Ear problems

Question 1

Ear. Wax. Mx

Contraindication?

Answer 1

Prescribe ear drops for 3–5 days initially, to soften wax and aid removal.

1. Olive oil, or almond oil drops can be used 3-4 times daily for 3-5 days ( check nut allergy).
2. Sodium bicarbonate 5%, sodium chloride 0.9%,

Do not prescribe drops if you suspect the person has a perforated TM,

Question 2

Cholesteatoma

rfx (4), Symptoms (3) complicx, Mx,

Answer 2

A cholesteatoma is an abnormal sac of keratinizing squamous epithelium and accumulation of keratin within the middle ear or mastoid air cell spaces

RFx

• Otitis media
• Eustachian tube dysfunction>>Promotes invagination of the tympanic membrane
• Congenital anomalies
• Otological surgery

symptoms

• foul, smelly discharge Not responding to antibiotics
• Hearing loss or Tinnitus
• Less commonly otalgia vertigo and cranial nerve seven involvement

Otoscopy

‘attic crust’ - seen in the uppermost part of the ear drum

Mx

For all people with suspected cholesteatoma, arrange semi-urgent referral to ENT

Question 3

What investigations would you do for cholesteatoma? (2)

Answer 3

Audiology assessment and CT scan

Before surgery discharge can be treated with antibiotics

Question 4

What is the reason for hearing loss in cholesteatoma?

Answer 4

Debris causing a conductive hearing loss or erosion by cholesteatoma of the ossicles.

Question 5

TM perforation managment

and advice

Answer 5

Otoscopy.
Pure tone audiogram.

Keep the ear dry.

No more cleaning.

No eardrops.

Review in 4 weeks.

Question 6

BPPV

def, rf , symp,

Answer 6

Caused by calcium carbonate or OTOCONIA in the semicircular canals of the inner ear and every time the head moves the otoconia move in the semicircular canals moving the Endolymoh causing vertigo

RFX

1. head injury
2. prolonged recumbent position (ex a visit to the dentist or hairdresser), ear surgery,
3. following an episode of any inner ear pathology (for example, vestibular neuronitis, labyrinthitis, Meniere’s

symp

• VERTIGO that lasts less than one minute and triggered by head movements
• N & V
• Hearing not affected
• Lightheadedness

Question 7

BPPV

diagnosis, advice (4) , Mx, follow up?

Answer 7

1. Dix hall pike test

• vertigo
• nystagmus

Advice

• Inform the DVLA
• Avoid to getting out of bed quickly in the morning
• Avoid tasks involving looking upward
• Reassure people recover within several weeks

Mx

• Offer Epley manoeuvre
• Suggest brandt-daroff-exercises

Follow-up in 4 weeks if symp no gone

Question 8

Menieres disease