Ear disease

Question 1

What type of tuning fork is used to test hearing?

Answer 1

512 Htz

Question 2

Where is the tuning fork placed in rinnes test? What about in webers test?

Answer 2

Rinnes - base of tuning fork is placed on mastoid process

Webers - base of tuning fork is placed on bony prominence of the head

Question 3

What is a pure tone audiogram used for?

Answer 3

Detecting hearing loss and differentiating between high/low frequency and conductive/sensorineural loss

Question 4

How are the left and right ears denoted on an audiogram respectively?

Answer 4

Left - crosses

Right - circles

Question 5

How is bone conduction denoted on an audiogram?

Answer 5

Square bracket

Question 6

What is a tympanogram?

Answer 6

Test of pressure within the patients ear (air forced into ear)

Question 7

What type of scope is used to examine the ear?

Answer 7

Otoscope

Question 8

How can the common symptoms of ear disease be remembered?

Answer 8

6 D’s -

Deafness
Discomfort
Discharge
Dizziness
Din din (tinnitus) 
Defective facial movement (paralysis)

Question 9

What classifications of deafness are there?

Answer 9

Conductive
Sensorineural
Mixed
Central

Question 10

Where is the pathology in conductive deafness?

Answer 10

External or middle ear

Question 11

Where is the pathology in sensorineural deafness?

Answer 11

Sensory - cochlea

Neural - auditory nerve

Question 12

Where is the pathology in mixed deafness?

Answer 12

External/middle ear + Cochlea/auditory nerve

Question 13

Where is the pathology in central deafness?

Answer 13

Brain

Question 14

Which nerves can be involved in ear discomfort (earache)?

Answer 14

Trigeminal (maxillary and mandibular branches)
Facial
Glossopharyngeal
Vagus

Nb - remember pain is often referred

Question 15

What pathologies can cause discharge to come from the ear?

Answer 15

Acute otits media
Chronic otitis media
Skull fractures (cerebrospinal fluid)
Iatrogenic (surgery)

Question 16

Into which two broad categories can dizziness be classified?

Answer 16

Central (brain)

Peripheral (ear pathology - with/without hearing loss)

Question 17

How may dizziness induced by central pathology present?

Answer 17

Dizziness + acute lisp

Question 18

What is tinnitus?

Answer 18

An abnormal sound not coming from an external source - normal in silence but abnormal when there is ambient noise

Question 19

What type of tinnitus should always be investigated?

Answer 19

Unilateral tinnitus

Question 20

How is tinnitus treated?

Answer 20

Adaptation strategies/techniques

Hearing aids

Question 21

Are facial palsies relating to the ear upper or lower motor neurone pathologies?

Answer 21

Lower most often

Question 22

How can lower and upper motor neurone pathologies be clinically differentiated?

Answer 22

Upper - bilateral palsy

Lower - unilateral palsy

Question 23

Is itch a feature of otitis externa?

Answer 23

Often

Question 24

What are rare complications of acute otitis media?

Answer 24

Brain abscess

Mastoiditis

Question 25

How is non-resolving otitis media with effusion treated?

Answer 25

Grommet insertion | Hearing aid

Question 26

Which two types of patients often get otitis media with effusion?

Answer 26

Children with cleft palate | Children with down's syndrome

Question 27

How is chronic otitis media managed?

Answer 27

Antibiotics + myringoplasty

Question 28

What type of hearing loss does ear drum perforation cause?

Answer 28

Conductive (should resolve as ear drum heals)

Question 29

What is a cholesteatoma?

Answer 29

Keratinised squamous cell epithelium within the middle ear

Question 30

What is primary acquired cholesteatoma?

Answer 30

Cholesteatoma which arises due to perforation of the tympanic membrane (chronic otitis media)

Question 31

Why does the ear drum retract/perforate in otitis media with effusion?

Answer 31

Due to the negative pressure within the ear

Question 32

What are the types of cholesteatoma?

Answer 32

Congenital/Derlacki - SC epithelium trapped in mastoid bone during embryogenesis (conductive hearing loss as it expands, ear drum will be intact) Primary acquired - chronic negative airway pressure causes retraction and perforation of tympanic membrane causing abnormal placement of SC Secondary acquired - insult to the tympanic membrane (AOM, trauma, surgery, etc) causes abnormal placement of SC

Question 33

How is cholesteatoma investigated?

Answer 33

CT of temporal bone

Question 34

How is cholesteatoma managed?

Answer 34

Surgical removal

Question 35

What are the possible complications of otitis media?

Answer 35

Abscess Facial paralysis Thrombophlebitis Mastoiditis

Question 36

What is a bezoids abscess?

Answer 36

Abscess in sternocledomastoid

Question 37

Cholesteatoma is locally destructive but not malignant. T/F

Answer 37

True

Question 38

Define acute otitis media, otitis media with effusion and chronic otitis media

Answer 38

AOM - acute inflammation of the middle ear OME/glue ear - effusion in middle ear caused by negative pressure due to eustachian tube dysfunction (precede OR follow AOM) COM - mucosal (perforation of tympanic membrane) or squamous (tympanic membrane retraction +/- cholesteatoma)

Question 39

What is otitis media with effusion associated with?

Answer 39

Parental smoking Early entry into child care Not breastfeeding Feeding infants while lying down