What the 6 common ear symptoms?
- Hearing Loss
- Facial Weakness
How do we examine the ears?
- Tuning fork (Rinne’s & Weber’s)
- Whispered Voice Tests
Explain the tuning fork tests
- Air vs Bone Conduction
- IF B>A then theres conductive hearing loss in that ear
- Tuning fork to forehead
- If its louder in one ear then its either conductive loss in that ear or sensorineural in the opposite
What investigations can be done for hearing?
- Pure Tone Audiogram
How do we interpret the results from a pure tone audiogram
It measures how quiet a sound you can hear at various frequencies
We can also do it with bone vs air conduction
What are the result ‘types’ from a tympanogram?
Type A - normal
Type B - Immobile Tympanic membrane
Type C - Low Middle Ear pressure
List the common disorders of the outer ear?
- ‘Cauliflower ear’
- Needs to be drained
- Itching, pain, discharge & hearing loss
- Abx/steroid eardrops
Malignant Otitis Externa
- Osteomyelitis of the temporal bone
- Months of systemic Abx
List some common disorders of the middle ear?
- Otitis Media with effusion (glue ear)
- Acute Otitis Media
- Chronic Suppurative Otitis Media
Define otitis media with effusion?
Eustachian tube isnt working causing a vaccum in the middle ear that draws out fluid from the lining
How do we treat ‘glue ear’?
If the hearing loss is persistant over months or affects their work/school then put in a grommet.
A Grommet is a tube through the ear drum that allows pressure to equalise in the middle ear
How does acute otitis media present?
Increasing pain leading to a perforated ear drum
The pain then goes away and the drum heals
What are the types of chronic suppurative otitis media?
- Perforated Tympanic Membrane
What is a cholesteatoma?
Abnormal skin growth in the middle ear.
The skin forms a pouch so it doesnt shed, instead it builds up. Eroding structures of the ear, facial nerve and into the brain
List some common disorders of the inner ear?
- Age related hearing loss
- It starts at the higher frequency
Noise Induced Hearing Loss:
- Also starts at higher frequency
Ototoxic Meds e.g. Gentamicin
Vestibular Schwannoma (Acoustic Neuroma)
What is a vestibular schwannoma?
A benign tumour of the vestibular nerve
Causes sensorineural hearing loss in one ear
What causes tinnitus?
Possibly damage to the cochlear hairs
Its associated with presbycusis, noise related hearing loss and stress.
How would we investigate tinnitus?
We’d want to test for hearing loss.
If its unilateral or pulsatile we would want to do a scan
How do we treat tinnitus?
Manage stress to stop exacerbating it
Sound enrichment, e.g. hearing aids
What would we want to know about someones vertigo?
- Precipitating Factors such as position
- Associated symptoms
List some common types/causes of vertigo?
- Benign Positional vertigo
- Vestibular Neuritis/Labyrinthitis
- Meniere’s Disease
What causes benign positional vertigo?
Otoconia (small crystals) in the semi-circular canals of the inner ear.
Its precipitated by changes in head position causing the stones to stimulate the hair cells
It only lasts a few seconds and occurs a few times a day
How do we test for and treat Benign Positional Vertigo?
A Dix-Hallpike test will induce vertigo
The Epley Manoeuvre moves the particles out the canal so they wont stimulate the hair cells
What is vestibular neuritis/labyrinthitis?
A reactivation of a latent HSV infection in the vestibular gangion.
Usually people have a few episodes of decreasing severity as the body fights off the virus better each time
The patient may be left with residual motion-provoked vertigo
How do we treat Vestibular Neuritis/Labyrinthitis?
A vestibular sedative acutely
Vestibular rehab afterward
What is Meniere’s disease?
Also known as endolymphatic hydrops.
Its thought to stem from unusual fluctuation of endolymph in the vestibular system.
How does meniere’s disease present?
Spontaneous vertigo often with:
- Fluctuating & Progressive unilateral hearing loss
- Aural Fullness
It can last hours and happen every few days, weeks or months
How do we treat meniere’s disease?
What is a migraine?
Spontaneous Vertigo +/-:
- Sensory Sensitivity
It can be precipitated by a migraine trigger such as stress, diet, alcohol or menstruation
Duration & Frequency are very variable
How would we treat a migraine?
Avoid the triggers
List some sources of Facial Palsy:
Lower Motor Neuron Facial Weakness
Infratemporal (Cholesteatoma) or Extratemporal (Parotid Gland Tumour) pathologies affecting the facial nerve
- Acute Idiopathic Facial Palsy