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The One Deck To Rule Them All > ENT: Ears > Flashcards

ENT: Ears Flashcards

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1
Q

Red flags for ENT ear presentations

A 
Hearing loss
Otalgia
Discharge
Tinnitus
Vertigo
  • Occupation = loud noise exposure?
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2
Q

512hz fork placed on mastoid bone

Positive: Air conduction > Bone conduction
Negative: Bone conduction > Air conduction

A

Rinne’s tests

Positive: Normal/sensorineural hearing loss
Negative: Conduction hearing loss

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3
Q

512hz fork placed on forehead

A

Weber’s test

no localisation: Normal /equal bilateral loss
localises to affected: conduction hearing loss
localises to non-affected: sensorineural hearing loss

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4
Q

Hearing tests in newborn

A

Otoacoustic emission test at birth
-If abnormal: Auditory brainstem test as newborn

6-9 months: distraction test
18 months -2.5 years: Recognition of familial objects

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5
Q

Hearing damage happens at

A

3000-6000hz

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6
Q

On audiogram, normal level is

A

> 20dB

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7
Q

Causes of sensorineural hearing loss

A 
Congenital hearing loss
Rubella
CMV
Drugs: 
  - Platinum chemo drugs (cisplatin)
  - Aspirin toxicity
  - Gentamicin 
  - Furosemide (reversible)
  - Quinines (reversible)
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8
Q

Haematuria
Progressive renal failure
Sensorineural hearing loss

A

Alport syndrome

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9
Q

Conductive hearing loss due to bone growth in external ear due to repeated exposure to cold

A

Exostasis

“Swimmer’s/ Surfer’s ear”

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10
Q 
Fixation of stapes footplate
Conductive hearing loss
Tinnitus
"Flamingo tinge" to tympanic membrane
Dip at 2-4hz on audiogram (Cahart's notch)
A

Otosclerosis

Age 20-40 years old
Autosomal dominant
Worse in pregnancy

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11
Q

Sensorineural hearing loss
Bilateral
Worse at high frequency
Speech is difficult to understand

A

Presbycusis

Male>Female
Found in 30% of >65s
Found in 50% of >75s

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12
Q

Management of otosclerosis

A

Hearing aid

Stapedectomy

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13
Q

Causes of tinnitus

A 
Meniere's disease
Otosclerosis
SSNHL
Hearing loss
Drugs
  - NSAIDs
  - Aminoglycosides
  - Loop diuretics
  - Quinine
Ear wax
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14
Q

Causes of sudden onset sensorineural hearing loss (SSNHL)

A 
Acoustic neuroma (80%) 
Idiopathic
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15
Q

Management of sudden onset sensorineural hearing loss (SSNHL)

A

Urgent referral

Prednisolone

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16
Q

Management of perforated tympanic membrane

A

Self resolves in 6-8 weeks
Keep dry + review in 4 weeks
Myringoplasty

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17
Q

Excessive endolymph

A

Meniere’s disease

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18
Q 
Sensorineural hearing loss (low frequency)
Vertigo
Tinnitus 
Sensation of aural fullness
Nystagmus
Epiisoles last mins-hours
A

Meniere’s disease

Positive romberg test

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19
Q

Acute management of Meniere’s disease

A

Buccal/IM Prochlorperazine

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20
Q

Prophylactic management of Meniere’s disease

A

Betahistamine

Vestibula rehab

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21
Q

Sudden onset vertigo
Triggered by changes in head position
Episodes last 20 seconds

Study These Flashcards
A

Benign paroxysmal positional vertigo (BPPV)

22
Q

Dix-hallpike test = positive

23
Q

Management of BPPV

Study These Flashcards
A

Epley manœuvre
Brandt-Daroff exercises (vestibular rehab)

Recurrence is common 3-5 years later

Prevention: Betahistamine

24
Q

Dizziness on neck extension in elderly

Study These Flashcards
A

Vertebrobasilar ischaemia

25
``` Recent viral infection Recurrent vertigo (worse on wakening) No hearing loss No tinnitus Lasts hours-days Nausea + vomiting Horizontal nystagmus ```
Vestibular neuronitis - affects on vestibular nerve (not cochlear)
26
Management of Vestibular neuronitis
Acute: Buccal/IM Prochlorperazine ``` Vestibular rehab exercises Antihistamines: - cinnarizine - cyclizine - promethazine ```
27
``` Recent viral infection Sudden onset vertigo Hearing loss Horizontal nystagmus Gait disturbance Nausea + vomiting ```
Labyrinthitis - affects both vestibular and cochlear nerves - common in 40-70 years old
28
Management of Labyrinthitis
Self limiting Prochlorperazine Antihistamines
29
Management for auricular haematoma "Cauliflowe ear"
Same day assessment | Incision + drainage
30
``` Otalgia Pain behind ear Fever External ear protruding anteriorly Swelling + erythema over mastoid Hx of recurrent otitis media ```
Mastoiditis - caused by otitis media spreading outwards - can lead to meningitis
31
Management of mastoiditis
Admit | Amoxicillin
32
2 years old Conduction hearing loss (> 3 months) Speech + language delay Behaviour + balance problems Flat tympanogram
Otitis media with effusion (glue ear)
33
Management of Otitis media with effusion (glue ear)
Grommets
34
Foul smelling ear discharge
Pre-auricular sinus
35
``` < 3 years old Acute onset otalgia "Ear tugging" Presence of middle ear effusion - bulging membrane - otorrhea - decreased mobility on otoscopy Erythema of membrane ```
Acute otitis media
36
Causes of Acute otitis media
Viral URTI disturbs normal nasopharyngeal microbiome, allowing bacteria to infect middle ear via eustachian tube - Streptococcus pneumoniae - Haemophilus influenzae - Moraxella catarrhalis
37
Management of Acute otitis media
Self-limiting Analgesia Severe: Amoxicillin (Erythromycin in PA) Recurrent: Grommets
38
Acute otitis media can lead to
Chronic Suppurative Otitis media (CSOM)
39
Perforation of tympanic membrane Otorrhoea > 6 weeks Cholesteatoma
Chronic Suppurative Otitis media (CSOM)
40
Growth of squamous epithelium that is trapped within skull causing local destruction
Cholesteatoma ``` Ages: 10-20 years Increased risk ( x 100) if cleft palate ```
41
``` Foul smelling, non-resolving discharge Hearing loss Vertigo Facial palsy Cerebellopontine angle syndrome ```
Cholesteatoma can lead to meningitis facial nerve infection
42
Investigation findings for Cholesteatoma
Crust seen in the upper eardrum (attic)
43
Management of Cholesteatoma
Surgical removal
44
Otalgia Discharge Erythema Eczematous canal
Otitis externa - common in diabetes + elderly
45
Causes of Otitis externa
``` Staph aureus Pseudomonas aeruginosa Fungal Seborrheic dermatitis Contact dermatitis ```
46
Management of otitis externa
1. Topical Gentamicin + hydrocortisone (drops) 2. Flucloxacillin (Erythromycin if PA) Fungal: Cotrimazole drops Diabetes: Ciprofloxacin (to cover pseudomonas)
47
Non-resolving otitis externa - Severe otalgia - Purulent otorrhea Temporal headaches
Malignant otitis externa - infection has spread to bone - found in immunocompromised patients + diabetics
48
Causes of Malignant otitis externa
Pseudomonas aeruginosa
49
Investigations for Malignant otitis externa
CT
50
Management for Malignant otitis externa
Ciprofloxacin

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