lift tympanic membrane and surrounding skin out of the way to access middle ear through ear canal: Stapedectomy - remove entire stapes and replace with prosthesis Stapedotomy - remove part of stapes bone, leave the base (footplate) attached to oval window Small hole made in base for prosthesis to attach
57
What is vertigo?
Sensation that there is movement between the patient and their environment, a problem with the vestibular system (peripheral) or brainstem/cerebellum (central) Vision, proprioception and signals from the vestibular system are responsible for maintaining balance and posture
58
What are the peripheral/vestibular causes of vertigo?
Benign paroxysmal positional vertigo Meniere's disease Vestibular neuronitis Labyrinthitis ``` Trauma to vestibular nerve Vestibular nerve tumours - acoustic neuroma Otosclerosis Hyperviscosity syndromes Herpes zoster infection - RH syndrome ```
59
What are central causes of vertigo?
Posterior circulation infarction - stroke Tumour - gradual onset Multiple sclerosis - relapsing and remitting Vestibular migraine - triggered by e.g. stress, bright lights, strong smells, certain foods, dehydration
60
What are the differences in presentation between peripheral and central vertigo?
Peripheral - sudden onset, short duration, hearing loss or tinnitus often present, coordination in tact, bad nausea Central - gradual onset, persistent duration, hearing not usually impaired, coordination impaired, mild nausea
61
What are key features that may point to a specific cause of vertigo?
Recent viral illness - labyrinthitis or vestibular neuronitis Headache - vestibular migraine, cerebrovascular accident, brain tumour Ear symptoms e.g. pain, discharge - infection Acute onset neurological symptoms - stroke
62
What should be examined in a patient presenting with vertigo?
Ear examination - any infection or pathology Neurological examination - assess for central causes of vertigo e.g. stroke, or MS Cardiovascular examination - assess for cardiovascular causes of dizziness e.g. arrhythmias or valve disease Special tests: Romberg's test Dix-Hallpike manoevre HINTS examination to distinguish between central and peripheral vertigo
63
What is the HINTS examination?
HI - head impulse test Patient sitting upright and fixing gaze on examiner's nose Examiner holds head then rapidly jerks it 10-20 degrees in one direction whilst still looking at nose Then move back to centre and repeat in opposite direction Patient with abnormally functioning vestibular system - eyes will saccade (rapidly move back and forth) N - Nystagmus Patient look left and right, eyes will saccade Few beats can be normal, unilateral more likely a peripheral cause Test of skew - alterative cover test Patient focuses on examiners nose Cover one eye at a time, eyes should remain fixed on nose with no deviation If there is vertical correction when eye uncovered - drifted up or down - central cause of vertigo
64
What is the management of a patient presenting with vertigo?
Suspected central vertigo - referral for further investigation e.g. CT or MRI head for cause Peripheral vertigo - prochlorperazine, antihistamines Betahistine reduced attacks in Meniere's Epley manoevre for BPPV Triptans, propranolol, amitriptyline for migraines DVLA guide
65
What is the cause of BPPV?
Due to calcium carbonate crystals displaced in semicircular canals May be displaced due to viral infection, trauma, ageing Disrupts flow of endolymph Head movement creates flow of endolymph triggering episodes of vertigo
66
What is the presentation of BPPV?
Head movements trigger episodes, e.g. turning over in bed Symptoms settle after 20-60 seconds Asymptomatic between attacks Occur over several weeks, resolve, then recur Does not cause hearing loss or tinnitus
67
What is the Dix-Hallpike manoeuvre?
Sit upright, head turned 45 degrees to one side - to right to test right ear and vice versa Support head to stay at 45 degrees whilst lowering patient backwards until head hanging off cough Then extend head back 20-30 degrees below couch Watch eyes for 30-60 seconds, look for nystagmus Repeat on other side
68
What is the Epley manoeuvre?
To treat BPPV move crystals so does not disrupt endolymph Follow steps of Dix Hallpike Rotate head 90 degrees past central position Roll onto side so head rotates further 90 degrees Patient sit up sideways with legs off the cough Position head in central position, chin to chest Support head in place for 30 seconds Look for nystagmus
69
What is the treatment for BPPV?
Epley's curative 90% of the time Brandt-Daroff exercises - sit on end of bide and lyinh sideways from one side to the other Surgical management is rare
70
What is Meniere's?
Long term inner ear disorder Excessive build up of endolymph causing higher than normal pressure Endolymphatic hydrops
71
What is the presentation of Meniere's?
40-50 years old Unilateral episodes of vertigo, hearing loss, tinnitus Vertigo comes and goes in episodes, 20 mins, settles Can come in clusters, then prolonged periods is better Hearing loss fluctuates, then becomes more permanent Sensorineural hearing loss, unilateral Fullness in the ear, drop attacks, imbalance
72
What is the management of Meniere's?
For acute attacks - prochlorperazine, antihistamines Prophylaxis with betahistine Pressure reducing therapies e.g. low salt diet medications e.g. betahistine, diuretics Intratympanic injection of steroid or gentamicin Decompression, labyrinthectomy, vestibular nerve section
73
What is vestibular neuronitis?
Inflammation of the vestibular nerve Usually transmits signals from vestibular system to brain for balance, along with cochlear nerve for cochlea for hearing = 8th cranial nerve, vestibulocochlear
74
What is the presentation of vestibular neuronitis?
Recent history of viral upper respiratory tract infection Symptoms most severe for first few days Acute onset of vertigo Initially constant, then triggered/worsened with head movement Nausea and vomiting, balance problems Hearing loss and tinnitus not features of neuronitis - consider labyrinthitis or Meniere's
75
What medical interventions are used in Meniere's disease?
Thiazides - bendroflumathiazide Betahistine (antivertigo) Antiemetic - prochlorperazine
76
What surgical interventions are used in Meniere's disease?
``` Grommets Dexamethasone middle ear injection Endolymph sac decompression Vestibular destruction using middle ear gentamicin injection Surgical labyrinthectomy (rare) ```
77
How is an acute vestibular neuritis investigated?
MRI to exclude acoustic neuroma Excludes lesion along central auditory pathway Pure tone audiogram Head impulse test - eyes will saccade when fixed on examiners nose
78
What is the management of vestibular neuronitis?
Steroids - normally orally, can be injected into middle ear Anti-virals Other treatments e.g. hyperbaric oxygen, carbogen
79
What is labyrinthitis?
Inflammation of the bony labyrinth of the inner ear includes semi-circular canals, vestibule, cochlea Usually following upper respiratory tract infection
80
What is the presentation of labyrinthitis?
Acute onset vertigo Hearing loss Tinnitus Symptoms associated with causative virus - cough, sore throat, blocked nose
81
How can labyrinthitis be diagnosed?
Clinical diagnosis, examination, head impulse test
82
What is the management of labyrinthitis?
Supportive care, short term use of medication Prochlorperazine Antihistamines e.g. cyclizine Antibiotics for bacterial labyrinthitis Underlying infection e.g. otitis media or meningitis needs appropriate treatment - hearing loss key complication of meningitis, hence offered audiology assessment
83
What are causes of sensorineural hearing loss?
Sudden sensorineural hearing loss over 72 hours Presbycusis - age related Noise exposure Meniere's Labyrinthitis Acoustic neuroma Neurological conditions e.g. stroke, MS, brain tumours Infections Medications - loop diuretics, aminoglycoside abx e.g. gentamicin, chemo drugs e.g. cisplatin
84
What are causes of conductive hearing loss?
``` Ear wax or foreign object Infection Fluid in middle ear Eustachian tube dysfunction Perforated tympanic membrane Otosclerosis Cholesteatoma Exostoses Tumours ```
85
What are acoustic neuromas?
Benign tumours of the schwann cells surrounding the auditory nerve innervating the inner ear Usually unilateral, benign - neurofibromatosis type II Occur at the cerebellopontine angle
86
What is the presentation of acoustic neuroma?
``` 40-60 years, gradual onset Unilateral sensorineural hearing loss - first symptom Unilateral tinnitus Dizziness or imbalance Sensation or fullness in the ear ``` Can grow large enough that they can cause facial nerve palsy if compress facial nerve Fore head not spared - lower motor neurone lesion
87
What are the investigations for an acoustic neuroma?
Sensorineural pattern of hearing loss on audiometry | Brain imaging MRI/CT to establish tumour
88
What is the management for an acoustic neuroma?
Conservative if no symptoms or tx inappropriate Surgery - partial or total removal Radiotherapy to reduce growth Risk of vestibulocochlear nerve injury - permanent hearing loss or dizziness Facial nerve injury - facial weakness
89
What is a cholesteatoma?
Abnormal collection of squamous epithelial cells in the middle ear, non-cancerous but can invade
90
What is the pathophysiology of a cholesteatoma?
Negative pressure in the middle ear due to eustachian tube dysfunction causes pocket of tympanic membrane to retract Squamous epithelial cells proliferate out of this pocket Can damage the ossicles and cause hearing loss
91
What is the presentation of a cholesteatoma?
Foul discharge from the ear Unilateral conductive hearing loss Infection, pain, vertigo, facial nerve palsy as continues to grow Otoscopy shows build up of white debris crust in the tympanic membrane
92
What is the management of a cholesteatoma?
CT head to confirm diagnosis, plan for surgery MRI assess invasion, damage to local soft tissues Surgical removal
93
Two muscles are involved in the Acoustic Reflex. What is this and name the muscles involved.
Protective muscles contract in response to loud noises Tensor Tympani and Stapedius
94
What is the difference between Vestibular Neuritis and Labyrinthitis?
Vestibular Neuritis only affect vestibular nerve Labyrinthitis affects vestibular nerve and labyrinth Vestibular Neuritis will not alter hearing
95
What causes Vestibular Neuritis?
Reactivation of latent type 1 HSV in Vestibular Ganglion Commonly preceded by URTI
96
What causes Labyrinthitis?
Usually viral in origin Bacterial is dangerous (passes between anatomical connections) May be associated with systemic disease
97
Name three clinical investigations you could do for suspected Labyrinthitis/VN
Head Impulse Test Nystagmus (consistent and unilateral) Skew
98
Name five investigations for Menieres
``` Full Neurological exam Pure tone audiometry MRI IAM Video Head Impulse testing ECG ```
99
What is an important management step in Menieres?
Inform DVLA
100
Name four risk factors for BPPV
Older Age Women Menieres (co diagnosis in 30%) Anxiety Disorders
101
What does the direction of Nystagmus in BPPV indicate about the canals?
Vertical and Rotary - Posterior Canal | Horizontal - Horizontal canal
102
BPPV is self limiting over a number of weeks but can reoccur. What should you advise the patient?
Notify DVLA Get out of bed slowly Epleys Manouvre (Dix Hallpike but wait for Nystagmus to subside then rotate 90 degrees and sit patient up)
103
Give a differential diagnosis for BPPV
Vestibular Migraine
104
Otosclerosis is caused by the pathological increased bone turnover. Give four risk factors
Genetics (Autosomal Dominant) Oestrogen Viral Lack of fluoride
105
There are two types of tinnitus: Pulsatile and Non Pulsatile. What is Pulsatile tinnitus? What is Non Pulsatile tinnitus?
Synchronous with heartbeat due to turbulent flow reaching cochlea Causes: Carotid Atherosclerosis, AV Malformation, Pagets, Otosclerosis Non-pulsatile Buzzing/high pitched/clicking Causes: Presbyacusis, Menieres, Drugs
106
Name three drugs associated with Tinnitus
Loop Diuretics NSAIDs Salicyclates
107
How is Tinnitus investigated?
MRI (if unilateral to exclude Acoustic Neuroma) Pulsatile - CT/MR Angiography Tinnitus Functional Index
108
Aside from Webers and Rinnes, Pure Tone Audiometry is used to investigate reduced hearing. What is this?
Evaluates the quietest sound that can be heard in each ear | Must exclude wax/infection beforehand
109
Describe the difference in audiometry graphs between Presbyacusis and Menieres
Menieres - hearing loss at a lower frequency | Presbyacusis - hearing loss at a higher frequency
110
Describe four surgical management options for reduced hearing loss
Bone anchored hearing aid Cochlea Implant Stapedectomy and Prosthesis Tympanoplasty
111
Give three management options for excess wax
Topical Olive Oil/Sodium Bicarbonate Microsuction Syringing
112
Name three congenital and two acquired causes of childhood deafness
Congenital - Rubella, Ear Atresia, Ossicular Abnormalities Acquired - Hypoxia, Jaundice, Meningitis, Head Injury
113
What is Ramsey Hunt Syndrome?
Reactivation of Herpes Zoster in geniculate ganglion
114
What are the motor branches of the facial nerve?
Within facial canal - Nerve to Stapedius Prior to Parotid - Posterior Auricular, Nerve to Digastic, Nerve to Omohyoid Within Parotid - Temporal, Zygomatic, Buccal, Mandibular, Cervical
115
Name five clinical features of Ramsay Hunt Syndrome
- Vesicular rash on ipsilateral ear/hard palate/ anterior 2/3 of tongue - Hearing loss - Ipsilateral facial weakness - Drooling - Hyperacusis
116
How is facial paralysis graded?
House Brackmann (I - IV)
117
Ramsey Hunt Syndrome is a clinical diagnosis. What features would point towards an alternative?
Systemic Illness Hearing abnormalities Forehead sparing
118
What are the main management points for Ramsey Hunt Syndrome?
Analgesia Steroids +PPI Aciclovir Eye care
119
What particular things would you want to note in a child with reduced hearing?
``` Age of first word Milestones Vocab extent Pain/Discharge Imbalance DH ```
120
Name three syndromes that include deafness
Waadenberg (+Heterochromia and wide nasal bridge) Jervell Lange Nielson CHARGE
121
Why do Electronic Hearing Aids work better for conductive hearing loss?
Sensorineural causes recruitment - loud sounds are heard exceptionally loudly
122
Name three conditions to avoid in someone who has to lip read
Poor background lighting Beard and Moustache Covering face with hand
123
What is a contraindication to Cochlear Implant?
Middle ear infection
124
Give four otological causes of Otalgia
Otitis Externa Furunculosis Otitis Media Acute Ototic Barotrauma
125
Name a non otological cause of Otalgia
Referred pain (Tonsillitis, Teeth, TMJ)
126
Name two causes of watery otorrhoea
Eczema of external ear | CSF
127
Name two causes of purulent otorrhoea
AOM | Furunculosis
128
Name two causes of bloody otorrhoea
Trauma | AOM
129
Name a cause of foul smelling otorrhoea
Cholesteotoma
130
The causes of vertigo can be diagnosed based on time frame. Give two causes of vertigo lasting 'hours to days'
Ototoxicity | Central vestibular disease
131
What would investigations of Otosclerosis show?
Tympanogram - normal type A Pure Tone Audiometry - Carhart notch (dip at 2kHz)
132
How are audiograms plotted?
Document volume at which patient can hear different tones Frequency in Hz on x axis Volume in dB on y axis X - left sided air conduction ] - left sided bone O - right sided air [ - right sided bone