Session 7: Group Work Flashcards
Comparing the two tympanic membranes. Describe how the tympanic membrane appears when there is otitis media with effusion.
Retraction of TM
Evidence of fluid
Straw coloured
E > M
What causes this condition and why does it predispose to acute ear infections?
Eustachian tube dysfunction leading to fluid and negative pressure in the middle ear.
Would the hearing loss of otitis media with effusion be conductive or sensorineural?
Conductive
It affects the mobility of TM and the ossicles so they cannot effectively amplify sound.
How is otitis media with effusion managed? Is it the same for all patients.
Usually conservative as it usually resolves spontaneously within 3 months.
Tympanostomy tube might be required to equilibrate pressure.
NHS guidelines state to give antibiotics if:
Cystic fibrosis is present
Child is less than 3 months old
Child is less than 2 years old and both ears are affected
If there are recurrent infections.
What is an acoustic neuroma?
Benign tumour of the schwann cells of the vestibulocochlear nerve.
Which parts of the ear are affected in conductive hearing loss.
External or middle ear.
Which parts of the ear are affected in sensorineural hearing loss?
Cochlea or cochlear nerve.
With reference to the anatomical relations of the vestibulocochlear nerve in the area of the cerbellopontine angle. Explain why the patient reported numbness on the right half of his face.
Cerebellopontine angle can be found just superior to the internal acoustic meatus where CN VIII will enter.
CN V arise from the pons and close to the cerebellopontine angle.
As the acoustic neuromas grows on the CN VIII it can start to impinge the trigeminal nerve by its origin. This leads to facial numbness.
Explain Weber’s test.
Pinch a tuning fork and put its end on the forehead of the patient.
The patient should hear the sound equally in both ears.
What is the problem if a patient hears the sound of Weber’s test louder in one ear?
It may be conductive hearing loss or sensorineural hearing loss.
If it is conductive hearing loss the sound will be amplified and louder in the affected ear.
If it is sensorineural hearing loss the sound will be lower in the affected ear.
How can you determine which ear is affected and if it is conductive or sensorineural hearing loss?
By Rinne’s test
Explain Rinne’s test.
Pinch on the tuning fork to produce sound. But the stem of the tuning fork behind the ear on the mastoid process. This tests bone conduction (cochlea).
Then pinch on the tuning fork again and put the fork close to the ear (2.5 cm away). This tests air conduction
In a normal ear the air conduction should be louder than the bone conduction.
In a conductive hearing loss the bone conduction will be louder than the air conduction.
In a sensorineural hearing loss the air conductino will be louder than the bone conduction.
