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Session 7 Flashcards

1
Q

Symptoms and signs of ear disease

A

Otalgia (ear pain)
Discharge
Hearing loss
Tinnitus
Vertigo
Facial nerve palsy

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2
Q

What makes up the external ear

A
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3
Q

What makes up middle ear

A
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4
Q

What makes up inner ear

A
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5
Q

Which nerves carry general sensation from ear and why is this important

A

Cervical spinal nerves C2/C3
vagus
Trigeminal (Auriculotemporal)
Glossopharyngeal (tyrannical nerve)
Small contribution from facial nerve

Implications for referred pain

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6
Q

The medial surface of the tympanic membrane and middle ear cavity is supplies by the

A

Glossopharyngeal nerve CN 8

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7
Q

Otalgia with a normal ear examination should lead you to suspect an

A

Alternative site of pathology

Non-otological:
TMJ dysfunction (CN Vc)
Diseases of oropharynx (CN IX)
Disease of larynx and pharynx including cancers (Cn IX and CN X)

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8
Q

How long is external auditory meatus in adults

A

2.5cm

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9
Q

What does the external auditory meatus do

A

Collects, transmits and focuses sound waves onto the tympanic membrane

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10
Q

Types of pinna (auricle) abnormalities

A

Congenital
Inflammatory
Infective
Traumatic

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11
Q

Examples of pinna abnormality

A

Facial palsy and red painful ear with vesicles = Ramsay hunt syndrome

Perichondritis = perichondrium infected e.g. piercing or insect bite

pinna haematoma (from injury)

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12
Q

What is pinna haematoma

A

Accumulation of blood between cartilage and it’s overlying perichondrium from blunt injury

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13
Q

Why does pinna haematoma occur

A

Common in contact sports

Subperichondrial haematoma deprives cartilage of blood supply = pressure necrosis of tissue

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14
Q

how do you treat pinna haematoma

A

Drainage and prevent re-accumulation of blood

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15
Q

What happens in untreated pinna haematoma

A

Fibrosis, new asymmetrical cartilage development, cauliflower deformity

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16
Q

External acoustic meatus embryology

A

Arises from cleft between 1st and 2nd pharyngeal arch which is lined with ectoderm (future skin)

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17
Q

Features of external acoustic meatus

A

Lined with keratinising, stratified squamous epithelium

Cartilaginous outer 1/3, bony inner 2/3

Sigmoid shape

Hair, sebaceous and ceruminous glands line cartilage (barrier to foreign objects), bone parts lack these

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18
Q

What are ceruminous glands

A

Produce ear wax

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19
Q

Explain the external acoustic meatus self-cleaning function

A

Desquamation and skin migration laterally off tympanic membrane out of canal- epithelial migration

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20
Q

What is otitis externa

A

INFLAMMATION
Discomfort, pain, itchiness, pain on moving Tragus or pinna

Can be discharge/temporary hearing loss

Could be caused due to malignant otitis externa

Could be swimmers ear due to moisture

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21
Q

Features of malignant otitis externa

A

Rare, serious, can be life threatening, immunocompromised people e.g. diabetes more at risk

Bacteria becomes invasive and erodes through bone

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22
Q

What is this

A

Bulging secondary to bacterial acute otitis media

(Can be viral), build up of pus and exudate

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23
Q

What is this

A

Otitis media with effusion

Underlying cause is not infection

Retracted and evidence of fluid within middle ear cavity

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24
Q

What is this

A

Cholesteatoma

  • Retraction of pars flaccida (TM) forms sac/pocket
  • Traps stratified squamous epithelium and keratin
  • Forming cholesteatoma
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25
Features of cholesteatoma
Usually secondary to chronic Eustachian tube dysfunction Negative pressures pull the pocket into the middle ear Painless, often smelly otorrhea (ear discharge) plus or minus hearing loss Not malignant but slowly grows and expands
26
When can there be more serious consequences to cholesteatoma
Due to enzymatic bony destruction, erosion of ossicles, mastoid/petrous bone, cochlea Can erode into brain
27
Why is the ear drum sucked in during cholesteatoma
Due to negative pressure caused by blockage of Eustachian tube
28
What is the middle ear
Air filled cavity between tympanic membrane and inner ear containing ossicles
29
Ossicles are connected via
Synovial joints
30
What do ossicles do
Amplify and relay vibrations from the TM to the oval window of the cochlea (inner ear) Transmitting vibration to waves in a fluid medium
31
What are the ossicles
Malleus, Incus, Stapes
32
Ossicle movement is tampered by
2 muscles Tensor tympani and stapedius Contract if excessive vibration due to loud noise (protective- acoustic reflex)
33
which is Otosclerosis
- One of the most common causes of acquired hearing loss in young adults - genetic and environmental causes - Ossicles fused at articulations due to abnormal bone growth (often between base plate of stapes and oval window) - Sound vibrations can’t be transmitted effectively to cochlea - Present with gradual unilateral or bilateral conductive hearing loss
34
What happens in the middle ear
Pharyngotympanic tube equilibrates pressure of middle ear with atmospheric pressure Mucous membrane continuously reabsorbs air causing negative pressure Allows for ventilation and drainage of mucus
35
What is otitis media with effusion
glue ear- not an infection Due to Eustachian tube dysfunction, fluid and negative pressure in middle ear decreases mobility of TM and ossicles Most resolve spontaneously within 2-3 months
36
When and how do you treat glue ear
Otitis media with effusion May persist and impede speech and language development or school performance Require grommets (tympanostomy tube) Act to maintain equilibration of pressures
37
Features of acute otitis media
Acute middle ear infection Otalgia, temperature, red/bulging TM Viral mostly Occasionally bacterial causes- streptococcus pneumoniae, haemophilias influenzae
38
Why do children get more acute otitis media
Pharyngotympanic tube is shorter and more horizontal Adenoids or pharyngeal obstruction to Eustachian tube - compromising ventilation and drainage Easier passage for infection from nasopharyx to middle ear
39
Complications of acute otitis media
Tympanic membrane perforation Facial nerve involvement Mastoiditis Intracranial complications
40
Why can facial nerve involvement occur in acute otitis media
Close relationship to middle ear cavity via facial canal Two intrapetrous branches run through middle ear cavity (chorda tympani, nerve to stapedius)
41
Examples of intracranial complications in acute otitis media
Meningitis Sigmoid sinus thrombosis Brain abscess
42
What is mastoiditis
Middle ear cavity communicates via mastoid antrum with mastoid air cells Middle ear infections spread into mastoid bone/mastoid air cells Needs IV antibiotics or surgery
43
What is the role of the inner ear
Vestibular apparatus and cochlea: fluid filled tubes Involved in hearing and position-sense/balance
44
How does the cochlea work
Fluid filled tube with specialised hair cells that generate action potentials when moved Movements at oval window—> movement of cochlear duct fluid —> movement of stereocilia —> generate AP via CN 8 —> brain
45
How do we hear
1. Auricle and external auditory canal focuses and funnels sound waves towards tympanic membrane which vibrates 2. Vibration of ossicles (stapes at oval window) sets up vibrations in cochlear fluid 3. Sensed by stereocilia in cochlear duct (spiral organ of Corti) 4. Movement of stereocilia in organ of Corti triggers AP in cochlear part of CN 8 5. Primary auditory cortex makes sense of input
46
How does vestibular apparatus work
Fluid filled tubes with specialised hair cells that generate AP when moved Includes semicircular ducts, saccule and utricle (also contain stereocilia) Moving position or rotation of head moves fluid —> bends stereocilia —> AP generated via CN 8 —> brain
47
What are the different semicircular canals called
48
What is Presbycusis
- Affects cochlea - Sensorineural hearing loss associated with old age - Bilateral and gradual - Hearing aids needed
49
What is Benign Paroxysmal Positional Vertigo (BPPV)
- Vertigo only - Due to vestibular apparatus - Short lived episodes (seconds) triggered by movement of head - Crystals in tube of vestibular apparatus - Dix-Hallpike and Epley manouvres
50
What is Ménière’s disease
- vertigo, hearing loss and tinnitus (typically unilateral) - May also describe aural fullness, Nausea and vomiting - 30 mins to 24 hours - Recovery in between episodes - Hearing may deteriorate over time - Problems with too much fluid in cochlear duct
51
What is acute Labrynthitis
History of URTI Involvement of all inner ear structures Hearing loss/tinnitus, vomiting and vertigo
52
What is acute vestibular Neuronitis
usually no hearing disturbances or tinnitus Sudden onset of vomiting and severe vertigo (lasting days)
53
Sequence of events when a patient presents with hearing loss
54
Causes of conductive hearing loss
55
Causes of sensorineural hearing loss
56
4 components of temporal bone
It has 4 components; a squamous part, petromastoid part, tympanic plate and styloid process
57
The petrous part of the temporal part contains the
Middle and inner ear
58
the upper surface of the temporal bone forms part of the
Floor of the middle and posterior cranial fossae
59
What is found on the surface of the petrous bone
Internal acoustic meatus- small opening that transmits the CN VII and CN VIII Facial nerve and vestibulocochlear
60
the internal and external acoustic meatus are not
One continuous bony channel
61
The inferior surface of the petrous bone contains
The opening of the carotid canal, through which the internal carotid artery travels, Downward bony projection called the styloid process
62
What attaches to the mastoid process
SCM and posterior belly of disgatric
63
What is within the mastoid process
Mastoid air cells- air filled spaces Communication between mastoid air cells and middle ear cavity via mastoid antrum
64
Middle ear is lined with
Pseudostratified columnar epithelium
65
General sensation from within the middle ear and inner surface of tympanic membrane is carried via the
Glossopharyngeal nerve (tympanic nerve)
66
Why do ears pop
Pharyngotympanic tube is usually closed, being intermittently opened by the pull of attached palate muscles when swallowing or yawning
67
The middle ear communicates with the mastoid air cells via the
Mastoid aditus and antrum
68
What is otosclerosis
A disease affecting the ossicles causing mature bone to be replaced with woven bone Footplate of stapes becomes fused to the oval window of the cochlea Vibrations cannot be transmitted to the inner ear, leading to hearing loss
69
Where does the chorda tympani run
Branch of facial nerve Runs across middle ear cavity over inner surface of tympanic membrane Carries taste from anterior 2/3 tongue
70
What does nerve to stapedius do
Branch of facial nerve which innervates a small muscle called stapedius- dampening XS vibration of the stapes footplate at the oval window (especially in response to loud noises)
71
The inner ear is also known as the
Labyrinth
72
The middle ear consists of
Semicircular canal, utricle, saccule and cochlea
73
What is tympanosclerosis
White plaques present on tympanic membrane
74
What is important about pars flaccida
Also referred to as the attic Common site for cholesteatoma
75
Normal Rinne’s test and Weber’s test
Air conduction greater than bone conduction
76
Conductive hearing loss findings
77
Sensorineural hearing loss findings

HNN (19 decks)

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