Ear Pathologies

Question 1

What are some examples of drugs which may cause hearing loss?

Answer 1

Gentamicin, furosemide, aspirin

Question 2

What should you always do if someone has ear pain with no obvious cause?

Answer 2

Examine the throat

Question 3

If an individual has earache but a normal ENT and dental exam, what investigation should be used?

Answer 3

MRI scan

Question 4

What can be a possible cause for unilateral, pulsatile tinnitus?

Answer 4

Vascular malformations

Question 5

What size of tuning fork should be used when performing Rinne and Weber’s tests?

Answer 5

512Hz

Question 6

Which test is this describing: hold the tuning fork beside the external acoustic meatus and then place it on the mastoid, ask the patient to tell you which one sounds louder?

Answer 6

Rinne’s test

Question 7

If in Rinne’s test, the vibration from the tuning fork is heard loudest at the mastoid, what type of hearing loss does this suggest?

Answer 7

Conductive

Question 8

Which test is this describing: place the tuning fork in the middle of the patient’s forehead and ask them to tell you if the sound is louder on one side or another, or if it sounds equal in both?

Answer 8

Weber’s test

Question 9

If in Weber’s test, sound localises to the affected side, what type of hearing loss does this suggest?

Answer 9

Conductive

Question 10

If in Weber’s test, sound localises to the non-affected side, what type of hearing loss does this suggest?

Answer 10

Sensorineural

Question 11

Which is more sensitive, Rinne or Weber’s test?

Answer 11

Weber’s test

Question 12

Which type of hearing loss will usually show an air-bone gap on audiogram?

Answer 12

Conductive

Question 13

A perforated tympanic membrane is a cause of conductive hearing loss, how should this be managed?

Answer 13

It should heal spontaneously in 6-8 weeks, if there is no improvement after this time then refer to ENT

Question 14

When is surgical management (myringoplasty) required for a perforated tympanic membrane?

Answer 14

If the patient is symptomatic

Question 15

How is otosclerosis inherited? Who does it typically affect?

Answer 15

Autosomal dominant, typically affects adults aged 20-40, more commonly females

Question 16

A conductive hearing loss at 2000Hz on audiometry is suggestive of what diagnosis?

Answer 16

Otosclerosis

Question 17

Tympanometry will typically be normal in which type of hearing loss?

Answer 17

Sensorineural

Question 18

What diagnosis should be suspected if sensorineural hearing loss is unilateral? What investigation is required?

Answer 18

Tumour (acoustic neuroma) - investigate with an MRI

Question 19

An audiogram showing sensorineural hearing loss at high frequencies bilaterally is most suggestive of what diagnosis?

Answer 19

Prebycusis

Question 20

An audiogram showing sensorineural hearing loss which is bilateral and prominent at 4000Hz is suggestive of what diagnosis?

Answer 20

Noise exposure

Question 21

An audiogram showing a low frequency unilateral sensorineural hearing loss is most suggestive of what diagnosis?

Answer 21

Meniere’s disease

Question 22

A red, bulging eardrum on inspection is suggestive of what diagnosis?

Answer 22

Acute otitis media

Question 23

80% of cases of acute otitis media will resolve spontaneously within what timeframe?

Answer 23

4 days

Question 24

In what situations should antibiotics always be given for acute otitis media?

Answer 24

If the child is < 2 years, is immunosuppressed or has complications from the infection

Question 25

What is the first line antibiotic for acute otitis media? How long should it be given for?

Answer 25

Oral amoxicillin for 5 days

Question 26

What is the second line antibiotic for acute otitis media? How long should it be given for?

Answer 26

Oral clarithromycin for 5 days

Question 27

Chronic otitis media is most often caused by infection with which organism?

Answer 27

Pseudomonas aeruginosa

Question 28

What organism is the most common cause of otitis externa?

Answer 28

Staph aureus

Question 29

What fungal organism is an important recognised cause of otitis externa, particularly seen in swimmers?

Answer 29

Aspergillus niger

Question 30

What is the first line treatment for bacterial otitis externa?

Answer 30

Ear hygiene and gentamicin 0.3% drops

Question 31

What is the first line treatment for fungal otitis externa?

Answer 31

Ear hygiene and clotrimazole 1% drops

Question 32

What organism is responsible for causing malignant otitis?

Answer 32

Pseudomonas aeruginosa

Question 33

90% of cases of malignant otitis are seen in patients with what underlying condition?

Answer 33

Diabetes

Question 34

What diagnosis should be suspected if the ear lobe is white, but the rest of the ear is red?

Answer 34

Perichondritis

Question 35

'Battle sign', i.e. bruising at the back of the ear, is suggestive of what diagnosis?

Answer 35

Temporal bone fracture

Question 36

What diagnosis should be considered in a young individual with bilateral vestibular schwannomas?

Answer 36

Neurofibromatosis type 2

Question 37

What diagnosis is most likely in an individual who gets brief episodes of vertigo, usually on looking upwards, with no associated tinnitus, hearing loss or aural fullness?

Answer 37

BPPV

Question 38

How is BPPV tested for?

Answer 38

Dix-Hallpike manoeuvre

Question 39

How is BPPV treated?

Answer 39

Epley manoeuvre

Question 40

What diagnosis is most likely in an individual who gets prolonged vertigo lasting for days, typically most severe on day 1 and getting better gradually, with no associated tinnitus or hearing loss, but possible vomiting?

Answer 40

Vestibular neuronitis

Question 41

What is an example of a vestibular sedative drug that can be used as supportive management for vestibular neuronitis, labyrinthitis and Meniere's disease?

Answer 41

Prochlorperazine

Question 42

What diagnosis is most likely in an individual who gets prolonged vertigo lasting for days, typically most severe on day 1 and getting better gradually, with associated tinnitus and hearing loss, and possible vomiting?

Answer 42

Viral labyrinthitis

Question 43

Aural fullness is typically a sign of what condition causing vertigo?

Answer 43

Meniere's disease

Question 44

Which type of facial nerve palsy spares the forehead?

Answer 44

Upper motor neurone

Question 45

What is the most common cause of an UMN facial nerve palsy?

Answer 45

Stroke

Question 46

How is Bell's palsy treated?

Answer 46

Eye care and prednisolone

Question 47

Ramsay-Hunt syndrome is caused by what organism?

Answer 47

HZV

Question 48

What feature will be seen in Ramsay-Hunt syndrome and not in Bell's palsy?

Answer 48

Vesicular rashes/blisters on or in the ear

Question 49

How is Ramsay-Hunt syndrome treated?

Answer 49

Aciclovir, steroids and analgesia

Question 50

At what age is the peak incidence of otitis media with effusion?

Answer 50

2-5 years

Question 51

Is otalgia a feature of otitis media with effusion?

Answer 51

No

Question 52

A dull, retracted tympanic membrane with visible fluid in the middle ear and conductive hearing loss is suggestive of what condition?

Answer 52

Otitis media with effusion

Question 53

The first line treatment for otitis media with effusion is to watch and wait for how long?

Answer 53

3 months

Question 54

If otitis media with effusion hasn't healed spontaneously in 3 months, what treatment is required?

Answer 54

Grommet insertion

Question 55

In cholesteatoma, there is an abnormal production of what type of epithelium? What does this produce?

Answer 55

Squamous epithelium, producing keratin

Question 56

What are the two main causes of cholesteatoma?

Answer 56

Repeated middle ear infections or perforated tympanic membrane

Question 57

You should always suspect what diagnosis in cases of non-resolving or recurrent otorrhoea?

Answer 57

Cholesteatoma

Question 58

How is a cholesteatoma treated?

Answer 58

Mastoid surgery