Ear

Question 1

Which group of people are more at risk of otitis media and why?

Answer 1

Children

- more narrow, horizontal and short eustachian tube

Question 2

What causes otitis media?

Answer 2

Often viral
Bacterial - S. pneumonia and H. influenzae
Often preceded by URTI

Question 3

What are some complications of otitis media?

Answer 3

mastoiditis
meningitis
facial palsy
brain abscess

Question 4

How would you categorise otitis media?

Answer 4

acute OM: increasing otalgia, no discharge, bulging red eardrum
acute suppurative OM: increasing otalgia, watery discharge (pop), perforation of eardrum

Question 5

How would you treat otitis media?

Answer 5

oral antx are contrary to evidence (do decrease pain in children) - amoxicillin / erythromycin
analgesia
perforated eardrum give steroid and antx drops (gentisoneHC)

Question 6

What would you see in otitis media on otoscopy?

Answer 6

bulging eardrum, redding or dull appearance, prominent blood vessels
+/- perforated eardrum

Question 7

What are some symptoms of otitis media?

Answer 7

ear ache, nausea, vomiting, cough, runny nose, fever, conductive hearing loss

Question 8

How would you treat otitis externa?

Answer 8

gentisoneHC or flucloxicillin / erythromycin

Question 9

What are 5 causes of vertigo and how they are different?

Answer 9

Labrynthitis - constant
BPPV
Migrane - episodic, aura, headache, photophobia
Meniere’s disease - hours, unilateral hearing loss, tinnitus, aural pressure
Acoustic neuroma

Question 10

What is benign paroxysmal postional vertigo?

Answer 10

loose otoliths in semicircular canals cause abnormal movement of endolymph within canal causing vertigo
(crystals which should be at the bottom move to the middle of the canals

Question 11

What are some symptoms of benign paroxysmal postional vertigo?

Answer 11

vertigo participated by head movements, sudden and disturbing onset (secs-mins), becomes less severe on repeated movements

Question 12

How do you test for BPPV?

Answer 12

Dix-hall pike maneuver

Will show rotational nystagmus

Question 13

How do you treat BPPV?

Answer 13

Epley maneuver

Brandt-Daroff exercise for maintainence

Question 14

What are some causes of referred otalgia?

Answer 14

dental problems, TMJ dysfunction, osteoarthritis of cervical spine, malignant pharynx and larynx, infection of pharynx, degenerative neck pain, throat infection

Question 15

What are the 4 main causes of otalgia?

Answer 15

Acute otitis media, ottits externa, furuncule, necrotising otitis externa

Question 16

What are some pathogenic causes of otitis media?

Answer 16

VIRAL - RSV, rhinovirus, parainfluenza

BACTERIAL - strep pneumo, haem influenza, moraxella catarrhalis

Question 17

How would you treat otitis media?

Answer 17

antibiotics do not benefit children (unless severe)

so give reassurance

Question 18

What are some complications of otitis media?

Answer 18

mastoiditis, tympanic membrane perforation
Intracranial - meningitis, abscess, lateral thrombosis
Extracranial - petrositis, LMN VII palsy, labyrinthitis, hearing loss, TM perforation

Question 19

What is otitis externa? What are some predisposing factors?

Answer 19

painful, discharging ear caused by pseudomonas or fungal infection
eczema or dermatitis is predisposing

Question 20

How would you treat and prevent otitis media?

Answer 20

TREAT - microsuction, pope wick, topical antibiotics, water precautions, clotrimazole for fungal
PREVENT - hands out, ear dry, treat skin disease, acetic acid spray

Question 21

What is a furuncule? How would you treat it?

Answer 21

It is a staphylococcal abcess on hair follicle in ear = exquisitely tender
TREAT - flucloxicillin, wick insertion

Question 22

What is necrotising otitis externa?

Answer 22

potentially fatal osteomyelitis of EAM nad bony tympanic plate (can spread along inferior surface of skull base)

Question 23

What are risk factors for necrotising otitis externa?

Answer 23

DM, elderly, immunocompromised

Question 24

How would you treat necrotising otitis externa? What are some complications of necrotising otitis externa?

Answer 24

Admission into hospital, IV antibiotics

Complications - meningitis, cerebral abscess, dural sinus thrombosis

Question 25

What are the symptoms of necrotising otitis externa?

Answer 25

huge pain, not impacted by topical antibiotics

Question 26

What is Rinne's test?

Answer 26

press tuning fork against mastoid bone and then hold 1cm away - is it louder behind hear or in front?

Question 27

What is Weber's test?

Answer 27

tuning fork placed in midline or forehead | - to find unilateral hearing loss

Question 28

What is conductive hearing loss? Give 3 possible causes

Answer 28

problem with middle or inner ear, eardrum etc | - wax, osteosclerosis, otitis media

Question 29

What is sensorineural deafness? Give 3 possible causes

Answer 29

problem with cochlear, nerves or brain function (bone conduction is better in tests - congenital, age related, occupational, meniere's disease, drug toxicity, post-infective

Question 30

What is osteosclerosis?

Answer 30

commonest cause of hearing loss in young adults, F>M, autosomal dominant conductive hearing loss from bone deposition around stapes footplate

Question 31

What are symptoms of osteosclerosis?

Answer 31

hearing loss, tinnitus, vertigo | - worse in pregnancy, menstruation and menopause

Question 32

How would you treat osteosclerosis?

Answer 32

surgically with stapedectomy or with hearing aids

Question 33

What is Meniere's disease?

Answer 33

uncommon condition where dilation of endolymphatic system in cochlear duct and saccule which can cause vestibular membrane of Reissner can rupture, compressing adjacent structures

Question 34

What are the symptoms and treatment of meniere's diasase?

Answer 34

attacks of nausea, vertigo, nystagmus, tinnitus and hearing loss that can last for up to 12 hrs cyclizine helps for vertigo, possibly betahistamine can help, operative decompression helps prevent progression of disease

Question 35

What are the common causative agents of labyrinthitis?

Answer 35

usually viral - mumps, cytomegalovirus, rubella | - usually spontaneous resolution

Question 36

What is glue ear?

Answer 36

at least 3 months of persistant middle ear effusion | not infection, is mucus overproduction or under clearance

Question 37

What are the symptoms of glue ear?

Answer 37

conductive hearing loss | pain is unlikely

Question 38

How would you treat glue ear?

Answer 38

conservative hearing aids grommets