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Head & Neck > Lecture 6.2: Common Disorders of the Ear > Flashcards

Lecture 6.2: Common Disorders of the Ear Flashcards

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1
Q

What is done during external inspection and
palpation of the Ear?

A
  • Pinna is inspected for size,
    position, shape, lesions and
    discharge. * Pinna palpated for tenderness,
    swelling or nodules. * Examiner should apply pressure
    on mastoid tip, which should be
    painless; tenderness may
    indicate mastoiditis
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2
Q

What is done at the start of an Ear Examination? (3)

A
  • WIPER
  • Ear least likely to have pathology is examined first
  • Examiner sits to the side of the patient
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3
Q

What us done during an Otoscopic Examination of the Ear? (3)

A
  • External auditory canal is straightened by pulling
    pinna up, out and back using the other hand
  • In a child, the ear canal is instead straightened by
    pulling the pinna down and back
  • Any wax should be left undisturbed unless
    interfering with visualisation
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4
Q

How should the Ear appear in a normal Otoscopic Examination? (3)

A
  • Tympanic membrane should appear intact,
    translucent, and pearly grey in colour
  • Blood vessels should be visible around the
    perimeter
  • The handle of the malleus should be seen near the
    centre
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5
Q

How are disorders and pathologies of the ear classified?

A

They are categorised according to location

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6
Q

What are the 3 catagerisations of locations of ear pathologies?

A
  • External Ear
  • Middle Ear
  • Inner Ear
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7
Q

What structures can be found in the External Ear? (4)

A
  • Pinna
  • External Ear Canal (EAC)
  • Helix
  • Lobule
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8
Q

What structures can be found in the Middle Ear? (5)

A
  • Tympanic Membrane
  • Ossicles (malleus, incus, stapes)
  • Oval Window
  • Round Window
  • Eustachian tube
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9
Q

What structures can be found in the Inner Ear? (4)

A
  • Cochlea
  • Semi-Circular Canals (Labyrinth)
  • Vestibule
  • Nerves
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10
Q

Symptoms of Ear Disease (3)

A
  • Otalgia
  • Pruritis
  • Otorrhoea
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11
Q

What is Otalgia? What does it indicate?

A
  • Ear Pain
  • May be related to inflammatory conditions in or
    around the ear
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12
Q

What is Pruritis? What does it indicate?

A
  • Itching
  • May result from a primary disorder of the external
    ear or as a result of discharge from middle ear
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13
Q

What is Otorrhoea? What does it indicate?

A
  • Discharge from Ear
  • Indicates Infection
  • Bloody discharge may be associated with leakage of
    cerebrospinal fluid secondary to skull fracture
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14
Q

What is Referred Otalgia?

A

Pain felt in the ear but originating from a nonotologic source

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15
Q

What is Anotia?

A

Congenital absence of pinna with narrowing or
absence of ear canal, can be uni/bilateral

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16
Q

What type of hearing loss do Anotia and Microtia cause?

A

Conductive Hearing Loss

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17
Q

How is Anotia and Microtia treated?

A
  • Treated surgically (repair of ear canal +/- cosmetic
    reconstruction/prosthetics)
  • May require bone-anchored hearing aid
    implantation
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18
Q

What is Microtia?

A

Underdeveloped auricle, can be unilateral or
bilateral, varies in severity

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19
Q

What is Pinna Haematoma?

A
  • Usually caused by blunt trauma to the ear
  • Perichondrial blood vessels tear, resulting in
    haematoma forming between the auricular cartilage
    and the overlying perichondrium
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20
Q

How is Pinna Haematoma treated?

A

Requires drainage of fluid

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21
Q

What happens if Pinna Haematoma is left untreated?

A
  • Fluid collects under perichondrium, separating it
    from the underlying cartilage,
  • This results in cartilage death and the formation of
    fibrous tissue (cauliflower ear)
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22
Q

How does BCC present on the Ear?

A

Often painless, raised, shiny, and vascular, with ulceration

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23
Q

What is the most common skin cancer? What is it associated with?

A
  • Basal Skin Carcinoma (BCC)
  • Associated with sun exposure and lighter skin
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24
Q

What is the second most common skin cancer? What is it associated with?

A
  • Squamous Skin Carcinoma (SSC)
  • Associated with sun exposure and lighter skin
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25
How does SCC present?
Typically presents as hard lump with scaly top layer, but may instead form an ulcer
26
Is SCC or BCC more likely to metastasise?
SCC
27
How are BCC and SCC treated?
Surgical excision
28
What is another name for Ear Wax?
Cerumen
29
What is the role of ear wax normally?
Provide protection against particulate matter and microbes, carrying them to the entrance of the ear canal through epithelial migration and jaw movement
30
What can happen if there is excess ear wax?
Can lead to conductive hearing loss
31
How is excess ear wax treated? (3)
* Softeners * Syringing * Curette Method
32
How may a foreign body in the auditory canal present? (3)
* Pain * Deafness * Discharge
33
How is a foreign body in the auditory canal treated?
Removal with forceps or hook, irrigation, or suction with catheter
34
What is Otitis Externa?
Inflammation of the external ear (auricle, external auditory canal, and outer surface of eardrum), may be localised, diffuse, acute, or chronic
35
How does Otitis Externa present? (5)
* Pain * Itching * May be associated with discharge * Possible hearing loss * Pain on movement of the tragus or auricle
36
What does Otoscopy of Otitis Externa reveal? (3)
* Erythema * Oedema * Exudate
37
How is Otitis Externa treated? (2)
* Topical Drops * Preventative measures (e.g. earplugs during swimming)
38
Malignant Otitis Externa
* Life threatening extension into mastoid and temporal bones * Often caused by pseudomonas * Usually affects early diabetics/immunocompromised patients * Extremely painful beyond what is normally expected * Can lead to cranial nerve palsies and death
39
What is Otitis Media?
Umbrella term for infective and inflammatory conditions affecting middle ear, may be acute or chronic
40
Who does Otitis Media more commonly affect?
More common in children due to shorter and more horizontal Eustachian tubes
41
How does Otitis Media present? (3)
* Hearing Loss * Otalgia * Fever
42
What does Otoscopy of Otitis Media reveal? (2)
* Tympanic membrane will be erythematous and may be bulging * If fluid pressure perforates TM, there may be purulent discharge visible
43
How is Otitis Media treated? (3)
* Analgesics * Antipyretics * Antibiotics if required
44
How is Perforation of the Tympanic Membrane treated?
* Often heals spontaneously * Treatment involves ear drops and surgery if necessary
45
What is Purulent Ottorhoea?
* Pus draining from the ear canal * Seen in TM perforation
46
What is Mastoiditis?
Inflammation of mucosal lining of mastoid antrum and mastoid air cell system inside the mastoid process due to infection causing acute suppuration with back pressure into the mastoid cavity
47
What is Mastoiditis often a complication of?
Serious complication of otitis media, can lead to death
48
Signs and Symptoms of Mastoiditis (7)
* Earache * Fever * Malaise * Tender Mastoid * Swollen Mastoid * Erythematous Mastoid * Prominent pinna
49
How is Mastoiditis treated? (2)
* Antibiotics * May require surgery
50
What is Otitis Media with Effusion (OME)?
Chronic inflammatory condition without acute inflammation caused by eustachian tube disfunction, there is an effusion of glue-like fluid behind an intact tympanic membrane
51
Signs and Symptoms of OME
* Usually Painless * Conductive Hearing Loss * Speech and Language Delay * Educational Problems * Dull and Retracted TM with visible effusion and/or bubbles
52
What condition does OME often follow?
Often follows a slowly resolving acute otitis media
53
How to manage OME? (3)
* Otovent * Grommets * Hearing Aids
54
What can prolongued negative middle ear pressure lead to?
Retraction of the tympanic membrane and cholesteatoma
55
What is Otovent?
* Involves regularly inflating a specialised balloon with the nostril * Increases middle ear pressure, thereby equalising pressure either side of the tympanic membrane * In cases of middle ear effusions, this can enable clearance down the Eustachian tube
56
What is a Grommet?
* Small tube inserted into ear drum in order to equalise middle ear pressure and prevent accumulation of fluid there * A temporary measure, falling out after 12-24 months as the TM heals
57
What is a Cholesteatoma?
Expanding growth consisting of keratinising squamous epithelium in the middle ear and/or mastoid process
58
What happens if a Cholesteatoma gets too big?
Can result in destruction of the bones of the middle ear, as well as growth through the base of the skull into the brain
59
Signs and Symptoms of Cholesteatoma
* Hearing Loss * Odorous Discharge * Recurrent Infections * Conductive Hearing Loss * Discharge * Keratin Debris * Attic Crusts * Polyps
60
Complications of a Cholesteatoma
Brain infections and abscesses
61
How is a Cholesteatoma treated?
Treatment is usually surgical
62
When can Facial Nerve Dysfunction occur?
The facial nerve runs through the middle ear and is vulnerable to damage from middle ear disease
63
Signs and Symptoms of Facial Nerve Dysfunction (8)
* Ipsilateral Facial Weakness * Loss of Taste * Hyperacusis * Decreased Salivation * Tear Aecretion * Smoothing out of Forehead * Eyebrow Drooping * Drooping of Corner of Mouth
64
What is Otosclerosis?
Remodelling of the bony labyrinth, restricting movement of the stapes, fixation of the stapes footplate to the oval window of the cochlea
65
Complications of Otosclerosis (3)
* Conductive Hearing Loss * Tinnitus * Vertigo
66
What can cause Otosclerosis? (2)
* Genetic * Environmental Factors/Infections (Measles)
67
How is Otosclerosis treated? (3)
* Sodium Fluoride (slows progression of disease) * Stapedectomy * Amplification with Hearing Aids
68
Deafness will arise if...? (2)
69
What is Audiometry?
Diagnostic hearing test, measuring ability to hear pitch (Hz) and loudness (dB)
70
What is normal hearing range in Hz?
Between 20-20,000 Hz
71
What is Benign Positional Vertigo?
* Repeated, brief periods of a spinning sensation upon head movement * Typically lasts less than one minute
72
What can cause Benign Positional Vertigo?
Can be caused by a small otolith moving around loose in inner ear OR an unidentified cause
73
How is Benign Positional Vertigo diagnosed?
Dix-Halpike manouvre causing nystagmus
74
How is Benign Positional Vertigo treated?
May be treated with the Epley manouvre
75
What is Menieres Disease?
An ear condition that can cause sudden attacks of vertigo lasting minutes/hours, due to endolymphatic hydrops (excess fluid/pressure in endolymph)
76
How does Menieres Disease present? (4)
* Vertigo * Tinnitus * Hearing Loss * Inner Ear Fullness
77
How is Menieres Disease treated?
Attacks are often treated with medications to help with nausea and anxiety, no treatment for actual condition
78
What is Labyrinthitis?
Inflammation of the labyrinth
79
Signs and Symptoms of Labyrinthitis (7)
* Spinning Sensation * Hearing Loss * Tinnitus * Nausea * Vomiting * Nystagmus * Can cause permanent hearing loss in extreme cases
80
What can cause Labyrinthitis? (2)
* Infection * Head Injury
81
How is Labyrinthitis treated?
Depends on cause
82
What are Vestibular Migraines?
* A feeling of rotation or illusory sensations of motion or both associated with headache * Treated as migraine
83
What is Rinne’s Test?
* Performed by placing a vibrating 512Hz tuning fork against patient’s mastoid bone, then asking patient to tell you when sound no longer heard * The fork is then placed near the auditory canal, and the patient is asked whether they can now hear the sound
84
Rinnes Test: What does it mean if Bone > Air Conduction?
Conductive Hearing Loss
85
Rinnes Test: What does it mean if Air > Bone Conduction?
Normal or Sensorineural Hearing Loss
86
What is Weber's Test?
* A vibrating tuning fork is placed in the middle of the forehead * The patient is asked whether the sound is louder on one side or equal in both * In a normal test, the sound is heard loudest in the middle of the head
87
Weber's Test: Normal Hearing
Midline Localisation
88
Weber's Test: Sensorineural Hearing Loss
Localises to normal ear/Localises opposite to affected ear
89
Weber's Test: Conductive Hearing Loss
Localises to affected ear

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