Ear Flashcards

(39 cards)

1
Q

Name some peripheral causes of vertigo?

A
  • Benign paroxsymal positional vertigo (BPPV)
  • Vestibular neuritis
  • Meniere disease
  • Otoscleroris
  • Labrynthitis
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2
Q

List some central causes of vertigo?

A
  • MS
  • Acoustic neuroma
  • Vestibular migraine
  • CV disease
  • Cerebellopontine angle and posterior fossa meningiomas
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3
Q

How does BPPV present?

A
-Episodic vertigo 
   • sudden onset 
   • provoked by head turning 
   • last >30 secs 
   • other symptoms rare (NO HEARING LOSS)
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4
Q

How is BPPV diagnosed?

A

Establish important negatives:

  • NOT persistent vertigo
  • NO speech, visual, motor or sensory problems
  • NO tinnitus, headache, ataxia, facial numbness, dysphagia

Hallpike test +ve

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5
Q

What is the dix hall pike test?
How do you do it?
What is a positive test?

A

Dix-hallpike test is DIAGNOSTIC for BPPV

  • Lower down on coach head turned to 45 degree angle
  • Nystagmus=+ve test
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6
Q

What is the Eply manoeuvre?

A

Eply manoeuvre is TREATMENT for BPPV

-move head 90 degrees (from R>L) then tilt so they are looking at floor

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7
Q

What is an acoustic neuroma?

A

Usually painless benign subarachnoid tumours that cause problems by local pressure, and then behave as SOL

Rare = 1 / 100,000 / year

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8
Q

Where do acoustic neuromas usually arise?

A

Superior vestibular Schwann cell layer

Sometimes called vestibular schwannoma

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9
Q

How do acoustic neuromas present?

A

Acoustic neuroma
-Ipsilateral tinnitus +/- sensorineural deafness
(cochlear nerve vompression)
-Disequilibrium common (wobbly)
-Trigeminal compression may give numb face
-Vertigo rare

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10
Q

What investigations are done for an acoustic neuroma?

What is a key differential?

A

MRI scan for ALL PATIENTS WITH UNILATERAL TINNITUS/DEAFNESS

Key differential = meningioma

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11
Q

What is the management of an acoustic neuroma?

A
  • Surgery is difficult and not often needed eg if elderly

- Methods of preserving hearing and facial nerve eg stereotactic radiosurgery

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12
Q

What is the symptoms of ototoxicity?

List some ototoxic drugs?

A

Cause bilateral tinnitis with associated hearing loss

Cisplatin and aminoglycosides (end in mycin) = permanent hearing loss

Aspirin, NSAIDs, quinine, macrolides and loop diuretics are associated with tinnitus and reversible hearing loss

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13
Q
Which ones cause hearing loss?
Meniers 
BPPV 
Lambrynthitis 
Vestibular neuritis
A
  • BPPV and Vestibular neuritis DO NOT CAUSE HEARING LOSS

- Meniers and Lambrynthitis DO CAUSE HEARING LOSS

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14
Q
How often is the vertigo?
Meniers 
BPPV 
Lambrynthitis 
Vestibular neuritis
A

BPPV (seconds) and Meniers (minuets) = EPISODIC VERTIGO

Lambrynthitis and Vestibular neuritis = PERSISTANT VERTIGO

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15
Q

What is Meniere’s disease?

A

Disorder of the endolymph volume (labyrinthine fluid) with progressive distention of the labyrinthe

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16
Q

What are the symptoms of Meniere’s disease?

How long do symptoms last?

A

Triad of:

  • Vertigo (with sickness)
  • Tinnitus
  • Hearing loss (sensorineural)

-Preceded by AURAL FULLNESS
-+/- nystagmus
Symptoms are episodic, lasting minutes to hours

17
Q

How can you treat Meniere’s disease? (acute/prophylaxis)

A

Acute:
Prochlorperazine (buccal for severe sickness)

Prophylaxis:

  • Betahistine 16mg/8hr po
  • Limit salt intake

Surgical procedures:
Labyrinthectomy (but causes total ipsilateral deafness)
-medical (Instillation of gentamicin via grommets)

18
Q

What is vestibular neuronitis/labyrinthitis?

A

Inflamation of inner ear (either labrynth or vestibular nerve)

19
Q

How does vestibular neuronitis/labyrinthitis present?

A
-Sudden and severe PERSISTANT vertigo (days) 
   • does not progressively get worse 
   • worsened by head movements 
-Nausea + vomiting 
-Nystagmus AWAY from affected side 

Neuronitis - VERTIGO with no hearing loss or tinnitus
Labyrinthitis -VERTIGO WITH hearing loss + tinnitus

(NB cochlear + SCC = labyrinth)

20
Q

What are common causes of vestibular neuronitis/labyrinthitis?

A

-Often following URTI /herpes simplex reactivation

21
Q

How do you manage vestibular neuronitis/labyrinthitis?

A

Reassure, could take prochlorperazine/antihistamine for vertigo

vestibular rehab if lasting 1+ week

22
Q

How does acute otitis media present?

A
  • Otalgia - might be pulling at ear
  • Malaise
  • Crying, poor feeding, restlessness
  • Fever
  • Vomiting
  • Coryza/rhinorrhoea

Perforation of TM often relieves pain - a child who is screaming and distressed may settle remarkably quickly then ear starts to discharge green pus

23
Q

What is the management of acute OM?

A

Analgesia

Acute OM resolves in 60% in 24hr with no abx

24
Q

When should abx be considered in acute OM?

A

Immediate abx:

  • Systemically unwell
  • Immunocompromised
  • No improvement in symptoms in >4 days

Immediate or 2 day ‘delayed’ abx:
<3 months old
Perforation / discharge
<2yrs with bilateral OM (most commonly caused by Haemophilus influenza)

25
What AB in otitis media?
Amoxicillin 40mg/kg/day in 3 divided doses for 5 days Erythromycin if penicillin allergic
26
When would you admit a child for Otitis media? (based on temp and age)
Admission if child < 3 months with temp > 38 or 3-6 months with temp > 39 or suspected comps
27
What is chronic otitis media? (3 types)
1) Benign / inactive COM - Dry tympanic membrane perforation without active infection 2) Chronic serous OM - Continuous serous drainage - Typically straw coloured 3) Chronic suppurative otitis media - Persistent purulent drainage through a perforated tympanic membrane
28
What is the management of COM?
- Take swab - Topical or systemic abx based on swab results - Aural cleaning - Water precautions - Careful follow up - Surgery
29
When is surgery considered in COM?
``` Aural cleaning and abx fail Persistent perforation / discharge Conductive hearing loss Chronic mastoiditis Cholesteatoma formation ```
30
What are the two surgical procedures offered in COM?
Myringoplasty = repair of tympanic membrane alone using a graft Mastoidectomy = surgical repair of tympanic membrane and ossicles
31
what are the complications of otitis media? (4)
Effusion (common) - swollen/bulging TM - chronic inflammatory process without acute inflammation Perforation (fairly common) -May progress to chronic Suppurative Otitis Media Mastoiditis - severe pain - forward protrusion of ear w/ tender boggy mass behind ear → can cause meningitis → UEGRNT treatment Cholesteatoma -keratinizing squamous epithelium colonizes middle ear due to tympanic membrane retraction
32
What is the leading cause of hearing loss in children?
OM with effusion (OME) = glue ear
33
What is the management of OME?
Usually transient, mild and resolves spontaneously 50% with bilateral will resolve within 3 months Observation for 3 months then reassess hearing Auto-inflation of eustation tube via a balloon through the nose can help during this period Surgery (Tympanostomy tube / grommets)
34
How may a cholesteatoma present?
``` Foul discharge +/- deafness Headache Pain Facial paralysis Vertigo ``` These symptoms indicate impending CNS complications
35
What are risk factors for cholesteatoma?
Chronic otitis media | Trauma
36
What is the management for cholesteatoma?
Mastoid surgery to remove the sac of squamous debris
37
What do the otolith organs do?
Detect tilt and acceleration/deceleration There are 2 otolith organs (utricle + saccule)
38
What do the semi-circular canals do?
Detect rotation | Control eye movements in the plane of the canal
39
What does dysfunction of semi-circular canals lead to?
Nystagmus