Ear conditions

Question 1

what investigation might you do for an ear condition

Answer 1

MRI

Question 2

the 6 Ds of ear problems (important for comms skills)

Answer 2

deafness 
discomfort (earache/pain) 
discharge
dizziness 
din din (tinnitus) 
defective face movement (eg bells palsy)

Question 3

aetiology of conductive hearing loss (4)

Answer 3

glue ear
earwax
cholesteatoma
otosclerosis

Question 4

with what type of hearing loss would you do a tympanometry

Answer 4

conductive

Question 5

aetiology of sensorineural hearing loss (5)

Answer 5

loud noise exposure 
aging (presbysusis)
genetics 
brain tumour 
gentamicin

Question 6

who gets acute otitis media

Answer 6

kids

Question 7

what is acute otitis media

Answer 7

inflammation/infection of the middle ear

Question 8

common bacteria in acute otitis media

think about cause and people

Answer 8

strep pneumonia
haem influenza
strep pyogenes

Question 9

where does acute otitis media come from

think about anatomy

Answer 9

URTI via Eustachian tube

Question 10

what happens when the URTI reaches the middle ear cavity in acute otitis media

how does this present clinically

Answer 10

inflammation
pus

= perforated ear drum (sometimes)

= pain and discharge

Question 11

how does the patient generally feel in acute otitis media

Answer 11

fever
lethargy
‘off food’

Question 12

acute otitis media treatment

Answer 12

self limiting (4 days), paracetamol for pain

Question 13

acute otitis media treatment is persistent >4 days

Answer 13

amoxicillin PO

Question 14

microbio of recurrent otitis media

Answer 14

pseudomonas aeruginosa

Question 15

is there an infection in glue ear (otitis media with effusion)

Answer 15

NO!

unlike the name suggests

Question 16

where is the fluid (glue like consistency) in glue ear (otitis media with effusion)

Answer 16

behind the tympanic membrane (middle ear)

Question 17

what is usually the aetiology of glue ear (otitis media with effusion)

Answer 17

eustachian tube dysfunction

Question 18

which ages is glue ear (otitis media with effusion) common in

Answer 18

2, 5, 6

Question 19

how does a kid with otitis media with effusion (glue ear) present (2)

Answer 19

hearing loss (high TV volume, language delay, poor school performance)
no pain

Question 20

tests for glue ear (3)

Answer 20

otoscopy
audiometry
tympanometry

Question 21

finding on otoscopy for glue ear

Answer 21

fluid (bubbles) behind ear drum

Question 22

finding on audiometry for glue ear

Answer 22

conductive hearing loss (bone conduction better than air conduction) by 20 decibels

Question 23

tympanometry of glue ear

Answer 23

flat line = bc tympanic membrane cant vibrate

Question 24

treatment of glue ear (2)

Answer 24

self limiting <3 months, see back in 3 months time

if persistent >3months = grommets

Question 25

is there earache and fever with otitis media with effusion (glue ear)

Answer 25

no

Question 26

'swimmers ear'

Answer 26

otitis externa

Question 27

aetiology of otitis externa

Answer 27

swimming trauma from finger nails lack of ear wax hearing aids think about it - they are all only applicable to the outer ear, not the middle ear

Question 28

otitis externa with black dots what is the microbio

Answer 28

aspergillus niger

Question 29

microbio of otitis externa

Answer 29

``` pseudomonas aeruginosa staph aureus aspergillus niger (black dots) ```

Question 30

how does the skin of the ear canal loop on otoscopy of otitis externa

Answer 30

red and swollen

Question 31

how will the patient present with otitis externa

Answer 31

painful itchy increased earwax hearing reduced (from increased ear wax)

Question 32

at home treatment for otitis externa

Answer 32

clean and dry ear

Question 33

treatment of severe otitis externa (2 - fungal and bacterial)

Answer 33

topical clotrimazole - fungal | gentamicin drops - bacterial

Question 34

complication of otitis externa

Answer 34

malignant otitis

Question 35

what is malignant otitis

Answer 35

extension of otitis externa to mastoid and temporal bones

Question 36

microbio of malignant otitis

Answer 36

pseudomonas aeruginosa

Question 37

presentation of malignant otitis | 3 previous symptoms, 3 present symptoms

Answer 37

previous earache, discharge, hearing loss in one ear now bad ear pain, headache, facial nerve palsy

Question 38

treatment of malignant otitis (2)

Answer 38

surgical debridement and antibiotics

Question 39

investigation for otitis externa

Answer 39

biopsy and culture of discharge

Question 40

investigation for malignant otitis

Answer 40

biopsy and culture of discharge

Question 41

what is cholesteatoma

Answer 41

abnormal stratified squamous epithelium in the middle ear

Question 42

aetiology of cholesteatoma

Answer 42

perforated tympanic membrane | chronic otitis media congenital

Question 43

where does the abnormal stratified squamous epithelium come from in cholesteatoma if the ear drum is perforated

Answer 43

external acoustic meatus

Question 44

who usually gets cholesteatomas who can get cholesteatomas

Answer 44

kids anyone

Question 45

what does the abnormal stratified squamous epithelium in the middle ear in cholesteatoma produce that does this looks like

Answer 45

keratin 'cheesy' discharge (smells)

Question 46

what is the classification system for cholesteatoma

Answer 46

sade I-IV

Question 47

what nerve may be affected by cholesteatoma how does this present

Answer 47

CN VII facial facial paralysis (ipsilateral)

Question 48

cholesteatoma treatment

Answer 48

mastoid surgery

Question 49

cholesteatoma investigation

Answer 49

diffusion weighted MRI | otoscopy

Question 50

how would cholesteatoma look on otoscopy

Answer 50

pearly white

Question 51

complications of cholesteatomy

Answer 51

intracranial abscess

Question 52

what is a vestibular schwannoma

Answer 52

tumour of vestibular part of vestibulocochlear nerve CN VIII

Question 53

what type of hearing loss does vestibular schwannomas present with

Answer 53

unilateral sensorineural hearing loss

Question 54

what is a bilateral schwannoma in a young person associated with what else would you be looking for in this patient (1)

Answer 54

neurofibromatosis type 2 café au lait spots

Question 55

are vestibular schwannomas benign or malignant

Answer 55

benign

Question 56

vestibular schwannoma investigation and finding

Answer 56

MRI - looks like a golf ball

Question 57

blunt trauma to outer ear, looks swollen and red | no lacerations

Answer 57

pinna haematoma

Question 58

pinna haematoma treatment (2)

Answer 58

aspiration/drainage | antibiotics - to cover for secondary infection

Question 59

complication of untreated pinna haematoma

Answer 59

ischemic necrosis (cauliflower ear)

Question 60

treatment of ear laceration (3)

Answer 60

debridement closure with stiches antibiotics to prevent infection

Question 61

head trauma 'battle sign' bruising (behind ear on mastoid process) hearing loss facial nerve palsy vertigo

Answer 61

temporal bone fracture

Question 62

is a transverse or longitudinal temporal bone fracture more likely to cause CN VII and CN VIII damage (hence sensorineural hearing loss)

Answer 62

transverse (it goes form front to back)

Question 63

is a transvers or longitudinal temporal bone fracture more likely to cause conduction hearing loss

Answer 63

longitudinal (bc it travels horizontally (ish) through the different parts of the ear)

Question 64

infection in early pregnancy sensorineural hearing loss that presents age 2 what is the infection

Answer 64

cytomegalovirus