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Flashcards in Otology Deck (33)
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1

How do conductive and sensorineural hearing loss differ in terms of location?

Conductive hearing loss is caused by external or middle ear

Sensorineural hearing loss caused by inner ear

2

What should you inquire about in an otology history?

Otalgia
Otorrhoea
Hearing loss
Tinnitus
Vertigo

3

What is the most common otology test?

Pure tone audiogram

4

What does PTA stand for and what is it testing?

Pure Tone Average

Works out if hearing loss is conductive or sensorineural
(Air or bone conduction)

5

Can ear wax cause problems?

No

This is a common misconception.
Ear wax is normal. Basically impossible for it to block ear. Can only cause hearing loss if you push it deep into ear with cotton buds and it sticks to tympanic membrane.

6

what are common pathologies of the external ear?

Otitis externa (V. V. common)
Foreign body
Exostoses

7

What is exostoses?

bony swelling in the ear canal

Ask the patient "did you go swimming in cold water a lot as a child?
-This is the most common cause
-Will impress patients

8

What are the common pathologies of the middle ear?

Acute suppurative otitis media
Glue ear
Tympanosclerosis
Perforated tympanic membrane
Cholesteatoma
-Retracted tympanic membrane
Ossicular problems
-Discontinuity or fixation

9

Whats the usual process of acute otitis media?

Increasing severe pain in ear
Discharge of the ear (perforation of tympanic membrane)
Resolution of the pain and healing

10

What causes glue ear?

Blocked eustation tube
vacuum created
Body produces fluid to rid vacuum

11

What is tympanosclerosis?

Bleeding between layers of tympanic membrane.
This calcifies
Benign- very common

12

What should you advise patients with a perforated tympanic membrane?

They may get recurrent infections
Need to keep water out of their ear

13

What is cholesteatoma?

Collection of skin where it shouldn't be.

Poor gustation tube function
Vacuum in inner ear
Eardrum sucked in a bit over long period of time
Epithelial cells of ear canal migrate distally
Depression of eardrum effects the movement of cells
Dead skin builds up

Can burrow causing problems
Easy to miss so watch out for

14

What are the main pathologies of the inner ear?

Sensorineural hearing loss
Tinnitus
Vertigo

15

What pathologies are contained in Sensorineural hearing loss?

Presbyacusis
Noise induced hearing loss
Infections
Ototoxic medications
Genetics (pendred syndrome)
Vestibular Schwannoma

16

What is presbyacusis?

Hearing loss of old age
Will drop off at higher frequencies

17

How does the audiogram compare in presbyacusis and noise indicted hearing loss?

Presbyacusis = will drop off at higher frequencies

Noise induced = will go down and then slightly improve as frequency increases

18

What recurrent infections can cause sensorineural hearing loss?

Measels
Mumps
Rubella
Influenza
Acute suppurative otitis media
Meningitis

19

Give some medications which are ototoxic

Aminoglycosides (including the antibiotics: gentamicin, streptomycin, neomycin)

Loop Diuretics (furosemide)

Salicylates

Quinine

Tea Tree Oil

20

What is Vestibular Schwannoma?

Aucoustic neuroma or Vestibular Schwannoma is a rare benign tumour of the vestibular nerves

This can press on the cochlear nerve causing hearing loss

Unilateral hearing loss could possibly be this

21

What is the most QoL improving treatment in ENT

Hearing aid

Cochlear implants can be used with for sensorineural problems

22

Give the definition, pathology, investigation and treatment for Tinnitus

Definition:
-Any perception of sound
-One ear both ears or the head

Pathology
-No directly treatable pathology in vast majority
-Hearing loss and stress important contributing factors

Investigation:
-Unilateral (Vestibular Schwannoma?)
-Pulsatile (blood vessel?)
Refer for both

Treatment:
-Sound enrichment
-Stress management

23

What is vertigo?

A hallucination of movement

24

What is the pathology of vertigo?

Benign Positional vertigo
Miners disease
Vestibular neuritis
Migraine

25

What are the key things to find out in episodes of vertigo?

Duration
Frequency
Associated symptoms
Precipitating factors

26

What is the pathology and history of Benign positional vertigo?

Pathology:
-Particles in posterior semicircular canal

History:
-Vertigo precipitated by specific changes in position:
---particularly rolling over in bed
-No associated hearing loss or tinnitus
-Duration: seconds
-Frequency: up to several times per day

27

What is the examination and treatment for Benign Positional Vertigo?

Examination:
-Dix-Hallpike test (diagnostic maneouvre)

Treatment:
-Epley Manoevre

28

What is the pathology and history of Meniere's Disease?

Pathology:
-Endolymphatic Hydrops
---Raised fluid pressure in the inner ear
---Happens spontaneously
---One ear at a time

History:
-Spontaneous vertigo
-Associated unilateral hearing loss, tinnitus, aural fullness
-Duration: hours
-Frequency: every few weeks to months

29

What are the treatments for Meniere's Disease?

Conservative:
-Low salt diet
-Betahistine (improves blood flow to inner ear)
-Bendrofluazide (diuretic to reduce pressure)
-Intratympanic dexamethasone (steroids into eardrum-> soaks through)
-Endolymphatic sac decompression

Destructive
-Intratympanic gentamicin
-Vestibular nerve section
-Labyrinthectomy

30

What is the pathology and history of Vestibular Neuritis?

Pathology:
-?viral, ?Vascular

History:
-Spontaneous vertigo
- +/- hearing loss, tinnitus
-Duration: days
-Frequency: single episode