Ear Disease

Question 1

what 10 questions would you want to ask a patient presenting with ear disease

Answer 1

• Hearing loss?
• Tinnitus?
• Vertigo?
• Otalgia?
• Ear discharge?
• Facial weakness?
• Previous ear surgery?
• Nasal symptoms?
• Neurological symptoms?
• Family history

+/- paediatric questions

Question 2

What are the three types of hearing loss

Answer 2

Conductive
Sensorineural
Mixed

Question 3

Lower motor neuron vs upper motor neurone facial weakness S&Ss

Answer 3

All parts of face not moving? - lower motor neurone lesion
Forehead still moving? - upper motor neurone/stroke

Question 4

What are the five most common causes of conductive hearing loss

Answer 4

Otitis externa
Acute otitis media
Otitis media with effusion (glue ear)
Cholesteatoma
Perforation

Question 5

Otitis externa is ________________ of the skin of the ear canal that is ______________ infective

Answer 5

Otitis externa is inflammation of the skin of the ear canal that is almost always infective

Question 6

What two types of infection are associated with otitis externa

Answer 6

Bacterial & fungal

Question 7

Otitis externa aetiology/ risk factors

Answer 7

Water, cotton buds, skin conditions

Question 8

What acute group is most commonly affected by acute otitis media

Answer 8

Children

Question 9

What two conditions is acute otitis media commonly associated with

Answer 9

URTIs
Glue ear

Question 10

Chronic otitis media is otitis media that has last for _____________ or longer

Answer 10

3 months

Question 11

Otitis media with effusion in children is associated with….

Answer 11

Eustachian Tube Dysfunction or Obstruction
Acute otitis media

Question 12

Otitis media with effusion in adults is associated with….

Answer 12

Rhinosinusitis
Nasopharyngeal carcinoma
Nasopharyngeal lymphoma

Question 13

Otitis media with effusion diagnosis

Answer 13

Conductive Hearing Loss with flat tympanogram

NOTE: kids often present with change in behaviour or problem with speech development instead of hearing loss

Question 14

Otitis media with effusion in kids treatment options

Answer 14

Wait & see (for eustachian tube development)
Hearing aids
Grommet insertion
Adenoidectomy

Question 15

Perforation of the tympanic membrane is commonly associated with……

Answer 15

Acute Otitis Media (& sometimes trauma)

Question 16

What would the tympanic membrane look like in acute otitis media

Answer 16

Red & bulging

Question 17

Ear perforation treatment

Answer 17

Usually resolves on its own

Question 18

Pathophysiology of cholesteatoma

Answer 18

Growth of keratinising squamous epithelium in middle ear
Collection of dead skin cells & keratin in middle ear
As it expands it erodes bone

Question 19

Cholesteatoma histological appearance

Answer 19

squamous epithelium with abundant keratin production, associated inflammation

Question 20

Is Cholesteatoma congenital or acquired

Answer 20

usually acquired but can be congenital

Question 21

What is cholesteatoma association with

Answer 21

chronic otitis media or perforated tympanic membrane

Question 22

Cholesteatoma clinical features

Answer 22

hearing loss, discharge, complications

Question 23

What complication would you expect if acute otitis media associated with cholesteatoma was to spread laterally

Answer 23

Subperiosteal abscess
(infection/swelling at back of ear)
(makes ear stick out)

Question 24

What complication would you expect if acute otitis media associated with cholesteatoma was to spread medially

Answer 24

Sensorineural Hearing Loss /Tinnitus / Vertigo / Facial Palsy

Question 25

What complication would you expect if acute otitis media associated with cholesteatoma was to spread superiorly

Answer 25

Brain abscess or meningitis

Question 26

What complication would you expect if acute otitis media associated with cholesteatoma was to spread posteriorly

Answer 26

Venous sinus thrombosis

Question 27

What test can be used to identify a brain abscess

Answer 27

CT with contrast (pus doesn’t take up contrast)

Question 28

Cholesteatoma investigations

Answer 28

Otoscopy

Question 29

Cholesteatoma management

Answer 29

Mastoid surgery to remove the sac of debris, reconstruction

Question 30

Otosclerosis presentation

Answer 30

Gradual onset conductive hearing loss that progresses more rapidly during pregnancy (usually affects women)

Question 31

Otosclerosis treatment

Answer 31

Hearing aids OR Surgical replacement of stapes bone through stapedectomy

Question 32

Otosclersois on audiometry

Question 33

What is presbycusis

Answer 33

Degenerative disorder of the cochlear resulting in hearing loss (usually at high frequencies)

Question 34

Presbycusis audiometry findings

Question 35

Presbycusis management

Answer 35

High-frequency-specific hearing aid

Question 36

What noise is usually affected in presbycusis

Answer 36

High frequency noises

Question 37

What happens in noise induced hearing loss

Answer 37

Cochlear damage

Question 38

How does noise induced hearing loss present on audiometry

Answer 38

- Sensorineural hearing loss - Characteristically has a dip at 4 kHz

Question 39

What drugs are associated with sensorineural hearing loss

Answer 39

- Gentamicin and other aminoglycosides - Chemotherapeutic drugs - cisplatin, vincristine - Aspirin and NSAIDs (in overdose)

Question 40

Drug induced hearing loss treatment

Answer 40

Stop drug

Question 41

What is a vestibular schwannnoma

Answer 41

Benign tumour arising in Internal Auditory Meatus

Question 42

Vestibular Schwannoma presentation

Answer 42

Hearing loss, tinnitus and imbalance

Question 43

Vestibular Schwannoma diagnosis

Answer 43

MRI scan

Question 44

Vestibular Schwannoma treatment

Question 45

What two types of trauma are associated with hearing loss

Answer 45

Direct trauma to ear Head injury/ skull fracture

Question 46

How can a skull fracture cause conductive hearing loss

Answer 46

Ossicle dislocation

Question 47

How can a skull fracture cause sensorineural hearing loss

Answer 47

Nerve or cochlear damage

Question 48

What type of hearing loss caused by skull fracture can be treated

Answer 48

Conductive (very little can be done for sensorineural)