Otology

Question 1

what nerve runs right through the ear?

Answer 1

the facial nerve

Question 2

what symptoms someone with ear problems present with?

Answer 2

> hearing loss
> tinnitus
> vertigo
> otalgia
> otorrhoea
> facial weakness

Question 3

what does otorrhoea mean?

Answer 3

discharge from the ear

Question 4

what does oltagia mean?

Answer 4

pain in the ear

Question 5

what is tinnitus?

Answer 5

hearing a sound in your ear such as a buzzing or whining

Question 6

what can be used to examine the patients ear?

Answer 6

otoscope or microscope

Question 7

in a conductive hearing loss would bone conduction be louder than air?

Answer 7

yes it would so the test is negative

Question 8

what would a positive rinnes test suggest?

Answer 8

that either hearing is normal or that the hearing loss is sensorineural

Question 9

what would the result of a webers test be if there was sensorineural hearing loss in the right ear?

Answer 9

the sound would t=be lateralised to the left

Question 10

what sort of hearing loss in the right ear would lateralise sound to the right in webers test?

Answer 10

conductive hearing loss

Question 11

what investigations can be carried out in hearing loss?

Answer 11

> pure tone audiogram

> tympanogram

Question 12

if you do not drain an auricular haematoma what may it become?

Answer 12

a cauliflour ear

Question 13

describe otitis externa

Answer 13

> very common
inflammation of the skin of the ear canal
itching, pain and discharge

Question 14

how would you treat otitis externa?

Answer 14

> topical antibiotics and steroids
if ear is filled with debri treatment may not be effective
preventative measures, don’t put things in ears

Question 15

what is malignant otitis externa?

Answer 15

an aggressive form of otitis externa. this is not a malignant neoplasm. severe pain and granulation tissue in the ear canal

Question 16

what is glue ear?

Answer 16

otitis media with effusion: there is sterile fluid under the eardrum

Question 17

how does a non-working Eustachian tube create an effusion under the ear drum?

Answer 17

the pressure cannot be equalised so a vacuum is create and fluid secreted due to the low pressure

Question 18

what is a grommet?

Answer 18

this is the treatment for glue ear. a plastic tube inserted into the eardrum equalises the pressure. after a few months the eardrum heals and it is pushed out

Question 19

when would you put in grommets?

Answer 19

after watchful waiting of the child and if the hearing loss is persistent and significant

Question 20

what is acute otitis media?

Answer 20

infection of the ear durm

Question 21

what can chronic suppurative otitis media lead to?

Answer 21

> perforated tympanic membrane

> cholesteatoma

Question 22

what is cholesteatoma?

Answer 22

this is a collection of skin in the in middle ear caused by a Eustachian tube dysfunction that creates a vacuum so skin does not migrate out of the ear canal.

Question 23

what problems can cholesteatoma lead to?

Answer 23

> erosion of the mastoid process
erosion of the facial nerve
erosion into the brain creating an abscess
infection of the skin lump

Question 24

what complications can arise from suppurative otitis media?

Answer 24

> tympanosclerosis- calcium deposits in the tympanic membrane
otosclerosis- extra bone formation creating conductive hearing loss

Question 25

what is presbyacusis?

Answer 25

progressive sensory neural deafness occurring with age

Question 26

name an ototoxic medication

Answer 26

gentamyacin

Question 27

what is the effect of menieres disease?

Answer 27

> deafness > tinnitus > vertigo > build up of fluid in the inner ear

Question 28

what is vestibular schwannoma?

Answer 28

a benign tumour with sensorineural hearing loss in one ear

Question 29

what would you investigate form tinnitus?

Answer 29

weather it is unilateral or pulsatile then get an MRI

Question 30

how would you treat tinnitus?

Answer 30

with sound enrichment or stress management

Question 31

what is the differential diagnosis for vertigo?

Answer 31

> benign positional vertigo > menieres disease > vestibular neuritis (labyrinthitis) > migraine

Question 32

what features would you want to find out about vertigo?

Answer 32

> duration > frequency > associated symptoms > precipitating factors

Question 33

what is the pathology of benign positional vertigo?

Answer 33

otoconia (calcium carbonate particles) in semi-circular canals

Question 34

what are the clinical features of benign positional vertigo?

Answer 34

``` > precipitated by changes in head position > lasts seconds > happens several times a day > so associated symptoms > positive dix-hallpike test ```

Question 35

how would you treat benign positional vertigo?

Answer 35

epley manoeuvre

Question 36

what is vestibular neuritis?

Answer 36

reactivation of latent HSV infection of vestibular ganglion

Question 37

what are the clinical features of vestibular neuritis?

Answer 37

``` > spontaneous vertigo > no associated symptoms > lasts days > a few episodes > residual motion provoked vertigo ```

Question 38

how would you treat acute vestibular neuritis?

Answer 38

vestibular sedatives

Question 39

how would you treat chronic vestibular neuritis?

Answer 39

vestibular rehabilitation

Question 40

what is the pathology of menieres disease?

Answer 40

endolymphatic hydrops, raised pressure of the endolymphatic part of the cochlear

Question 41

what are the clinical features of menieres disease?

Answer 41

``` > spontaneous vertigo > unilateral hearing loss > tinnitus > aural fullness > lasts hours > happens every few days/weeks/months > fluctuates and progresses to unilateral hearing loss ```

Question 42

what is the treatment for menieres disease?

Answer 42

> betahistine > bendrofluazide > intratympanic dexamethasone > intratympanic gentamicin

Question 43

what is the last resort treatment for menieres disease?

Answer 43

intratympanic gentamicin as this is injected into the middle ear and absorbed to the inner ear killing the nerve cells.

Question 44

what are clinical features of migraine?

Answer 44

> spontaneous vertigo > variable frequency and duration > headache, sensory sensitivity > triggers

Question 45

what may cause intratemporal facial palsy?

Answer 45

cholesteatoma

Question 46

what may be an extratemporal cause for facial palsy?

Answer 46

parotid gland tumour

Question 47

what is bells palsy?

Answer 47

acute idiopathic facial palsy (refer to ent to check there is n other cause)