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Derm, Opth + ENT > Ear > Flashcards

Ear Flashcards

(68 cards)

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1
Q

How do you treat meatal swelling?

A

Ribbon gauze soaked in magnesium sulphate

or pope wick changed daily then gentamicin or neomycin

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2
Q

What causes mastoiditis?

A

Breakdown of bony partitions (trabeculae) between mastoid air cells

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3
Q

When should mastoiditis be suspected?

A

Continuous discharge for >10 days

If systemically unwell

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4
Q

Causes of ear pain

A 
Referred pain from CN9 (tonsillitis)
CN10 - carcinoma of pyriform fossa
CN5 mandibular division (upper molars or TMJ)
C2/C3 pain due to posture
Mastoiditis 
OM
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5
Q

Causes of otorrhea

A

Acute = OM or OE
Chronic inflammatory disease
In acute, pain is dominant before discharge

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6
Q

What is subacute suppurative OM?

A

Continuous discharge from ear >3 weeks after OM

Due to mucosal infection or infection of nasopharynx

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7
Q

What is safe chronic suppurative OM?

A

Active mucosal chronic OM
Perforation is central so there is always a rim of ear drum
Involves pars tensa
Discharge arises from secreting mucosa

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8
Q

What is unsafe chronic suppurative OM?

A 
Active chronic with cholesteatoma
May spread intra cranially due to erosion of bone
Atticantral 
Discharge is foul smelling 
May need radical mastoidectomy
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9
Q

Causes of conductive hearing loss

A

Obstruction due to wax, foreign body, debris
Perforation causing reduction in SA of TM - also allows incident sound pressure which causes distortion of sound waves
Discontinuity of ossicular chain - usually due to infection (particularly of long process of incus)
Fixation of ossicular chain due to otosclerosis which immobilises foot of stapes
Eustachian tube blockage (glue ear) - progressive deafness due to accumulation of viscous material

MUST EXCLUDE CARCINOMA OF NP as this can present as conductive hearing loss

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10
Q

Causes of sensorineural hearing loss

A

Bilateral progressive = age, noise damage, drug ototoxicity
Unilateral progressive = meniere’s or acoustic neuroma
Sudden loss = mumps, measles, chicken pox, trauma

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11
Q

Meniere’s

A

Fluctuating hearing levels and recurrent episodes of vertigo

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12
Q

Complications of otitis media

A 
Mastoiditis 
TM perforation 
Labrynthitis 
Meningitis 
Intracranial abscess 
Hearing loss 
Sinus thrombosis 
Damage to facial nerve
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13
Q

Management for otitis media

A

Can resolve spontaneously
Amoxicillin 5-7 days for:
high risk/ systemically unwell pts
Clarithromycin 2nd line

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14
Q

RF for OM

A

Children <4
Passive smoking
Formula fed
Craniofacial abnormalities

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15
Q

S+S of OM

A

Ear pain, tugging of ear

fever, poor feeding, crying, rhinorrhea

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16
Q

What is chronic suppurative OM?

A

Chronic inflammation of middle ear with otorrhoea through perforated TM
Causes ear discharge, hearing loss, hx of OM

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17
Q

What may cause persistent OME?

A

Impaired eustachian tube function
Low grade infection
Persistent local inflammatory reaction
Adenoidal infection or hypertrophy

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18
Q

RF for OME

A

Kids with Downs, cleft palate, CF, PCD, allergic rhinitis

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19
Q

Management of OME

A

Active observation - resolves in 6-12 weeks

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20
Q

What are the types of otitis externa?

A 
Diffuse = involves skin + subdermis of ear canal 
Localised = infection of hair follicle 
Malignant = spread into bone
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21
Q

Bacteria causing OE

A

Pseudomonas aerigenosa or staph aureus

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22
Q

Complications of OE

A

Abscess, inflamed TM, malignant OE

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23
Q

Management of OE

A

Symptomatic relief

Topical tx for infection

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24
Q

What is ear wax made of?

A

Dead flattened cells, cerumen, sebum + foreign substances

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25
RF for impacted ear wax
``` Narrow or deformed ear canals Numerous hairs in ear canals Benign bony growths in canal Dermatological disease on scalp/ ear Elderly Hx of OE Downs ```
26
S+S of impacted ear wax
``` Conductive hearing loss Blocked ears Ear ache Tinnitus Itchiness Vertigo ```
27
Management of impacted ear wax
Ear drops for 3-5 days (Sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil drops) 2nd line: ear irrigation Referral to ENT
28
What is a cholesteatoma?
Abnormal sac of keratinising squamous epithelium + accumulation of keratin within middle ear
29
S+S of cholesteatoma
Foul smelling discharge | Conductive hearing loss
30
What images of TM would indicate cholesteatoma?
Evidence of discharge Presence of deep retraction pocket Crust or keratin in upper part of TM Perforated TM
31
Management of cholesteatoma
Otomicroscope + micro-suctioning
32
dB threshold for deafness
0-20
33
What are typical dB levels for a whisper, average home noise + conversational speech?
``` 30 = whisper 50 = noise 60 = speech ```
34
Gradings of hearing loss
``` 25-40 = mild, cannot hear whispers 40-70 = moderate, cannot hear speech 70-90 = severe, cannot hear shouting >95 = profound, cannot hear noises that would be painful ```
35
Causes of hearing loss in children
``` Conductive = glue ear Sensorineural = genetics, intrauterine infection/ drugs, prematurity, infections ```
36
RF for hearing loss in children
``` Fam hx Infection (rubella, mumps, meningitis) Ototoxic meds Prematurity/ low birth weight Craniofacial abnormalities Klinefelters/ Turners Severe hyperbilirubinemia Head injury Neurodegenerative disorders ```
37
Screening for deafness in children
Automated otoacoustic emissions test (AOAE) then Automated auditory brainstem response test (AABR) if this is positive Pure tone sweep test upon school entry
38
Management of deafness in children
Communication support - hearing aids, radio aids, cochlear implants, lip reading, BSL
39
Management of conductive hearing loss
Grommets | Auto-inflation
40
Types of hearing aid
External Cochlear implants Bone anchored hearing aids
41
What is presbyacusis?
Hearing loss in older people as they age | Usually bilateral, high pitched sounds most affected
42
RF for presbyacusis
Arteriosclerosis Exposure to loud noise, chemicals or meds Smoking
43
Management of presbyacusis
``` Hearing aids Lip reading Hearing assistive devices Cochlear implants Active middle ear implant ```
44
Difference between vestibular neuritis + labyrinthitis
``` VN = only vestibular nerve L = VN + labyrinth ```
45
Causes of labyrinthitis
``` URTI - viral Bacterial Vertebrobasilar ischemia Meningitis Meniere's Ototoxic meds ```
46
S+S of labyrinthitis
``` Sudden, spontaneous + severe vertigo Not triggered but exacerbated by movement N+V Hearing loss Tinnitus URTI symptoms ```
47
What drugs can cause vertigo?
``` Aminoglycosides Anti-HTN (amlodipine) Anti-depressants Benzos Anti-epileptics ```
48
Investigations for ?labyrinthitis
``` Pts fall towards affected side when walking HINTS: Head impulse test Nystagmus check Skew deviation (cover/ uncover test) ```
49
What HINTS results suggest labyrinthitis + ischemic stroke?
``` labyrinthitis = abnormal head impulse, unidirectional nystagmus + no vertical skew stroke = normal head impulse, bidirectional nystagmus + vertical skew ```
50
Management of labyrinthitis
Prochlorperazine or antihistamines | Myringotomy + evacuation of effusion if needed
51
Complications of labyrinthitis
Falls Unilateral hearing loss BPPV
52
Pathology of acoustic neuroma
Tumours of vestibulocochlear nerve arising from Schwann cells of nerve sheath Usually benign + slow growing Cause symptoms through mass effect + pressure
53
Difference between CPA tumours + internal auditory canal tumours?
CPA can grow without affecting function | Internal canal tumours cause hearing loss or vestibular disturbance early
54
RF for acoustic neuroma
Neurofibromatosis | High dose ionising radiation
55
S+S of acoustic neuroma
Unilateral/ asymmetrical hearing loss or tinnitus Impaired facial sensation Balance problems
56
Investigations for ?acoustic neuroma
Audiology | MRI
57
Management of acoustic neuroma
Microsurgery Stereotactic radiosurgery Observation
58
What features should you examine in nasal trauma/ FB?
``` Epistaxis or rhinorrhea Septal haematoma Septal deviation Lacerations, ecchymoses, swelling Crepitus Facial/ mandibular fracture Ophthalmoplegia Facial anesthesia ```
59
Management of nasal trauma
Ice + analgesia Refer to ENT if deviation present Closed reduction
60
Presentation + common FB in nose
Nasal obstruction/ persistent offensive discharge from 1 nostril Beads, buttons, sweets, nuts, seeds, peas
61
When to refer to ENT for FB in nose?
Hx of prolonged nasal discharge FB is in posterior position Pt is unco-operative
62
Management of nasal FB
Use topical anesthetics + vasoconstrictor spray Blow positive pressure through nose (parents blowing in pts mouth while obstructing unaffected nostril) Use nasal speculum + hook/ forceps Use suction Use Fogarty balloon catheter
63
Presentation of septal perforation
``` Nasal whistling sound Discharge from nose Nasal congestion Infection Epistaxis ```
64
Pathology of nasal polyps
Lesions arising from nasal mucosa Frequently in clefts of middle meatus Part of spectrum of chronic rhinosinusitis
65
What are nasal polyps associated with?
Asthma Aspirin sensitivity Cystic fibrosis Churg Strauss syndrome
66
S+S of nasal polyps
``` Nasal airway obstruction Discharge Dull headaches Snoring Reduced smell ```
67
Investigations + management of polyps
``` Flexible endoscopy (rhinoscopy) Topical corticosteroids Endoscopic sinus surgery 2nd line ```
68
Complications of nasal polyps
Acute bacterial sinusitis Sleep disruption Can lead to craniofacial abnormalities

Derm, Opth + ENT (6 decks)

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