Ear Flashcards
1
Q
Why is hearing loss in children such an important topic?
A
It affects their language, speech, development, and school performance.
2
Q
What features of a peadiatric past medical history might indicate need for audiological assessment in a child?
A
- Prematurity
- Low birth weight
- Neonatal hypoxia or jaundice
- Intraventricular haemorrhage
3
Q
What is the most common cause of conductive hearing loss in children?
A
Glue ear a.k.a. Otitis media with effusion
4
Q
Who is glue ear most common in?
A
Children between 3 and 6 years of age.
1/3 of children suffer at some point with different degrees of glue ear
5
Q
With what is glue ear associated?
A
Upper respiratory tract infections
6
Q
What is the pathophysiology behind otitis media with effusion?
A
Eustachian tube dysfunction - occlusion, often due to its short and horizontal course in children, and its opening out near the adenoids which may be enlarged.
7
Q
How does glue ear look on audiometry?
A
Audiometry shows conductive hearing loss.
Tympanometry shows flat trace (immobile tympanic membrane).
8
Q
What are the 2 most common causes of hearing loss in adults?
A
- Presbyacusis
- External meatus blocked by wax
9
Q
Other than presbyacusis, what can cause sensorineural hearing loss in an adult?
A
Idiopathic Noise exposure Inflammatory disease Tumours Ototoxic drugs
10
Q
Other than wax in the external meatus, what can cause conductive hearing loss in an adult?
A
- Eardrum perforation
- Exostoses
- Otosclerosis
- Ossicle discontunuity
11
Q
What is presbyacusis?
A
Hearing loss due to hair cell loss on cochlear with increase in age.
12
Q
How does presbyacusis present?
A
Reduced auditory sensitivity to sound over time, often manifesting as difficulty understanding speech especially in noisy environments.
13
Q
Is high or low frequency hearing generally lost in presbyacusis?
A
High frequency
14
Q
What other symptoms might a pt with presbyacusis have?
A
Tinnitus
15
Q
How is a diagnosis of presbyacusis confirmed?
A
Pure tone audiometry
16
Q
What does pure tone audiometry show for presbyacusis?
A
High frequencies lost
Lo frequencies normal
No increased air-bone conduction gap (i.e. sensorineural hearing loss)
17
Q
Is presbyacusis usually bilateral or unilateral?
A
Bilateral - if unilateral, that might indicate need for further investigation e.g. imaging
18
Q
What general measures can we employ to help a pt manage with presbyacusis?
A
- Improve communication techniques (face ot face, little surrounding noise)
- Reassure and educate
- Assistive listening devices
- Speech reading techniques
19
Q
What technology can be used to help a pt manage with presbyacusis?
A
Hearing aids
Cochlear implants
Active middle-ear implants
20
Q
Why do patients not use hearing aids?
A
- Discomfort
- Don’t think they work well enough
- Appearance
- Difficulty with background noise
- Financial
21
Q
What types of hearing aid are available?
A
- Behind ear
- In ear
- In canal
- Bone anchored
22
Q
At what age is otitis media with effusion most common?
A
Between ages 3 and 6
23
Q
After what age is otitis media with effusion rare?
A
11
24
Q
Which congenital problems confer an increased risk of developing otitis media with effusion?
A
Cleft palate, Down’s syndrome.
25
How can otitis media with effusion be managed in the short term?
Most cases resolve spontaneously
26
How can otitis media with effusion be managed in the long term/if it reoccurs?
Adenoidectomy, Grommet insertion
27
How long do Grommets last once they have been inserted?
Up to 12 months
28
Will otitis media with effusion be fixed once a child has Grommets?
Yes until they come out. Depending on the child they may need to be inserted again until Eustachian tube has grown and changed shape sufficiently.
29
What side effect can grommets cause?
Tympanosclerosis = white patches on tympanic membrane, but this does not usually affect hearing.
30
Is otitis media with effusion common in adults?
No - if it presents then suspect an underlying condition.
31
Is medical management of otitis media with effusion recommended?
No - unless there is another underlying infection making the situation worse.
32
When should a child with OME be referred to secondary care?
If there is significant hearing difficulties, or a pre-existing hearing impairment or underlying condition like Down's syndrome or cleft palate.
33
What is the indication for surgery for OME?
Persistent bilateral OME lasting 3 months or more, or significant hearing loss, or developmental difficulties.
34
What are grommets?
Ventilation tubes for the Eustachian tubes.
35
Is grommet insertion done under GA or LA?
GA generally but can be done under LA if need-be.
36
When is adenoidectomy recommended for OME?
If recurrent upper respiratory symptoms are a feature.
37
What is the prognosis for OME?
Spontaneous resolution is common, most children are clear within 12 weeks, but about a third have recurrent episodes.
38
What is otitis externa?
Inflammation of the outer ear - this includes the auricle, external auditory canal, and outer surface of eardrum.
39
How common is otitis externa?
Very - around 10% of all people will experience it at some point.
40
What factors increase the risk for developing otitis externa?
Hot humid climate, swimming, old age, immunocompromise, diabetes, obstruction of normal meatus, wax build up or insufficiency, or trauma to the ear canal.
41
What factors increase the risk for developing otitis externa?
Elastic cartilage
42
What kind of cartilage forms the outer third of the ear canal?
About 2.5cm long, a sigmoid shape, running anteriorly and inferiorly from the external meatus.
43
What shape is the ear canal?
Epithelial migration from TM towards ear canal opening keeps it clear of debris. Hairs help prevent objects entering the ear canal.
44
What can cause otitis externa?
Infection, allergies, irritants, and inflammatory conditions which disturb the lipid/acid balance of the ear canal.
45
Is otitis externa caused by infection usually bacterial or fungal?
Bacterial - fungal makes up about 10%.
46
Which virus can cause otitis externa?
Herpes zoster (Ramsay Hunt syndrome)
47
What inflammatory conditions can cause otitis externa?
Seborrhoeic dermatitis, acne, psoriasis, atopic eczema, SLE.
48
What irritants can cause otitis externa?
Topical medications, hearing aids, earplugs, foreign body, trauma, water from swimming, chemicals e.g. hair spray/dyes.
49
What are the main symptoms of otitis externa?
Pain and itching, and discharge may be an issue.
50
How does an ear canal with otitis externa look on otoscopy?
Erythematous, oedematous, exudate, often pain with movement of tragus or auricle.
51
What is the interchangable term for acute otitis externa?
Swimmer's ear
52
What usually causes chronic otitis externa?
Fungal infections, alongside systemic conditions such as DM or immunosuppression.
53
What is malignant otitis externa?
A life-threatening extension of otitis externa into the mastoid and temporal bones.
54
Who is most at risk of developing malignant otitis externa?
Elderly pts with diabetes or who are immunocompromise.
55
What symptoms with otitis externa would suggest malignant otitis externa?
Pain and headache of greater intensiy than clinical signs, facial nerve palsy may be present.
56
Which organisms are usually responsible for malignant otitis externa?
Pseudomonas spp. or Staph. aureus.
57
How should otitis externa be managed?
Settle symptoms, cure infection, reduce risk of recurrence, and prevent complications.
58
Is management of otitis externa the same for adults and children?
Yes.
59
How should acute otitis externa be treated?
Topical drops (abx or acetic acid), and oral abx if cellulitis or lymphadenopathy, or IV abx if systemic symptoms.
60
How should chronic otitis externa be treated?
Treat the cause and reduce aggravating symptoms.
61
What lifestyle advice can we give to people with chronic or recurrent otitis externa?
Keep ear dry, use ear buds or ear plugs if they have to get wet. Avoid cotton wool to plug discharge. Avoid swimming and try and prevent water entering ear.
62
What complications are associated with otitis externa?
Temporary hearing loss, become chronic, cellulitis, necrotising otitis externa, sepsis.
63
What is the single most common cause of hearing impairment?
Otosclerosis
64
How does otosclerosis generally present?
Bilateral hearing loss
65
Describe the pathogenesis of otosclerosis.
Adherence of stapes footplate to bone around oval window causing conductive hearing loss. This occurs due to genetic predisposition to ony turnover in the stapes, which is not the normal variant.
66
What kind of inheritence pattern does otosclerosis follow?
Autosomal dominant with variable penetrance.
67
A patient presents with hearing loss and a degree of tinnitus developing over some months. They have a FHx of this, and notice that certain voices are harder to hear, but their own voice sounds louder to them. Which type of voice tone is harder for thi spatient to hear, given the diagnosis?
Low tones i.e. deep male voices.
This is characteristic of otosclerosis.
68
How is suspected otosclerosis investigated?
Audiometry is primary Ix.
If unclear/mixed hearing loss, CT is useful in distinguishing between other causes of sensorineural hearing loss.
69
How is otosclerosis managed?
- Hearing aids
- Sodium fluoride/bisphosphonates
-Stapedotomy (small hole made in stapes footplate).
70
What is the main complication of otosclerosis?
Significant, but not total, hearing loss.
71
What are the complications of stapedotomy surgery for otosclerosis?
Total unilateral hearing loss
Facial nerve injury
TM perforation
72
What are the different types of otitis media?
- Acute otitis media
- Otitis media with effusion
- Chronic suppurative OM
- Mastoiditis
- Cholesteatoma
73
What is acute otitis media?
Acute inflammation of middle ear which may be viral or bacterial.
74
What is Chronic suppurative Otitis media?
Long-standing suppurative middle ear inflammation, usually with a persistently perforated tympanic membrane.
75
What is mastoiditis?
Acute inflammation of mastoid periosteum and air cells due to spread of infection from middle ear.
76
What is a cholesteatoma?
Presence of keratinising squamous epithelium in middle ear due to TM retraction.
77
With which presentation is otitis media associated?
A cold!
78
Other than upper respiratory tract infections, what risk factors are there for otitis media?
- Eustachian tube dysfunction
- Allergies
- Sinusitis
- Craniofacial abnormalities
- Smoking
- Immunosuppression
79
How does otitis media present?
Otalgia most commonly.
Hearing loss
Fever
80
How is otitis media managed?
Analgesia and antipyretics
Antibiotics indicated if bacterial/continues for 4+ days with continued worsening, or systemic unwellness.
Nasal/oral steroids if associated with chronic sinusitis/allergies
Admission if systemically very unwell or those with complications.
81
What are the complications of otitis media?
```
Meningitis
Mastoiditis
Facial nerve palsy
Chronic suppurative OM
TM perforation
```
82
What abx should be given if indicated for otitis media?
5 days of amoxicillin
| erythromycin/clarithromycin if pen-allergic
83
What is the name for a tumour of the vestibulocochlear nerve?
Acoustic neuroma
84
What do acoustic neuromas arise from?
Schwann cells of vestibulocochlear nerve sheath.
85
Which genetic condition predisposes to acoustic neuromas?
Neurofibromatosis - usually bilateral ANs.
86
A patient presents with a few weeks history of progressive unilateral hearing loss, tinnitus, and some balance problems. Can this condition present suddenly as well as progressively?
Yes - acoustic neuromas can present with sudden and complete unilateral hearing loss.
87
What pattern of hearing loss does an acoustic neuroma cause?
Sensorineural
88
What is the diagnostic gold standard for acoustic neuromas?
MRI
89
What are the 3 treatent options for an acoustic neuroma?
1. Microsurgery
2. Stereotactic radiosurgery
3. Observation
90
Who is conservative management of an acoustic neuroma suitable for?
Pts with small neuromas and good preserved hearing.
Serial scans used to monitor growth.
91
Who is surgical management of an acoustic neuroma suitable for?
Anyone who's tumour is growing and hearing is affected.
92
Which type of surgery is the prefered type for an acoustic neuroma?
Microsurgery
93
What are the types of cholesteatoma?
```
Congenital (2%)
Primary acquired (80%)
Secondary acquired (18%)
```
94
What happens as a cholesteatoma progresses?
Lateral wall of epitympanum is erodes, and ball of epithelium grows to surround the ossicles. It is locally invasive and destructive in nature and may erode the ossicles.
95
Why does secondary acquired cholesteatoma occur?
Due to TM insult e.g. perforation, trauma, or surgery.
96
A patient presents with progressive unilaeral conductive hearing loss, with recent onset vertigo and facial nerve palsy. What might be seen when looking in the ear?
Retracted TM or perforated TM.
| Pearly white mass/material present behind a portion of the TM, usually superiorly.
97
Do cholesteatomas cause otorrhoea?
Yes - it may be frequent, or unremitting, painless, and foul smelling.
98
How should a cholesteatoma be ideally managed?
Surgery, as medical management will not prevent growth or complications.
99
What are the complicatiosn associated with a cholesteatoma?
Progressive deafness, dizzines, and facial nerve palsy.
100
What is the prognosis like for a cholesteatoma that has been operated on?
5-30% residual disease post-surgery
7-10% risk of development of cholesteatoma in other ear.
101
How is hearing loss quantified?
By dB (decibels) relative to normal hearing.
Hearing loss is worse with higher decibels meaning more hearing loss.
0 is perfect, less than 0 is better than normal hearing.
102
What is considered normal hearing in adults?
0-25 dB
103
What is considered normal hearing in children?
0-15 dB
104
What is the most simple test for hearing?
Whispered voice test
105
Describe the whispered voice test.
Whisper a combination of 3 numbers from ~60cm away from pts ear from behind, while blocking one ear.
106
What frequency tuning fork is used for Weber's and Rinne's tests?
512 Hz
107
What can affect the results for pure tone audiometry?
- Background noise
- Calibration of machine
- Threshold determination
108
What is the test called that measures the stiffness of the TM?
Tympanometry
109
What does a flat tympanometry trace indicate?
Fluid in middle ear
110
What indicates a different pressure within the middle ear to normal on a tympanogram?
The line on the tympanogram will be shifted
111
What is the most common cause of vertigo?
BPPV - Benign paroxysmal positional vertigo
112
What is vertigo?
The illusion of movement
113
Where is the pathology in the majority of BPPV cases?
Posterior semi-circular canal
114
What is the pathophysiology of BPPV?
Otoliths/debris in semi-circular canals moves within endolymph after movement eases, stimulating hair cells, resulting in sensation of ongoing movement despite other sensory input.
115
What is the most common cause of BPPV?
Idiopathic in 60% of cases
116
If BPPV is not idiopathic, what can cause it?
- Head injury
- Post-viral
- Stapes surgery (complication)
- Chronic middle ear disease
117
Is nausea and vomiting common in BPPV?
Nausea is but vomiting is not.
118
What is a preauricular sinus?
Common congenital malformation, small dell adjacent to external ear.
119
Where are pre-auricular sinuses in relation to facial nerve and parotid gland?
Lateral and superior
120
Which cranial nerve is resposible for most of the motor functions in the head and face?
Seventh cranial nerve
121
How does facial nerve palsy present?
Weakness of muscles of facial expression and eye closure.
122
What symptoms might someone experience alongside facial muscle weakness in facial nerve palsy?
- Loss of taste on anterior 2/3 of tongue
- Intolerance to high-pitched/loud noises
- Mild dysarthria
These indicate an intracranial lesion
123
How can we distinguish between a LMN and UMN facial nerve lesion?
LMN involves the forehead muscles, whereas UMN lesions have forehead sparing because there is bilateral innervation
