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Unit 14 > Ear diseases > Flashcards

Ear diseases Flashcards

1
Q

What is the embryological origin of the external ear?

A

From the 1st and 2nd pharangeal arches
Which create 6 hillocks of His
Then develops into the external ear.

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2
Q

Label the features of the external ear in orange.

A

Helix
Auricular tubercule
Antihelix
Helix

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3
Q

Label the features of the external ear in pink?

A

Antitragus
Lobule of ear
Intertrgaic incisure
Tragus

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4
Q

Label the features of the external ear in green.

A

Cavum conchae
Anterior notch
Crus of helix
Crura of antihelix

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5
Q

Label the features that are normally visible when looking at the tympanic membrane via otoscopy.

A

Handle of malleus
Umbo (end of malleus)
Annulus fibrosus ( thickened peripheral ear of pars tensa)
Light reflex
Orifice of the eustachian tube
Lateral process of the malleus

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6
Q

What are the two main portions of the ear drum?

A

Pars tensa - majority of ear drum, tense, below malleus prominence
Pars flaccida - upper/attic portion, flacid below the malleus prominence

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7
Q

What is the usefulness of the cone of light in the eardrum?

A

Points anterior inferiorly - used to indicate what ear looking at

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8
Q

How to identified a retracted or bulging eardrum from appearance?

A

Retracted - view more of ossiciles (not just malleus)
Bulging - less or no of malleus visible

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9
Q

What structures neighbour the middle ear and can be at risk of erosion during otitis media?

A

Inferior - bulb of jugular vein
Facial nerve canal
Carotid canal - and contained internal carotid artery
Temporal bone - into the meninges (risk of meningitis)
Mastoid bone - mastoiditis

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10
Q

What are the three different ossicles?

A

Malleus
Incus
Stapes

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11
Q

What is the role of the endolymphatic duct in the ear?

A

Drains the continuously produced endolymphatic fluid from the vestibular apparatus and auditory apparatus.

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12
Q

What is the purpose of having semicircular canals on both sides of the head?

A

Three canals on each side
Each canal is at a different angle.
Horizontal - align on each side
Anterior and posterior canals on opposite sides align
One of the pair gives a negative signal one gives a positive signal - confirm movement.

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13
Q

How can defects in the semicircular canals affect vision?

A

Unable to fix gaze on item, particularly when head moving
Nystagmus - flickering eye movements (can make feel dizzy)

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14
Q

Where do nerves leave the internal auditory meatus into the cranium?
What nerves?

A

Consists of mainly the facial nerve CN7, Vestibulocochlear nerve CN8 (c for cochlear, and vestibular)
Located in the petrous portion of the temporal bone

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15
Q

What are some red flags in a patient history for ear problems?

A

Otalgia (ear pain)
Bleeding
Unilateral otitis media >18yrs (fluid build up), can be caused by blocked eustachian tube indicate tumour at back of nose

Refer for two week wait appointment

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16
Q

What are some important symptoms to consider in an ear clinical history?

A

Discharge
Hearing change
Tinnitus - perception of sound that does not have an external source
Vertigo/dizziness
Aural fullness - ear pressure or clogging sensation

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17
Q

How does pH relate to acute otitis external?

A

Norm acidic
More alkaline - risk of infection - commonly caused by shampoo or chlorine in ear

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18
Q

Give are the basic features of acute otitis externa.

A

External ear disease
More common in adults
Presents with itch and pain
Frequent in swimmers
Usually caused by a Pseudomonas infection or staph aureus

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19
Q

What is the basic treatment for acute otitis external?

A

Cleaning - microsuction
Topical ear drops - ciprofloxacin +/- dexamethasone
Swab for analysis
Advise aural hygeine - keep ear dry
If gross ear canal swelling may need a wick (tube/structure to help drops get into ear past swelling).

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20
Q

What are some risk factors for acute otitis media?

A

Children - eustachian tube is more horizontal, narrow and shorter so easier for viral infection/inflammation to spread up, also immature immune system

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21
Q

What is a common cause of acute otitis media?

A

Viral infection in the nasopharynx spread up the eustachian tube, creates a superimposed pyogenic bacterial infection in middle ear (often Haem, influenza or streptococci)

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22
Q

Describe how acute otitis media leads to discharge.

A

Inflammation in middle ear
Increased pressure
Pain
Perforation of eardrum
Discharge and relief from pain

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23
Q

What is the common treatment for acute otitis media?

A

Pain relief
Delayed oral and ear drop antibiotics - between 48-72hrs - poor evidence and norm viral in cause
Surgery if complications e.g tympanoplasty, or incision to drain pus.

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24
Q

What are some complications of acute otitis external?

A

Fungal infection - otomycosis
Necrotising Otitis externa

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25
Q

What is otomycosis?

A

A complication of acute otitis external - particularly if lots of topical antibiotics
A fungal infection presents as severely itchy
Asperigillus cause will have yellow-black spores
Candida - thick white cream

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26
Q

What is necrotising otitis externa?

A

Infection in the external ear canal spreads through soft tissue and can erode the surrounding bone.
Osteomyelitis (inflammation of bone and bone marrow) of the temporal bone.
Presents with severe ear pain, high risk of complications.
Often results from pseduomonas infection.

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27
Q

What are some risk factors for necrotising otitis externa?

A

Recurrent or persistent otitis externa
Diabetes
Immunosuppression
Elderly
Ear syringing

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28
Q

What is the basic management strategy for necrotising otitis external?

A

Protracted course of systemic antibiotics
Topical antibiotic drops
Regular microsuction
Diabetes control

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29
Q

What is a cholesteatoma?

A

Accumulation of benign keratinizing squamous cells in the middle ear - cells are hyperproliferating and secete enzymes which can be locally destructive.
Commonly seen in attic of tympanic membrane
Debris can become infected causing chronic ear discharge
Requires surgery.

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30
Q

What are the potential complications of a cholesteatoma?

A

Erosion of bone by activating osteoclasts, epithelium proliferate and invade destroying temporal bone and carrying infection to bone/soft tissues
- facial palsy due to necrosis of facial nerve
- intercranial sepsis
- meningitis

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31
Q

How do patients with cholesteatoma present?

A

Painless otorrhea - foul smeeling
Ache behind ear
Sense of pressure in ear
Conductive hearing loss
History of repeated ear infections

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32
Q

What are the two broad causes of a cholesteatoma?

A

Congenital - persistent epithelial cell left in the middle ear during embryonic development
Acquired - eustachian tube dysfunction in TM retraction -> effect keratin migration -> trapped keratin.

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33
Q

What are the key features of acute otitis media?

A

Middle ear disease
More common in children
Usually follow a URTI (usually viral)
Causes pain, then perforation and discharge with pain relief in the ear.

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34
Q

What might acute otitis media look like during otoscopy?

A

Bulgin of the tympanic membrane due to fluid build up
More opaque in appearance - loss of view of malleus.

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35
Q

What are some common complications of acute otitis media?

A

Build up of pressure can erode through nearby bone
Perforation of tympanic membrane
Hearing loss
Vertigo
Intra-cranial infection
Acute mastoiditis
CNVII palsy
Intracranial complications
Other abcesses

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36
Q

How does perforation of the tympanic membrane present?

A

Intense pain in ear with significant discharge from ear

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37
Q

How to manage tympanic membrane perforation?

A

Conservative - reassurance, water precuations
Topical antbiotics - if intermittent discharge
Myringoplasty - eardrum repair is recurrent discharge, is a graft placed to epithelium to regrowm

38
Q

What is chronic suppurative otitis media?

A

Norm 12 weeks plus
Complication of perforation of the tympanic membrane from acute otitis media
Unhealing perforation, with risk of developing recurrent episodes of discharge (due to chronic or repeated infection), risk of ossicle erosion leading to more severe hearing loss
Present with increasing deafness
Risk of intracranial and extracranial spread.

39
Q

What is acute mastoiditis?

A

What acute otitis media fluid discharges into the mastoid bone.
results in inflammation of lining mastoid air cells (can have associated abscess)
Results in swollen, tender, boggy mastoid.
May have otalgia and discharge
Risk of meningitis.
Protrusion of pina, loss of post-auricular sulcus.

40
Q

What are the treatment of acute mastoiditis?

A

Aggressive IV antibiotic therapy - as are often also septic.
Consider topical antibiotic drops
Regular observation by medical team at at least 4hrly vital signs
May requires CT/MRI to identify complications e,g intracranial abcess
Surgery - grommets, cortical mastoidectomy (remove and drain infected area)

41
Q

How does facial nerve palsy relate to ear disease?

A

Complication of necrotising ottis externa or acute mastoiditis
Cranial Nerve 7 palsy
Not forehead sparing
Can spread to CN8 causing hearing loss, tinnitus and vertigo

42
Q

What are some different causes of facial nerve palsy?

A

Ear disease
Trauma
Surgery
Cancer (ear or parotid)
Acoustic Neuroma
Shinges - Ramsay Hunt (HZV)

43
Q

What are some presentations of facial nerve palsy?

A

Facial paralysis (unilateral)
Otalgia/jaw pain
Vesciles close to ear cana/tongue/hard palate
Loss of taste to 2/3 of tongue, dry mouth and eyes
Rank via House-Brackman Scoring Criteria (1 point for every 0.25c, eyebrow movement)

44
Q

What is otitis media with effusion?

A

Chronic - present for 3 months or more
Middle ear effusion without signs of infection
May be associated with URTI viral infection
Fluid build-up - causes negative pressure in middle ear as eustachian tube narrows.
Eustachian tube dysfunction disturbing ventilation of the middle ear.
Sucks fluid in mucosa of middle ear – exudate
Also called glue ear.
Typically resolves in 3months
Most common cause of acquired congenital hearing loss in children.

45
Q

What is the presenting history and examination findings of otitis media with effusion?

A

Ear pressure/pain
Disequilibrium
Popping noise
Deafness
On examination will have a dull TM, fluid levels/buddles visible through the membrane.

46
Q

What are some risk factors for otitis media with effusion?

A

Found in 30% children between 2 to 7yrs
Common in children with cleft palate or down syndrome (anatomy of eustachian tube affected)

47
Q

What is the treatment for otitis media with effusion?

A

50% resolve spontaneously within 3 months (should receive counselling and audiometry)
Is persistent, bilateral or in children -> ventilation tubes/grommets

48
Q

What are the cautions around otitis media with effusion in adults?

A

If unilateral need to exclude nasopharyngeal tumours that can block drainage of the eustachian tube.

49
Q

What foreign objects get stuck frequently in ear?

A

Insects - use olive oil to kill then remove
Batteries - emergency
Cotton buds

50
Q

What is shown in the image?

A

Scarring of the ear drum = tympanosclerosis - from infection or resolved gromets

51
Q

What is shown in the image?

A

Cholesteatoma

52
Q

What is shown in the following image?

A

Perforation of the tympanic membrane

53
Q

What is shown in the following image?

A

Pinna haematoma

54
Q

What is a pinna haematoma?
What are some complications?

A

Occurs from shearing force applied to pinna (common in rugby and NBA)
Skin stretches and bleeds from perichrondirum, pushes away from cartilage, cartilage fibrosis and scars in absence of blood supply.
Treatment - incision to drain blood, then heal and push cartilage back to perichrondrium
Can lead to cauliflower ear.

55
Q

What is shown in the image?

A

Perichondritis

56
Q

What is shown in the image?

A

Pinna Cellulitis of the ear

57
Q

What norm causes pinna cellulitis of ear?

A

Staph aureus
Skin infections from psoriasis, eczema, otitis externa

58
Q

What is pericrhondritis?
Cause, treatment, complication

A

infection on perichondrium, norm pseudomonas and penetrating trauma
Treat with IV Abx
Does not effect lobule as no cartilage.
Can cause cauliflower ear

59
Q

What is shown on the image?

A

Pre-auricular sinus

60
Q

What is vertigo?

A

A symptoms - sensation or room spinning
Can be associated with vomitting

61
Q

What are the three main peripheral/ENT causes of vertigo?

A

Benign Paroxysmal Positional Vertigo
Neuronitis/labryinthitis
Meiniers Disease

62
Q

What is the key presentation of Benign Parosysmal Positional Vertigo?

A

Vertigo that is …..
Episodic
LAsting seconds
Occurs when turning head such as rolling over in bed.

No hearing loss or tinnitus

63
Q

What is the key presentation of neuronitis/labryinthitis?

A

Vertigo that is
Neuronitis - persistent continuous vertigo
Larbrynthitis - vertigo and hearing loss

64
Q

What is the key presentation of menieres disease?

A

Change of perssure in inner ear endolymphatic system - cause aural fullness
Recurrent, episodic (minutes to hours) vertigo
With nause/vomitting
Low level sensorineural hearing loss
Can be uni or bilateral

65
Q

What is benign paroxysmal positional vertigo?

A

Type of vertigo
Commonly caused by dislodgement of otoconia (crystalloid debris) in the semicircular canals (most common posterior)
Causing abnormal sensation of movement as endolymph flow through canals is disrupted.
Can be displaced by viral infection, head trauma, ageine or without clear cause.

66
Q

What procedure is used to diagnose BPPV?

A

Dix Hallpike test
Move patient head to move endolymph through semicircular canal and trigger vertigo.
Sit upright turn head 45 degrees, support head in this position and rapidly lower until extend off edge of by by 20-30 degrees
Look for nystagmus (norm towards affected ear) and ask for vertigo

67
Q

How is BPPV treated?

A

Epley manouvre - multiple rotations of head, support and weight for any vertigo to clear aim to move crystals into position in semicircular canals to not disrupt endolymph flow.

Brandt-Daroof Exercises - by patient at home,involving sitting then lying sideways on bed, rotating head slightly to face ceiling, repeat.

68
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve
Produces persistent continuous vertigo, may be worse on head movement, also sometimes nausea and vomiting and balance problems
Often has preceeding viral infection

69
Q

What is labryinthitis?

A

Inflammation of the entire labyrinthine apparatus
Produced acute onset continuous vertigo plus hearing loss and tinnitus
Usully attributed to a viral upper respiratory tract infection. Can be secondary to bacterial ototis media or meningitis but rarer.

70
Q

What condition is red flag to be ruled out with persistent vertigo?

A

Central causes such as a posterior circulation stroke or a tumour.

71
Q

What is acoustic Schwannoma (acoustic Neuroma)?

A

Benign brain tumour of myelin sheath
Arises from vestibular portion of CN8 norm ar cerebellopontine angle.
Norm unilateral
Cause - unilateral sensorineural hearing loss (sudden or progressive), tinitus, auricular fullness and vertigo.
May cause facial nerve palsy if tumour grows

72
Q

What underlying condition can a bilateral acoustic neuroma indicate?

A

Neurofibromastosis type 2
Genetic conditions causes tumour growth along nerves especially schwann cells.

73
Q

What is tinnitus?

A

Hallucination of sound
Common
Concern if becomes bothersome, may affect hearing (unable to her other sounds)
Associated with presbycusis, menieres etc

74
Q

What is the concern with presentaion of unilater persistent tinnitus?

A

May indicate vestibular schwannoma - require MRI to rue out.

75
Q

What is shown in the image?

A

Unilateral vestibular schwannoma (acoustic neuroma)

76
Q

What is the newborn baby hearing screening?

A

Occurs by 4 weeks
Asses automated otoacoustic emission test
Auditory brainstem response

77
Q

What is audiometry?

A

Measures range (Fz) and sensitivity of hearing (dB), plots on chart can compare ear, bone conduction, air conduction, maksed and unmasked,

78
Q

What is the normal range of pure tone hearing?

A

0-19dB

79
Q

What ranges of pure tone hearing indicate hearing loss?

A

Quietest dB heard is….
20-40 = mild
41-70 = moderate
71-95 = severe
95-110 = profound
111+ = total or dead ear.

80
Q

What is tympanometry?

A

Tests eardrum movement
Probe in ear pushes air into external ear towards membrane.
Shows degree of movement, direction of movement and can identify perforation -shows a graphical representation of compliance of middle ear as a result of air pressure
Highest peak on graph is when most compliant (should be around 0 daPa)

81
Q

What are some of the psychosocial consequences of bilateral hearing loss?

A

Speech development
Social interaction - isolation, loneliness, increased risk of dementia

82
Q

What are some of the psychological and developmental consequences of unilateral hearing loss?

A

Disorientation
Poor sound localisation
Poor speach discrimination in noisy environments.

83
Q

What are some different types of hearing loss?

A

Otosclerosis
Meniere’s
Trauma - base of skull/temporal bone fracture affecting cochlear or nerve.
Presbycusis
Noise induced
Sudden sensorineural hearing loss

84
Q

What is otoslerosis?

A

Slow progressive conducting hear loss
AD inheritance (incomplete penetrance) - cause fixation or abnormal remodelling of ossicles
Is bilaters in 75-80%, mainly affects low frequencies and also causes tinnitus.

85
Q

What is Meniere’s disease?

A

Causes a triad of hearing loss, vertigo and tinnitus
Long term disroder - build up of endolymph in labyrinth of inner ear, high pressure disrupts sensory signals.

86
Q

What is presbycusis?

A

Old age, high end sensorineural hearing loss.

87
Q

What is noise induced hearing loss?

A

High end sensorineural hearing loss - get 4000Hz notch
Untreatable

88
Q

What is sudden sensorineural hearing loss?

A

Hearing loss with onset less than 72hrs (must rule out other neurology such as stroke)
Treat as emergency - within 24hrs
Must rule out conductive
Often treat with steroids.
Audiology (More than 30db in 3 consequetive frequencies).
Many causes is an umbrella term

89
Q

What are the different types of hearing support?

A

Hearing aids - behind ear, in ear, in canal, completely in canal, body worn
Bone anchored devices - soft band or surgical implants
Middle ear implants
Cochlear implants
Other aids - Bluetooth aids, hearing loops, visual alarm systems

90
Q

How to interpret Rinnes and Webers?

A

Webers - norm middle, conductive deviate to bad ear, sensorinueral deviate to good ear
Rinnes - norm positive (sensorineural loss may be false positive), negative - conductive or false negative

Unit 14 (17 decks)

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