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Ear conditions Flashcards

(100 cards)

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1
Q

Name the 6 D’s

A 
Deafness
Discomfort 
Discharge 
Dizziness
Din Din (tinnitus) 
Defective movement of the face (CN VII palsy)
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2
Q

Otitis externa - definition

A

Inflammation of the outer ear canal

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3
Q

Otitis externa - who commonly gets it?

A

Swimmers

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4
Q

Otitis externa - bacterial causes (2)

A

Staph aureus

Pseudomonas aerginosa

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5
Q

Otitis externa - fungal causes (2)

A

Aspergillus niger

Candida albicans

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6
Q

Otitis externa - clinical features

A

Redness and swelling of the skin of the outer ear canal
Initially itchy
Can become sore and painful
Discharge / increased amounts of earwax

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7
Q

Otitis externa - can hearing be affected?

A

Yes

- if the canal becomes blocked (e.g. by swellings or secretions)

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8
Q

Otitis externa - management

A

Suction clean the ear (instant relief)
Keep the ear clean and dry until it recovers
May need antimicrobials/antibiotics if bacterial

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9
Q

Otitis externa - malignant otitis - definition

A

Extension of the otitis externa into the bone surrounding the ear canal (mastoid and temporal bones)

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10
Q

Otitis externa - malignant otitis - cause

A

Pseudomonas aerginosa

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11
Q

Otitis externa - malignant otitis - clinical features

A

Pain

Headache

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12
Q

Otitis externa - malignant otitis - signs

A

Facial nerve palsy (drooping face on side of the lesion)

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13
Q

Otitis externa - malignant otitis - investigations

A 
Inflammatory markers (raised)
Imaging (to see extent of osteitis)
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14
Q

Acute otitis media - definition

A

Acute inflammation of the middle ear with/without an accumulation of fluid

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15
Q

Acute otitis media - who gets it

A

Infants and children

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16
Q

Acute otitis media - cause

A 
Usually viral (URTI) 
Occasionally bacterial (strep pneumonia, haemophilus influenza, moraxella catarrhalis, strep pyogenes)
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17
Q

Acute otitis media - pathogenesis

A

Often an URTI which involves the middle ear due to the extension of infection up the eustachian tube. This causes fluid/pus accumulation in the middle ear.

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18
Q

Acute otitis media - clinical features

A 
Screaming child in middle of night 
Earache (otalgia)
Discharge (if tympanic membrane perforates) 
Conductive hearing loss 
Fever 
Lethargy
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19
Q

Acute otitis media - investigations

A

Otoscopy (red and inflamed ear drum)
Swab pus (if discharge present)
DO NOT regular biopsy (only if alternative differential diagnosis needs exclusion)

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20
Q

Acute otitis media - management (if less than 4 days)

A

Most self limiting, resolve within 4 days

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21
Q

Acute otitis media - management (if more than 4 days)

A

First line: oral amoxicillin

Second line: oral erythromycin

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22
Q

Acute otitis media - management with antibiotics should be topical/oral?

A

Oral

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23
Q

Otitis media with effusion - definition

A

Glue ear
This is not an infection
Accumulation of fluid behind an intact ear drum (without signs/symptoms of acute inflammation)

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24
Q

Otitis media with effusion - pathogenesis

A

Eustachian tube gets anatomically blocked and the middle ear is unable to equalise the pressure with the atmospheric environment (nasopharynx end of eustachian tube)
Build up of negative pressure and fluid accumulated in middle ear space

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25
Otitis media with effusion - causes of eustachian tube blockage
Enlarged adenoid tonsils Recurrent URTI Recurrent AOM
26
Otitis media with effusion - who gets it
Children
27
Otitis media with effusion - clinical features
``` Hearing loss (conductive) NO earache, fever, irritability Middle ear effusion Impaired tympanic membrane mobility Speech delay ```
28
Otitis media with effusion - examinations
``` Otoscopy - tympanic membrane retraction - reduced tympanic membrane mobility visible middle ear fluid/bubbles Tuning fork test - conductive hearing loss ```
29
Otitis media with effusion - investigations
Audiometry - conductive hearing loss Tympanometry - flat line due to presence of fluid suggests a middle ear effusion
30
Otitis media with effusion - initial management
Watchful waiting for 3 months | - may resolve naturally
31
Otitis media with effusion - management after 3 months duration
If bilateral and clinical features persist then refer to ENT - under 3: grommets - if grommets don't work: re-insert grommets and adenoidectomy
32
Otitis media with effusion - complications
Recurrent attacks of AOM
33
Otitis media with effusion - complications of grommets
``` Infection Fall out early Fall into middle ear cavity Persistent perforation Swimming/bathing issues ```
34
Chronic otitis media - definition
Persisting acute otitis media causes a hole to form in the ear drum resulting in chronic otitis media
35
Cholesteatoma - definition
Keratinised squamous epithelium in the middle ear where it shouldn't be Abundant keratin production in the middle ear
36
Cholesteatoma - pathology
Lots of surface flakes - large pink areas on histology slides High cell turnover Cystic swelling in middle ear (due to loss of movement of keratin)
37
Cholesteatoma - what should the normal lining of the middle ear be and what is it in this condition?
Normal: cuboidal/columnar glandular epithelium Cholesteatoma: keratinised squamous epithelium
38
Cholesteatoma - what are the 2 types
Acquired | Congenital
39
Cholesteatoma - which is more common: acquired/congenital?
Acquired
40
Cholesteatoma - the tympanic membrane is in tact / perforated in acquired cholesteatoma?
Perforated
41
Cholesteatoma -the tympanic membrane is in tact / perforated in congenital cholesteatoma?
In tact
42
Cholesteatoma - clinical features
Associated inflammation Lots of flakes Discharge
43
Cholesteatoma - investigations
CT: densities of cholesteatoma MRI: poor localisation of bony landmarks
44
Vestibular schwannoma - definition
Benign tumour of peripheral nerves (schwann cells) Connective tissue tumour Associated with the vestibular portion of CN VIII
45
Vestibular schwannoma - where are they found
Within temporal bone At angle between pons and cerebellum Causes significant compression of brain stem
46
Vestibular schwannoma - pathology
Lots of elongated, streaming nuclei Spindle cell morphology Verocey bodies
47
Vestibular schwannoma - what condition are they commonly associated with?
Neurofibromatosis
48
type 1 neurofibromatosis
``` Wide spread Bony defects Cafe au last spots Axillary freckling Lisch nodules in eye ```
49
type 2 neurofibromatosis
Young patient
50
BPPV - definition
Benign positional paroxysmal vertigo | Common inner ear balance disorder
51
BPPV - what usually happens to the granules of crystals that are attached to the hair cells in the utricle?
They fall to the bottom due to gravity
52
BPPV - what happens to the granules of crystals in the utricle in BPPV?
They become loose and float freely in the fluid | They collect in the cupola of the semicircular canal
53
BPPV - which semicircular canal is most commonly affected?
Posterior
54
BPPV - causes
Head trauma Ear surgery Idiopathic
55
BPPV - classic presentation
Patient turns over in bed and the room spins Patient bends forward and room spins Patient puts head up and room spins
56
BPPV - clinical features
Repeated, brief episodes of vertigo with movement Vertigo usually lasts less than 1 minute May have several attacks per day No hearing loss or tinnitus
57
BPPV - examinations
Hallpike's test Epley manoeuvre Semont manoeuvre Brant-Daroff exeercises
58
BPPV - examinations - hallpike's test
Pt lie down from sitting postion with head turned to one side Patient must keep eyes open as you are looking for eye movements (nystagmus) Patients with nystagmus will have BPPV
59
BPPV - Common diagnostic eye sign
Nystagmus
60
BPPV - management
Do the manoeuvres
61
Mineres disease - definition
Swelling of endolymph compartment which causes the perilymph and endolymph fluids to mix Not common
62
Mineres disease - cause
Unknown
63
Mineres disease - clinical features
Recurrent spontaneous rotational vertigo | Tinnitus on affected side
64
Mineres disease - which type of hearing loss is it associated with?
Sensori-neural hearing loss
65
Mineres disease - management
``` Supportive treatment Tinnitus therapy Hearing aids Grommet insertion Intratympanic gentamicin/steroids Surgery ```
66
Vestibular neuronitis - definition
Affects the vestibular nerve (balance)
67
Vestibular neuronitis - cause
Viral
68
Vestibular neuronitis - clinical features
Prolonged vertigo for number of days Nausea No associated tinnitus or hearing loss
69
Vestibular neuronitis - management
Self limiting | Vestibular sedatives
70
Labrynthitis - definition
Affects the whole labyrinth (balance and hearing)
71
Labrynthitis - cause
Viral
72
Labrynthitis - clinical features
``` Prolonged vertigo - sudden onset vertigo on day 1 which improves over the following days Nausea Tinnitus Hearing loss ```
73
Labrynthitis - management
Self limiting
74
Oscillopsia - definition
When there is no vestibular output | Loss of the vestibular ocular reflex (VOR)
75
Oscillopsia - clinical features
Eyes constantly bouncing around as they can't focus on the environment
76
Oscillopsia - cause
Gentamicin
77
Tinnitus - management
Try to adapt to the noise and 'throw it away' | Mask the noise
78
Nystagmus - definition
Quick flickering of eyes
79
Serous discharge means middle ear pathology is MORE/LESS likely
Less
80
Cholesteatoma - management
Mastoid surgery | - to remove the squamous debris
81
Perforated tympanic membrane - causes
Trauma | Chronic middle ear infection
82
Otosclerosis - definition
New bony deposits occur in the base of the stapes
83
Otosclerosis - who gets it
Females, middle aged, hereditary
84
Otosclerosis - management
Hearing aids | Stapes surgery
85
What is the commonest cause of deafness?
Presbycusis
86
Presbycusis - definition
Degenerative disorder of the cochlea | Age related hearing loss
87
Presbycusis - what type of hearing loss does it produce
Sensorineural
88
Presbycusis - lower frequencies are affected most. True or false?
False | - higher frequencies are affected most
89
Vertigo which lasts seconds-minutes
BPPV
90
Vertigo which lasts minutes-hours
Meniures disease
91
Vertigo which lasts hours-days
Labrynthitis
92
Which semicircular canal is most affected by BPPV?
Posterior
93
BPPV symptoms become less severe on repeated movements. True or false?
True
94
What diagnoses BPPV?
A positive hallpike test
95
Management of BPPV ?
Epley manouevre
96
What does gentamicin do to the ear?
It destroys the vestibular epithelium | Can lead to hearing loss
97
What is another name for vestibular schwannoma?
Acoustic neuroma
98
Where does vestibular schwannoma usually occurs?
Angle between the pons and the cerebellum
99
Vestibular schwannoma clinical features?
Unilateral hearing loss Vertigo occurs later on CN palsies: CN V, VI, VII, IX, X
100
Vestibular schwannoma investigation
MRI scan

ENT SOH (9 decks)

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