Flashcards in Otology Deck (33)
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
What should you inquire about in an otology history?
What is the most common otology test?
Pure tone audiogram
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)
Can ear wax cause problems?
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.
what are common pathologies of the external ear?
Otitis externa (V. V. common)
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
What are the common pathologies of the middle ear?
Acute suppurative otitis media
Perforated tympanic membrane
-Retracted tympanic membrane
-Discontinuity or fixation
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
What causes glue ear?
Blocked eustation tube
Body produces fluid to rid vacuum
What is tympanosclerosis?
Bleeding between layers of tympanic membrane.
Benign- very common
What should you advise patients with a perforated tympanic membrane?
They may get recurrent infections
Need to keep water out of their ear
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
What are the main pathologies of the inner ear?
Sensorineural hearing loss
What pathologies are contained in Sensorineural hearing loss?
Noise induced hearing loss
Genetics (pendred syndrome)
What is presbyacusis?
Hearing loss of old age
Will drop off at higher frequencies
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
What recurrent infections can cause sensorineural hearing loss?
Acute suppurative otitis media
Give some medications which are ototoxic
Aminoglycosides (including the antibiotics: gentamicin, streptomycin, neomycin)
Loop Diuretics (furosemide)
Tea Tree Oil
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
What is the most QoL improving treatment in ENT
Cochlear implants can be used with for sensorineural problems
Give the definition, pathology, investigation and treatment for Tinnitus
-Any perception of sound
-One ear both ears or the head
-No directly treatable pathology in vast majority
-Hearing loss and stress important contributing factors
-Unilateral (Vestibular Schwannoma?)
-Pulsatile (blood vessel?)
Refer for both
What is vertigo?
A hallucination of movement
What is the pathology of vertigo?
Benign Positional vertigo
What are the key things to find out in episodes of vertigo?
What is the pathology and history of Benign positional vertigo?
-Particles in posterior semicircular canal
-Vertigo precipitated by specific changes in position:
---particularly rolling over in bed
-No associated hearing loss or tinnitus
-Frequency: up to several times per day
What is the examination and treatment for Benign Positional Vertigo?
-Dix-Hallpike test (diagnostic maneouvre)
What is the pathology and history of Meniere's Disease?
---Raised fluid pressure in the inner ear
---One ear at a time
-Associated unilateral hearing loss, tinnitus, aural fullness
-Frequency: every few weeks to months
What are the treatments for Meniere's Disease?
-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
-Vestibular nerve section