Ears - Hearing Loss, Tinnitis and Facial Palsies

Question 1

Causes of inner ear damage (2)

Answer 1

Sudden acoustic drainage

Prolonged exposure to XS noise –> cochlear fatigue

Question 2

What is presbycusis caused by

Answer 2

Progressive atrophy to larbryinth and cochlear nn

Question 3

Mx presbycusis

Answer 3

No cure :(

Hearing aids

Question 4

What type of HL is NIHL

Answer 4

Mostly SNHL

But also conductive due to ™ trauma

Question 5

Sx NIHL

Answer 5

Tinnitus

4KHz dip

Question 6

Mx NIHL (3)

Answer 6

Supportive
tinnitus counselling
Hearing aids

Question 7

What is otosclerosis

Answer 7

Disease of the otic capsule and bony labryinth

Question 8

How does otosclerosis lead to CHL

Answer 8

Bony outgrowth –> footplate stapes –> fixation

Question 9

How dose otosclerosis lead to SNHL

Answer 9

Hard bone –> spongy bone –> toxins –> cochlea

Question 10

RF otosclerosis

Answer 10

FHx

Question 11

What age does otosclerosis occur

Answer 11

Begins c. 30

Question 12

Sx otosclerosis

Answer 12

Bilateral HL

Paracusis wissi

Question 13

What is paracusis wissi

Answer 13

Hearing better in background noise

Question 14

Diagnosis otosclerosis

Answer 14

Tympanometry

Question 15

Tx otosclerosis (3)

Answer 15

Observe
Hearing aids
Stapedectomy

Question 16

Drugs causing ototoxicity (4)

Answer 16

Salicylates
Aspirin
Gentamicin
Furosemide

Question 17

Def tinnitus

Answer 17

Perception of noise in absence of external stimuli

Question 18

Objective tinnitus

Answer 18

Vascular origin - bruit

Question 19

Subjective tinnitus

Answer 19

Aural hallucination, outer hair cell activation

Question 20

Causes of pulsatile tinnitus (4)

Answer 20

Bruits
Anaemia
AV malformation
Hyperthyroidism

Question 21

Causes of non pulsatile tinnitus (4)

Answer 21

Otosclerosis
Head injury
Meniere’s
Presbycusis

Question 22

Mx tinnitus

Answer 22

Explanation of what it is 
Reassure 
Sound enrichment 
Hearing aids
Tinnitus masker 
Tinnitus retraining therapy

Question 23

What is a vestibular schwanoma

Answer 23

Benign slow growing tumour of the ear

Question 24

Sx vestibular schwanoma (4)

Answer 24

Unilateral hearing loss
TInnitus
Vertigo
Absent corneal reflex

Question 25

When vestibular schwanomas are bilateral, what are they associated with

Answer 25

NFM-2

Question 26

Diagnosis vestibular schwanoma

Answer 26

MRI

Question 27

Pathway of the facial nn

Answer 27

From between the pons + medulla --> IAM --> facial canal --> temporal bone --> geniculate ganglion --> petrosal nn --> lacrimal glands Branches --> chordi tympani + post auricular nn

Question 28

Fct of chordi tympani (2)

Answer 28

Anterior ⅔ taste | nn stapedius

Question 29

Fct post auricular nn (3)

Answer 29

EAM T M Pinna (sensory)

Question 30

What are the 5 motor branches of the facial nn

Answer 30

``` Two zebras buggered my cat Temporal Zygomatic Buccal Marginal Mandibular Cervical ```

Question 31

Causes of facial palsy - idiopathic

Answer 31

Bells palsy

Question 32

Causes of facial palsy - trauma (2)

Answer 32

``` Iatrogenic injury (surgery) Temporal bone fracture ```

Question 33

Causes of facial palsy - neoplastic (2)

Answer 33

Malignant parotid tumour | Temporal bone tumour

Question 34

Causes of facial palsy - congenital (6)

Answer 34

``` = CHARGE Coloboma heart Heart defects Atresia of choana Retardation of growth GU abnormalities Ear abnormalities/deafness ```

Question 35

Causes of facial palsy - systemic/inflamm (3)

Answer 35

Sarcoidosis GBS MS

Question 36

Hx for facial palsy (10)

Answer 36

``` Lesion - DDx UMN + LMN w/ frontalis sparing Onset - congenital/rapid/slow Severity - complete/incomplete Other Sx - dry painful eye, drool, hyperacusis Otological Sx Neuro Sx Parotid disease Systemic illness Head,,facial trauma ```

Question 37

What scale is used for grading facial movements

Answer 37

House-Brackman Scale

Question 38

1 on House Brackman scale

Answer 38

Normal

Question 39

5 on House Brackman scale

Answer 39

Asymmetry at rest

Question 40

Ix Facial palsy (4)

Answer 40

PTA Stapedial reflex Electroneuronography (specific for Bells palsy) MRI/CT

Question 41

Important facial pain conditions to exclude - paeds (4)

Answer 41

Moeibius syndrome Forceps delivery HZV Acute OM

Question 42

What is Moebius syndrome

Answer 42

Bilateral 6/7 nn palsy

Question 43

Important facial pain conditions to exclude - peripheral - adult (4)

Answer 43

``` Trauma Iatrogenic (post gland surgery) Tumours - parotid Sarcoidosis = TITS ```

Question 44

Imporant facial pain conditions to exclue - middle ear - adult (5)

Answer 44

``` MANIC Mastoiditis AOM Acoustic Neuroma Iatrogenic - mastoid surgery Cholesteatoma ```

Question 45

What are the 2 types of temporal bone fractures

Answer 45

Longitudinal Or Transverse

Question 46

What type of temporal bone fracture is most serious

Answer 46

Transverse

Question 47

What is ramsay hunt syndrome due to

Answer 47

HZV reactivation in GG

Question 48

PS Ramsay Hunt syndrome

Answer 48

Facial palsy Auricular pain Vesicles on T M/ Pinna Pain so severe + many never recover

Question 49

Mx Ramsay Hunt syndrome

Answer 49

Aciclovir

Question 50

What is Bells palsy?

Answer 50

Viral infection CN VII

Question 51

What is Bells Palsy preceded by

Answer 51

URTI

Question 52

PS Bells Palsy (2)

Answer 52

Sudden onset | COmplete hemiparalysis of the face

Question 53

Mx Bells palsy (3)

Answer 53

High dose PO pred 7 days Aciclovir Artificial tears + night eye patch

Question 54

Prognosis Bells palsy

Answer 54

Recovery takes c 2 months | 75% make a full recovery :)