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Yr4 - Neuro + SS > Ears > Flashcards

Ears Flashcards

(61 cards)

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1
Q

Nerve distribution of ear

A

Upper later surface = auriculotemporal nerve (CN V3)
Lower lateral surface and medial = greater auricular nerve (C3)
Superior medial surface = lesser occipital nerve (C2/3)
External auditory meatus = auricular branch of CN X

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2
Q

Mx of ear lacerations

A

Clean the wound
Primary closure - ensure all exposed cartilage covered with skin
Plastic reconstructive surgery if significant skin loss

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3
Q

Mx of bites to ear

A

Gather hx to determine causative organism
Leave wound open
Irrigate and give abx

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4
Q

Mx of haematoma

A

Can disrupt blood supply to the cartilage -> vascular necrosis
Risk of associated deformity - cauliflower ear
Requires urgent drainage
Pressure dressing to prevent re-accumulation

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5
Q

Mx of tympanic membrane perforation

A

Can cause pain and conductive hearing loss
Often heals alone
- watch and wait
- advise not to get wet
If hasn’t resolved within 6 months consider myringoplasty

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6
Q

Mx of haemotypmanum

A

Blood in middle ear
- often associated with temporal bone fracture
Associated with conductive hearing loss
Self-resolving
Follow up to ensure no residual hearing loss - damage to ossicles

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7
Q

Define otitis externa

A

Diffuse inflammation of external ear canal

- may also involve pinna or tympanic membrane

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8
Q

Epidemiology of otitis externa

A

Life incidence of 10%
Most common 7-12 year old group
Common in warmer temps and humid conditions

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9
Q

Risk factors for otitis externa

A

External ear obstruction - cerumen blockage promotes retention of water/debris
High humidity
Local trauma
Skin disease
Diabetes
Immunocompromised
Prolonged use of topical anti-bacterial - inhibit normal flora

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10
Q

Pathophysiology of otitis externa

A 
Most commonly bacterial infections
- pseudomonas aeruginosa
- staphylococcus aureus
May be fungal
- aspergillus
Breakdown of skin integrity, insufficient cerumen production or blockage of ear canal can predispose to colonisation
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11
Q

Presentation of otitis externa

A 
Rapid onset - within 48 hours
Discharge from ear
Painful ear - tragal tenderness
Ear canal swelling and erythema
Itchy ear
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12
Q

Ix for otitis externa

A 
Pneumatic otoscopy  
- normal in otitis externa
- abnormal in otitis media
Tympanometry
- normal
Swab discharge for culture if resilient
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13
Q

Mx of otitis externa

A 
Topical eardrops empirically
- gentamicin
- ciprofloxacin
- dexamethasone
Topical antifungals 
- acetic acid
Pain mx with simple analgesia
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14
Q

Complications of otitis externa

A

Malignant otitis externa

  • mainly seen in diabetes or immunocompromise
  • infection spreads from soft tissue into the bone
  • presents with chronic ear discharge, deep-seated severe ear pain, cranial nerve palsies
  • granulation tissue in ear canal
  • mx = IV ciprafloxacin as well as topical treatment
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15
Q

Define acute otitis media

A

Infection of middle ear space

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16
Q

Epidemiology of acute otitis media

A

> 80% of children present before 2 years

Peak incidence 6-18 months

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17
Q

Risk factors for acute otitis media

A 
FHx
Young age - shorter, more horizontal and poorly functioning eustachian tube
Absence of breastfeeding
Craniofacial abnormality - cleft palate
Immunological deficiency
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18
Q

Pathophysiology of acute otitis media

A

Middle earl lined with respiratory (pseudostratified columnar) epithelium
- susceptible to infection with resp viruses
Creates effusion
Suppurative inflammatory response
Blockage in eustachian tube creates negative pressure in middle ear
- pressure against tympanic membrane leads to pain

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19
Q

Presentation of acute otitis media

A 
Otalgia - children pull on ear
Preceding URTI symptoms
Bulging tympanic membrane
- purulent middle ear effusion
Myringitis - erythema of tympanic membrane
Sleep disturbance
Fever
Decreased appetite
Discharge
CLINICAL DIAGNOSIS
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20
Q

Mx of acute otitis media

A 
Analgesia - paracetamol/ibuprofen
Delayed amoxicillin prescription
- usually self-resolving
Grommets
- inserted to allow ventilation
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21
Q

Complications of acute otitis media

A 
Bullous myringitis 
- visible on otoscopy
- resolves with abx
Tympanic membrane perforation
- purulent otorrhoea
- abx
- usually heals rapidly
Mastoiditis
- infection extends into mastoid air cells
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22
Q

DDx of acute otitis media

A

Otitis media with effusion
- typically asymptomatic
- dull and retracted membrane
Myringitis - no symptoms associated with middle ear
Mastoiditis
- oedema, erythema and tenderness over mastoid process
Cholestaetoma
- normally presents with painless otorrhoea and hearing loss

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23
Q

Define chronic otitis media

A

Classified as active or inactive depending on whether discharge present
- active associated with chronic ear discharge and conductive hearing loss
Divided into squamous or mucosal
- squamous develops when keratinised squamous cells introduced into middle ear from retraction pocket or perforation
- mucosal develops when failure of tympanic membrane to heal after rupture

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24
Q

Presentation of chronic otitis media

A

Conductive hearing loss
Crusting in retraction pocket
Resistant to abx therapy

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25
Mx of chronic otitis media
Squamous disease - surgical clearance of cholesteatoma +/- mastoidectomy - risk of recurrence if not totally cleared Mucosal disease - topical abx - surgical repair of perforation
26
Risks of mastoid surgery
``` Facial nerve palsy Altered taste from damage to chorda typani CSF leak Tinnitus Vertigo Complete loss of hearing ```
27
Define otitis media with effusion
Fluid presence in middle ear with intact tympanic membrane
28
Epidemiology of otitis media with effusion
More common in children - shorter, more horizontal poorly functioning eustachian tube Assess post-nasal space as tumour may cause eustachian tube dysfunction
29
Presentation of otitis media with effusion
No pain Conductive hearing loss Middle ear effusion - bulging tympanic membrane
30
Ix for otitis media with effusion
``` Otoscopy - bulging tympanic membrane - air under drum Pure tone audiogram - conductive hearing loss Tympanometry - type B flat compliance curve - no tympanic membrane movement ```
31
Mx of otitis media with effusion
Conservative - settle in 3 months Consider hearing aid Grommet insertion +/- adenoidectomy in prolonged cases
32
Define oteosclerosis
Disease affecting ossicles in middle ear
33
Epidemiology of oteosclerosis
1-2% of population F:M 2:1 Genetic and environmental components
34
Pathophysiology of oteosclerosis
Mature bone gradually replaces with woven bone | Symptoms develop as stapes footplate becomes fixed to oval window
35
Presentation of oteosclerosis
Progressive hearing loss Tinnitus Improved hearing in noisy surroundings Pink hue on tympanic membrane
36
Ix for oteosclerosis
Tympanogram - normal A trace Pure tone audiogram - conductive hearing loss
37
Mx of oteosclerosis
Hearing aid | Stapedectomy
38
Define vertigo
Hallucinations of movement | Associated with problems with vestibular system
39
Causes of vertigo
``` Central - stroke - migraine - neoplasms - demyelination - MS - drugs Peripheral - BPPV - Meniere's - vestibular neuronitis ```
40
Define benign paroxysmal positional vertigo
Vertigo occurring with particular head movements - primary = idiopathic - secondary = a/w head trauma, migraines, ischaemic processes
41
Epidemiology of BPPV
Peak incidence 50-70 | More common in females
42
Risk factors for BPPV
Head trauma Migraines Inner ear surgery
43
Pathophysiology of BPPV
Crystals in semi-circular canals cause abnormal stimulation of hair cells
44
Presentation of BPPV
``` Episodic vertigo - provoked by specific positions - last less than 30 seconds Sudden onset intense vertigo Nausea Imbalance Lightheadedness ```
45
Ix for BPPV
``` Neuro and otological exam normal Dix-Hallpike test - patient sitting - turn head 45º - continue to support head - lower patient to 30º below horizontal - hold head for 30 secs and observe for nystagmus - return patient to seated position - positive if vertigo and nystagmus present ```
46
Mx of BPPV
``` Reassurance - most resolve spontaneously in 6 months Epley manoeuvre - patient sitting - rotate head to 45º to affected ear - lower patient to 30º below horizontal - maintain for 1-2 mins - observe for primary nystagmus - rotate head 180º to opposite ear - observe for secondary nystagmus - primary and secondary nystagmus in same direction indicates good response - maintain position for 30-60 seconds - sit patient up - should be no nystagmus or vertigo ```
47
Define Meniere's disease
Auditory disease characterised by sudden, episodic onset of vertigo, low frequency hearing loss, low-frequency roaring tinnitus and sensation of fullness
48
Types of Meniere's' disease
``` Primary - idiopathic Secondary - head trauma - migraines - ischaemic processes ```
49
Epidemiology of Meniere's disease
Disease of adulthood - onset in 4th decade Slightly higher female incidence Evidence of genetic link
50
Risk factors for Meniere's disease
Recurrent viral infection | Autoimmune disease
51
Presentation of Meniere's disease
``` Recurrent episodes of vertigo - spinning sensation - lasts minutes to hours - a/w N+V Hearing loss - fluctuates - worsening during vertigo periods - chronic during later stages - unilateral Tinnitus - unilateral Aural fullness Drop attacks - sudden loss of balance without loss of consciousness Positive Romberg's test - sway when standing with feet together and eyes closed Positive fukunda stepping test - turn towards affected side when marching in place with eyes closed ```
52
Ix for Meniere's disease
Pure-tone audiometry - unilateral sensorineural hearing loss - low frequency in early stages and high frequencies as disease progresses Speech audiometry - measures response to simple bisyllabic words - compared to pure tone hearing to identify non-organic hearing loss - no discrepancy Tymapanometry - normal
53
Mx of Meniere's disease
``` Dietary changes - reduce salt, chocolate, alcohol and caffeine Thiazide diuretics Betahistine - symptomatic treatment of N/V during attaches Prochlorperazine - vestibular sedatives in acute attacks Dexamethasone - injected into middle ear Surgery - grommet insertion - endolymphatic sac decompression - surgical labyrinthectomy ```
54
Define vestibular neurontitis
Inflammation in the inner ear causes severe incapacitating vertigo lasting several days - a/w N+V - horizontal nystagmus during an attack
55
Mx of vestibular neuronitis
``` Symptomatic relief with vestibular sedatives during the acute attack IV fluids if recovered Cawthorne-Cooksey exercises to help with prolonged poor balance - look up then down - look left then right - bending neck forwards and backwards - turning head left and right - shrugging and rotating shoulders - walking up and down stairs ```
56
Features of hearing tests
Differentiate sensorineural hearing loss from conductive hearing loss - sensorineural hearing loss otological emergency
57
Tuning fork tests
256 Hz or 512 Hz tuning fork used Weber test - knock tuning fork and place in centre of head - should be equal in both ears - if one ear sensioneural loss in other ear Rinne test - place tuning fork on mastoid for a few seconds then lateral to external ear meatus - should be louder when held in air than bone - Rinne positive - if louder over bone (negative) then conductive hearing loss
58
Uses of pure tone audiogram
Assess hearing thresholds at different frequencies Used from ages 4 up Tones played at different frequencies and quietest tone at each frequency recorded Hertz on x axis, decibel on right - lower decibel = quieter noise - anything above 20 is normal Air conduction and bone conduction measured - air by headphones assess whole auditory pathway - bone tested with bone conductor over mastoid bone
59
Findings of pure tone audiogram
Conductive - pathology in middle or external ear - audiogram has normal bone and reduced air conduction Sensorineural - pathology between cochlear and auditory of brain - audiogram has reduced bone and air conduction thresholds - no air bone gap Mixed - air conduction worse than bone - bone conduction worse than normal
60
Uses of tympanogram
Measures compliance of tympanic membrane at varying pressures Probe inserted into external ear canal Can be done at any age Compliance measured along y axis and pressure on x axis
61
Findings of Tympanogram
``` Type A trace - normal - peak centred at 0 on x axis Type B - flat trace - suggest middle ear effusion or perforation - effusion has normal canal volume - perforation has large volume Type C - suggests Eustachian tube dysfunction Peak occurs at negative pressure ```

Yr4 - Neuro + SS (9 decks)

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