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Flashcards in Otology Deck (30)
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1

What the 6 common ear symptoms?

- Hearing Loss
- Tinnitus
- Otalgia
- Otorrhoea
- Facial Weakness
- Vertigo

2

How do we examine the ears?

Physical:
- Otoscope
- Microscope

Hearing:
- Tuning fork (Rinne's & Weber's)
- Whispered Voice Tests

3

Explain the tuning fork tests

Rinnes:
- Air vs Bone Conduction
- IF B>A then theres conductive hearing loss in that ear

Webers:
- Tuning fork to forehead
- If its louder in one ear then its either conductive loss in that ear or sensorineural in the opposite

4

What investigations can be done for hearing?

- Pure Tone Audiogram
- Tympanogram

5

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

6

What are the result 'types' from a tympanogram?

Type A - normal
Type B - Immobile Tympanic membrane
Type C - Low Middle Ear pressure

7

List the common disorders of the outer ear?

Auricular Haematoma
- 'Cauliflower ear'
- Needs to be drained

Foreign Body

Otitis Externa
- Itching, pain, discharge & hearing loss
- Abx/steroid eardrops

Malignant Otitis Externa
- Osteomyelitis of the temporal bone
- Months of systemic Abx

8

List some common disorders of the middle ear?

- Otitis Media with effusion (glue ear)
- Acute Otitis Media
- Chronic Suppurative Otitis Media
- Tympanosclerosis
- Otosclerosis

9

Define otitis media with effusion?

Eustachian tube isnt working causing a vaccum in the middle ear that draws out fluid from the lining

10

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

11

How does acute otitis media present?

Increasing pain leading to a perforated ear drum
The pain then goes away and the drum heals

12

What are the types of chronic suppurative otitis media?

Either with:
- Perforated Tympanic Membrane
- Cholesteatoma

13

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

14

List some common disorders of the inner ear?

Presbycusis
- Age related hearing loss
- It starts at the higher frequency

Noise Induced Hearing Loss:
- Also starts at higher frequency

Ototoxic Meds e.g. Gentamicin

Meniere's Disease
Head Injury
Infection
Vestibular Schwannoma (Acoustic Neuroma)

15

What is a vestibular schwannoma?

A benign tumour of the vestibular nerve
Causes sensorineural hearing loss in one ear

16

What causes tinnitus?

Possibly damage to the cochlear hairs
Its associated with presbycusis, noise related hearing loss and stress.

17

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

18

How do we treat tinnitus?

Manage stress to stop exacerbating it
Sound enrichment, e.g. hearing aids

19

What would we want to know about someones vertigo?

- Precipitating Factors such as position
- Associated symptoms
- Frequency
- Duration

20

List some common types/causes of vertigo?

- Benign Positional vertigo
- Vestibular Neuritis/Labyrinthitis
- Meniere's Disease
- Migraine

21

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

22

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

23

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

24

How do we treat Vestibular Neuritis/Labyrinthitis?

A vestibular sedative acutely

Vestibular rehab afterward

25

What is Meniere's disease?

Also known as endolymphatic hydrops.

Its thought to stem from unusual fluctuation of endolymph in the vestibular system.

26

How does meniere's disease present?

Spontaneous vertigo often with:
- Fluctuating & Progressive unilateral hearing loss
- Tinnitus
- Aural Fullness

It can last hours and happen every few days, weeks or months

27

How do we treat meniere's disease?

Betahistine
Bendrofluazide
Intratympanic Dexamethasone
Intratympanic Gentamicin

28

What is a migraine?

Spontaneous Vertigo +/-:
- Headache
- Sensory Sensitivity

It can be precipitated by a migraine trigger such as stress, diet, alcohol or menstruation

Duration & Frequency are very variable

29

How would we treat a migraine?

Avoid the triggers
Prophylactic meds

30

List some sources of Facial Palsy:

Lower Motor Neuron Facial Weakness

Infratemporal (Cholesteatoma) or Extratemporal (Parotid Gland Tumour) pathologies affecting the facial nerve

Bells Palsy
- Acute Idiopathic Facial Palsy