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Ear, Nose and Throat > Ear > Flashcards

Ear Flashcards

1
Q

Classify the common causes of dysequilibrium according to duration?

A

Seconds

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Positional Hypotension
  • Cervical Spondylosis

Minutes - Hours

  • Labyrinthitis
  • Meniere’s disease

Hours - Days

  • Vestibular neuritis
  • Labyrinthine failure
  • Drugs
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2
Q

What are the signs/symptoms of Vestibular neuritis?

A

Acute vertigo lasting a few days

Nausea and vomiting

NO hearing loss

Usually in middle aged

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3
Q

What is the management of vestibular neuritis?

A

Supportive

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4
Q

What is the signs/symptoms of Meniere’s disease?

A

(Endolymph hydrops - idopathic inner ear disorder)

Vertigo lastings mins - hours

Tinnitis - worst before an attack

Unilateral paroxysmal fluctuation sensorineural hearing loss

Aural fullness

Symptoms may subside after 10-20 years

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5
Q

What is the management of Meniere’s disease?

A

Medical

  • Low sodium diet
  • Diuretics
  • Dietary restrictions
  • Intra-tympanic aminoglycoside administration

Surgical

  • For failed medical management
  • Endolymph sac decompression
  • Vestibular nerve sections
  • Labyrinthectomy (ablates hearing)
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6
Q

What are the signs/symptoms of BPPV?

A

Rotatary vertigo lasting seconds

Acute onset

Nausea

Normal neuro exam

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7
Q

What is the management of BPPV?

A

Epley’s manouvre

Step 1: Start sitting up on a bed, with your legs flat on the bed in front of you. Turn your head 45 degrees to the left.

Step 2: Lie down, keeping your head turned to the left. Wait 30 seconds.

Step 3: Turn your head to the right 90 degrees, until it’s facing 45 degrees to your right side. Wait 30 seconds.

Step 4: Roll over onto your right side before sitting up.

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8
Q

List the possible causes of conductive hearing loss

A

EAC:

  • Wax
  • Exostoses

Tympanic Membrane

  • Perforation
  • CSOM

Middle Ear

  • Middle Ear Effusion
  • Otitis Media with Effusion
  • Ossicular chain dysfunction
  • Otosclerosis
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9
Q

List the possible causes of sensorineural hearing loss

A

Age Related

Noise Induced

Drugs

  • Aminoglycosides
  • Streptomycin injections for TB
  • Cytotoxic - chemo drugs

Syphilis

Acoustic neuroma

Vascular

  • DM
  • HPT

Labyrinthitis

Perilymph fistula

Genetic (idiopathic)

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10
Q

What are the important things to note in a patient who complains of hearing loss?

A

SOCRATES

  • Site
  • Onset
  • Character
  • Radiation
  • Associated factors - Tinnitis, Disequilibrium
  • Time
  • Exacerbating/relieving factors
  • Severity (pain history)
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11
Q

What clinical tests can be done to assess hearing loss?

A

Loock test

Rinne

Weber

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12
Q

How could you investigate hearing loss?

A

Objective

  • Tympanometry
  • Oto-Acoustic Emission
  • Brainstem audiometry
  • MRI

Subjective
* Pure tone Audiometry

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13
Q

Classify hearing loss

A

Mild: 25-40 dB

Moderate: 40-60 dB

Severe: 60-90 dB

Profound: >90 dB

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14
Q

What is the management of obstructive earwax induced hearing loss?

A

Syringing

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15
Q

When would you not syringe an ear?

A

When there is a known perforation coz’ it can introduce infection

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16
Q

Discuss the management of traumatic perforations

A

Dry perforations

  • Should heal within a day
  • Keep dry

If wet control infection and get dry

  • Dry mopping
  • Boric Acid Powder
  • Quinolone Drops
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17
Q

Classify Chronic Supperative Otitis Media

A

With Cholesteotoma

Without Cholesteotoma

TB

  • More aggressive on local structures
  • CN7 palsy
  • White patches
  • Multiple perforation
  • Ossicular destruction/exposed
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18
Q

What are the complications of CSOM?

A

TM perfs

Ossicular Chain Damage

Chronic Hearing Loss

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19
Q

Discuss Otitis Media with Effusion (Glue Ear)

A

Most common cause of acquired conductive hearing loss in children - Unusual in adults

ET dysfunction resulting in negative pressure in middle ear > Body compensated & fills space with effusion

Causes..

  • Enlarged adenoids
  • URTI
  • Sinusitis
  • Bronchitis

NB if persists >3/52 exclude:
* Chronic Sinusitis / Nasophar. Ca.

Treat the cause

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20
Q

Discuss Tympanosclerosis

A

Scar tissue formation in the tympanic membrane

Associated with Grommets

Very seldom causes hearing loss > Reassure

21
Q

Discuss Otosclerosis

A

Overgrowth of bone fixes stapes footplate

Familial

Signs:

  • Conductive HL
  • Bilateral
  • No other cause

Management
* Hearing aid + Stapedectomy

22
Q

What are the 3 characteristic inner ear symptoms of sudden sensorineural hearing loss?

A

Sensorineural hearing loss
* 30 dB loss over 3 adjacent frequencies over 3 days

Tinnitus

Vertigo

23
Q

What is the management of sudden sensorineural hearing loss?

A

ENT emergency

High dose Steriods - 1mg/kg for 10days

Vasodilators - Betahistine

Serial audiometry

24
Q

Discuss Presbyacusis

A

Age-related hearing loss
> 60 years

Characteristics:

  • Hi>low (Sloping Audiogram)
  • Decrease speech discrim.
  • Recruitment (compensation)
  • Decreased Dynamic Range

Managed with Hearing Aid

25
Q

Discuss noise-induced hearing loss

A

Prolonged exposure >80-90 dB

Characteristic loss @ 4 kHz

Associated tinnitus

Managed with Hearing aid

26
Q

List 3 Ototoxic drugs

A

Aminoglycosides

Streptomycin

Cytotoxic chemotherapy drugs

27
Q

What are the signs of Otitis media with Effusion

A

Retracted Tympanic membrane

Reduced tympanic membrane mobility

Air fluid levels

Bubbles

28
Q

What are the signs of Chronic Otitis Media?

A

Foul smelling discharge

  • TM discharge
  • Cottage cheese like

Granulation tissue

Polyp

Hearing loss

29
Q

What are the symptoms and signs of Acute Otitis Media?

A

Pain (otalgia)

Fever

Erythematous Tympanic membrane

Bulging tympanic membrane

Immobile tympanic membrane

Exudate

30
Q

What is the management of acute otitis media?

A

Usually due to URTI

Oral ceftriaxone

Analgesia

31
Q

What is the management of chronic otitis media?

A

Aural Toilet

Dry mopping

Topical treatment

  • Boric Acid powde
  • Topical Ciprofloxacin
  • Topical Corticosteriods
  • Topical antifungal (if fungal)
32
Q

What are the signs and symptoms of Cholesteatomas?

A

An abnormal skin growth - Keratin debris

Classification

  • Congenital
  • Acquired

Symptoms

  • Foul smelling discharge
  • Conductive hearing loss
  • Pressure/fullness in the ear
  • Dysequilibrium
  • Facial weaknesss
33
Q

What is the management of cholesteatoma?

A

Excision

34
Q

What are the complications of cholesteatoma?

A

Meningitis

Intra-cranial abscess

Erosion of ossicular bones

35
Q

What are sites of referred otalgia?

A

TMJ dysfunction

Dental abscess

Sinusitis

Tonsilitis

Pharyngitis

Throat malignancy

Cervical pain

36
Q

What are the causes of otalgia due to problems in/around the ear?

A

External ear:

  • Otitis externa
  • Herpes zoster oticus (ramsey hunt syndrome)
  • Auricular cellulitis
  • Necrotising (malignant Otitis extrena)

Middle/Inner ear

  • Acute otitis media
  • Otitis media with effusion
  • Mastoiditis
  • Traumatic perforation
37
Q

What are the Acute causes of otitis externa?

A

Acute otitis externa

Granular myringitis

Auricular cellulitis

Herpes zoster Otica

Acute fungal otitis externa

38
Q

What are the chronic causes of otitis externa?

A

Necrotising otitis externa

Eczema

Seborrhoeic dermatitis

39
Q

What is the clinical presentation of acute otitis externa

A

1-2 day history of progressive ear pain

Itching

Purulent discharge

Conductive HL

Feeling of fullness/pressure in the ear

Exposure to water

40
Q

What would you find on examination of acute otitis externa

A

Pain on manipulation of the auricle

Inflammed EAC

Swollen ear canal

Scanty pasty discharge (purulent)

TM difficult to visualise

41
Q

What is the management of acute otitis externa?

A

Aural toilet (synringing and dry mopping)

AB’s - Ciprofloxacin

Topical steroids - Quadriderm

Keep ear dry!

42
Q

What is the clinical presentation of herpes zoster otica

A

Otalgia - Burning pain

May have a facial palsy

Vessicles in and around the EAC 3-7 after onset of pain

Maybe have SNHL due to cranial nerve palsy

43
Q

What is the management of herpes zoster otica?

A

Acycolvir

Oral steroids

Corneal protection - is there is facial nerve palsy

44
Q

What is the clinical presentation of necrotising otitis media?

A

Uncontrolled DM / Immunocompromised / Elderly

Causative organism = Pseudomonas

Discharge = Green, persistent

Deep boring pain

Granuloma in EAC

Facial nerve palsy - if progressive to skull base osteomyelitis

45
Q

What is the management of necrotising otitis externa?

A

Refer to ENT

IV ABs - Ciprofloxacin

Analgesia

Controle co-morbids

46
Q

A patient presents with discharge and facial nerve palsy, provide a DDx

A

TB Ear!

Herpes zoster otica

Necrotising otitis externa

47
Q

What are the indications for syringing an ear?

A

Hearing loss due to wax impaction

Discharging Otitis externa without a perforation

? wet perforation

FB that will not swell - crayons / toys

48
Q

What are the contraindications for syringing an ear?

A

Dry perforation

Fresh traumatic perforation

FB that will swell - Batteries/vegetables

49
Q

What are the indications for dry mopping?

A

After syringing

Otitis externa with discharge

Otitis media with discharge

Ear, Nose and Throat (3 decks)

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