Otology

Question 1

Common presenting symptoms in otology

Answer 1

Otalgia 
Otorrhoea 
Hearing loss 
Tinnitus 
Vertigo 
Facial weakness

Question 2

What is Rinne’s test used to test?

Answer 2

Bone conduction - determines whether hearing loss is conductive or sensorineural

Question 3

What would be the result of Rinne’s test in a patient with conductive hearing loss?

Answer 3

Bone conduction would be better than air conduction

Question 4

What would be the result of Rinne’s test in a patient with sensorineural hearing loss?

Answer 4

Air conduction would be better than bone conduction

Question 5

What can Weber’s test show?

Answer 5

Conductive hearing loss

Question 6

Sounds greater than what intensity (decibels) can cause hearing loss after a few hours?

Answer 6

85dB

Question 7

What is the normal range of human hearing (Hz)?

Answer 7

20-20,000 Hz

Question 8

What does tympanometry allow?

Answer 8

Diagnosis and monitoring of problems in the middle ear

Question 9

Tympanometry measures

Answer 9

the movement of the tympanic membrane in responses to changes in pressure

Question 10

What abnormalities might be identified on tympanometry?

Answer 10

Fluid in the middle ear
Otitis media
Perforated eardrum
Problems with the Eustachian tube

Question 11

What is vertigo?

Answer 11

“a hallucination of movement” -the sensation that you, or the things around you, are moving/spinning

Question 12

What are the key features to determine in a patient with vertigo?

Answer 12

Duration
Frequency
Associated symptoms
Precipitating factors

Question 13

What is benign positional vertigo?

Answer 13

Vertigo precipitated by specific changes in position (particularly rolling over in bed)

Question 14

What is the cause of benign positional vertigo?

Answer 14

Otoconia (calcium carbonate particles) in the semicircular canals

Question 15

What test would be positive in a patient with benign positional vertigo?

Answer 15

Dix-Hallpike test

Question 16

What is the treatment for benign positional vertigo?

Answer 16

Epley manoeuvre

Question 17

What is the cause of Meniere’s disease?

Answer 17

Endolymphatic hydrops - pressure in endolymphatic component is increased

Question 18

What are the symptoms of Meniere’s disease?

Answer 18

Spontaneous vertigo
Associated unilaterall hearing loss, tinnitus and aural fullness
Duration of hours
Frequency - every few weeks-months

Question 19

Possible conservative treatments for Meniere’s disease

Answer 19

Low salt diet 
Betahistine 
Benfrofluazide 
Intratympanic dexamethasone 
Endolymphatic sac decompression

Question 20

Possible destructive treatments for Meniere’s disease

Answer 20

Intratympanic gentamicin
Vestibular nerve section
Labyrinthectomy

Question 21

What is the cause of vestibular neuritis?

Answer 21

Reactivation of latent herpes simplex virus with injection of vestibular ganglion

Question 22

Symptoms of vestibular neuritis

Answer 22

Spontaneous vertigo 
Hearing loss 
Tinnitus 
Duration of days 
Single episode 
Associated unilateral hearing loss 
Residual motion-provoked vertigo

Question 23

Treatment of acute vestibular neuritis

Answer 23

Vestibular sedative

Question 24

Treatment of chronic vestibular neuritis

Answer 24

Vestibular rehabilitation

Question 25

Symptoms of migraine

Answer 25

``` Spontaneous vertigo Headache Photophobia Phonophobia Hearing loss, tinnitus ```

Question 26

Treatment of migraine

Answer 26

Avoid triggers | Prophylactic pharmacological treatment

Question 27

What is tinnitus?

Answer 27

Ringing/buzzing in the ears

Question 28

Treatment of tinnitus

Answer 28

Sound enrichment and stress management

Question 29

What is otitis media?

Answer 29

Painful inflammation and infection of the middle ear

Question 30

Symptoms of otitis media

Answer 30

``` Crying/Irritability/Sleeplessness/Pulling on the ears in children Ear pain Headache Neck pain Feeling of fullness in the ear Fluid drainage from ear Fever, vomiting, diarrhoea if systemically unwell Hearing loss Loss of balance ```

Question 31

Causes of acute otitis media

Answer 31

Eustachian tube blocked/swollen, trapping fluid in the middle ear which becomes infected Allergies, cold etc. Infected/enlarged adenoids Smoking

Question 32

Treatment of acute otitis media

Answer 32

Analgesia Antibiotic eardrops Apply warm, moist compress over affected ear

Question 33

What is chronic otitis media

Answer 33

Long-standing, persistently draining perforation of eardrum

Question 34

Causes of chronic otitis media

Answer 34

Acute otitis media | Blockage of eustachian tube

Question 35

What can cause flare-ups of chronic otitis media?

Answer 35

Cold infection Ear infection Water entering middle ear

Question 36

Treatment of chronic otitis media

Answer 36

Antibiotic eardrops Oral antibiotics if systemically unwell Tympanoplasty Removal of cholesteatoma

Question 37

What is otitis externa?

Answer 37

Inflammation of the external ear canal

Question 38

Causes of otitis externa

Answer 38

Commonly caused by bacteria and fungi

Question 39

Treatment of otitis externa

Answer 39

Clean the ear Micro-suction, microbiology swab Topical antibiotics Oral antibiotics if systemically unwell

Question 40

Treatment of otitis externa if spread to base of skull/nerves occurs

Answer 40

Hospital admission | IV antibiotics

Question 41

What is Bell's palsy?

Answer 41

Acute, idiopathic facial nerve palsy

Question 42

Treatment of Bell's palsy

Answer 42

Most people recover within a couple of months without treatment Corticosteroids Antivirals