ENT- ear diseases

Question 1

what is otitis media

Answer 1

inflammation of the middle ear

Question 1

who does otitis media predominantly affect

Answer 1

children

Question 2

most common bacterias of bacterial acute otitis media

Answer 2

strep pneumoniae
h.influenza
strep pyogens

Question 3

bacterial otitis media, if chronic which bacterias

Answer 3

pseudomonas
staph aureus
fungal

Question 4

how does the infection extend in otitis media

Answer 4

infection extends from throat to ear via the Eustachian tube

Question 5

what are the symptoms of acute otitis media

Answer 5

ear pain
fever
irritability
may have hearing loss

Question 6

what are some signs seen in acute otitis media

Answer 6

ear appears inflammed
middle ear effusion
opaque tympanic membrane
bulging tympanic membrane
mobility of tympanic membrane impaired

Question 7

80% of cases of acute otitis media resolve within how long without antibiotics

Answer 7

4 days

Question 8

antibiotics (amoxicillin/erythromycin) should be prescribed immediately for acute otitis media if-

Answer 8

symptoms worsen/don’t improve within 4 days
systemically unwell but not needing hospitalised
immunocompromised or high risk for complications
< 2 years with bilateral Otis media
perforation and/or discharge in the canal

Question 9

what are some complications of acute otitis media

Answer 9

sensorineural hearing loss
tinnitus
acute mastoiditis
brain abscess/meningitis
vertigo
facial palsy
venous sinus thrombosis

Question 10

what is otitis media with effusion aka

Answer 10

‘glue ear’

Question 11

what is otitis media with effusion

Answer 11

inflammation of the middle ear with accumulation of fluid without the signs and symptoms of acute inflammation

Question 12

what is otitis media with effusion associated with

Answer 12

Eustachian tube dysfunction/obstruction

Question 13

what are the most common organisms of otitis media

Answer 13

strep pneumonia
H.influenza
Moraxella

Question 14

what are the risk factors of otitis media with effusion

Answer 14

day care
older siblings
smoking household
recurrent URTI
craniofacial/genetic abnormalities
prematurity
immunodeficiencies

Question 15

causes of otitis media in adults

Answer 15

rhinosinusitis
nasopharyngeal carcinoma/lymphoma

Question 16

signs of otitis media with effusion

Answer 16

middle ear effusion- bubbles/fluid
altered TM colour
TM retraction
impaired TM mobility

Question 17

what is the first line investigation for otitis media

Answer 17

otoscopy

Question 18

90% of otitis media with effusion resolve within how long

Answer 18

3 months

Question 19

when to refer those with otitis media with effusion for surgery-

Answer 19

persistent (>3mnths) bilateral OME
CHL >25dB
speech/language problems
developmental/behavioural problems

Question 20

what is the first line surgical management for otitis media with effusion

Answer 20

grommets

Question 21

what are some possible complications of grommets

Answer 21

infection/discharge
early extraction
retention
persistent perforation
swimming/bathing issues

Question 22

what is cholesteatoma

Answer 22

growth consisting of kertanised squamous epithelium in the middle ear and/or mastoid process; non-cancerous but destructive and expanding

Question 23

acquired causes of cholesteatoma

Answer 23

chronic otitis media
perforated tympanic membrane

Question 24

what is a key risk factor for cholesteatoma

Answer 24

frequent ear surgery

Question 25

what is the most common symptom of cholesteatoma

Answer 25

unilateral discharge often foul smelling

Question 26

what is the definitive management of cholesteatoma

Answer 26

mastoid surgery, reconstruction

Question 27

which type of carcinoma account for the majority of the tumours of the ear

Answer 27

squamous cell carcinoma

Question 28

what is squamous cell carcinoma of the ear related to

Answer 28

chronic inflammation/radiation

Question 29

what is vestibular schwannoma

Answer 29

rare, benign tumour of the CN VIII sheath that arises in internal auditory meatus

Question 30

if have vestibular schwannoma bilateral and young consider what?

Answer 30

neurofibromatosis type 2

Question 31

what is the first line investigation for vestibular schwannomas

Answer 31

MRI

Question 32

what is the definitive management of vestibular schwannomas

Answer 32

surgical excision

Question 33

what are the symptoms of vestibular schwannomas

Answer 33

Progressive sensorineural unilateral hearing loss and tinnitus imbalance in larger tumours facial numbness can occur

Question 34

inner/middle/external ear affected in conductive hearing loss?

Answer 34

external and middle

Question 35

inner/middle/external ear affected in sensorineural hearing loss?

Answer 35

inner ear

Question 36

what is otitis externa

Answer 36

inflammation of the outer ear canal

Question 37

what is otitis external almost always caused by

Answer 37

infection

Question 38

bacterial causes of otitis externa

Answer 38

staph aureus proteus spp pseudomonas aeuruginosa

Question 39

fungal causes of otitis externa

Answer 39

Aspergillus niger Candida albicans

Question 40

common triggers of otitis externa

Answer 40

water exposure cotton buds skin conditions

Question 41

clinical features of otitis externa

Answer 41

redness and swelling of ear canal itchy sore and painful discharge/ear wax hearing may be affected

Question 42

first line management for otitis externa

Answer 42

topical aural toilet

Question 43

what is a perforated tympanic membrane often associated with

Answer 43

acute otitis media

Question 44

examples of trauma that cause perforation of tympanic membrane

Answer 44

sudden negative pressure inserting something into the ear

Question 45

clinical features of perforated tympanic membrane

Answer 45

sudden severe pain bleeding from ear hearing loss tinnitus

Question 46

what is otosclerosis

Answer 46

hereditary disorder in which new bony deposits occur within the stapes footplate and the cochlear, resulting in new onset gradual hearing loss

Question 47

is otosclerosis more common in men/women

Answer 47

women

Question 48

which decades is otosclerosis usually seen in

Answer 48

2nd-3rd decade

Question 49

what is otosclerosis linked to and therefore can be worse during when

Answer 49

linked to high oestrogen worse during pregnancy

Question 50

what investigation is used to diagnose otosclerosis

Answer 50

audiometry

Question 51

which surgical option is used to restore hearing in patients with otosclerosis

Answer 51

stapedectomy

Question 52

what is presbycusis

Answer 52

degenerative disorder of the cochlear resulting in hearing loss

Question 53

onset of presbycusis is variable but when is it usually seen

Answer 53

old age

Question 54

which frequencies are affected most in those with presbycusis

Answer 54

high frequencies

Question 55

is presbycusis usually conductive/sensorineural hearing loss?

Answer 55

sensorineural

Question 56

when does noise-induced hearing loss characteristically dip on audiometry

Answer 56

classical dip at 4 kHz

Question 57

which drugs are well known to cause sensorineural hearing loss

Answer 57

gentamicin and other aminoglycosides chemotherapeutic drugs aspirin and NSAIDs furosemide (rarer)

Question 58

if a patient reports dizziness that occurs for seconds what is the most likely cause

Answer 58

BPPV

Question 59

if a patient reports dizziness that occurs for hours what is the most likely cause

Answer 59

Menieres

Question 60

if a patient reports dizziness that occurs for days what is the most likely cause

Answer 60

vestibular neuritis

Question 61

if a patient reports dizziness that occurs for variable time lengths what is the most likely cause

Answer 61

migraine associated vertigo

Question 62

patients get dizzy when rolling over in bed- what is most likely cause

Answer 62

BPPV

Question 63

patients first attack of dizziness was severe, lasting hours, with nausea and vomiting- what is most likely cause

Answer 63

vesicular neuritis

Question 64

patient experiences dizziness and gets light-sensitive during dizzy spells- what is most likely cause

Answer 64

vestibular migraine

Question 65

patient reports dizziness and one ear feels full and experiences tinnitus around time of dizzy spell- what is most likely cause

Answer 65

Menieres disease

Question 66

what is menieres disease

Answer 66

idiopathic disorder causing vertigo

Question 67

Menieres disease attacks are compromised of a triad of?

Answer 67

severe paroxysmal vertigo sensorineural hearing loss tinnitus

Question 68

what is vertigo

Answer 68

recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 mins (often lasting hours)

Question 69

Menierres disease is typically low/high frequency sensorineural hearing loss

Answer 69

low frequency

Question 70

what is vestibular neuritis

Answer 70

inflammation of the vestibular nerve

Question 71

how long does dizziness associated with vestibular neuritis last

Answer 71

days

Question 72

which medications can help reduce the sensation of dizziness

Answer 72

antihistamines prochlorperazine

Question 73

what is BPPV (benign positional paroxysmal vertigo)

Answer 73

vertigo associated with presence of otoliths (ear stones) in the semi-circular canal instead of the urticle

Question 74

what is the most common cause of vertigo on looking up

Answer 74

BPPV

Question 75

causes of BPPV

Answer 75

head trauma ear surgery idiopathic

Question 76

when do patients with BPPV experience vertigo-

Answer 76

on looking up turning in bed first lying in bed at night getting out of bed in morning bending forward rising from bending moving head quickly

Question 77

how long do attacks of vertigo last in patients with BPPV

Answer 77

seconds

Question 78

what manoeuvre is used to diagnose BPPV

Answer 78

Dix-Hallpike manoeuvre- geotropic, torsional nystagmus

Question 79

what is acute mastoiditis

Answer 79

complication of acute otitis media involving infection of the mastoid air cells

Question 80

how does acute mastoiditis present

Answer 80

pain, tenderness, and swelling behind the ear

Question 81

what investigations are carried out to diagnose acute mastoiditis

Answer 81

CT MRI

Question 82

how do you treat acute mastoiditis

Answer 82

IV antibiotics surgical drainage in some cases

Question 83

complication of acute mastoiditis

Answer 83

meningitis

Question 84

what is a relatively rare complication of Otitis externa

Answer 84

malignant (necrotising) otitis externa

Question 85

what is the most common cause of malignant Otitis external (bacterial)

Answer 85

pseudomonas

Question 86

risk factors for malignant otitis externa

Answer 86

diabetes radiotherapy to head and neck

Question 87

which medication is commonly used to prevent episodes of menieres

Answer 87

betahistine- antihistamine

Question 88

what is the most common cause of hearing impairment post head injury

Answer 88

perforated tympanic membrane

Question 89

is otosclerosis conductive/sensorineural hearing loss

Answer 89

both- most commonly conductive

Question 90

does Menieres disease usually affect one or two ears

Answer 90

one

Question 91

is Menieres disease sensorineural/conductive hearing loss

Answer 91

sensorineural

Question 92

which is associated with hearing loss- labyrinthitis/vestibular neuritis?

Answer 92

labyrinthitis

Question 93

if hearing loss occurs in cholesteatoma is it conductive/sensorineural

Answer 93

conductive

Question 94

in webers test, what result would indicate sensorineural hearing loss

Answer 94

sound heard louder on side of intact ear

Question 95

in webers test, what result would indicate conductive hearing loss

Answer 95

sound heard louder on side of affected ear

Question 96

what result indicates rinnes test positive

Answer 96

air conduction>bone conduction

Question 97

rinnes test is positive/negative in sensorineural hearing loss?

Answer 97

positive- air>bone

Question 98

rinnes test is positive/negative in conductive hearing loss?

Answer 98

negative- bone>air