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Clinical Anatomy > The Ear > Flashcards

The Ear Flashcards

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1
Q

What can cause trauma to the external ear, and what are some possible manifestations?

A

Sport related injuries, result of violence involving a blow to the ear.
Lacerations, bites, pinna haematomas

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2
Q

What can untreated pinna haematoma lead to?

A

Disruption of blood supply to the cartilage, avascular necrosis of cartilage. Risk of associated deformity - Cauliflower ear.
Needs urgent drainage and pressure dressing application to prevent re-accumulation of blood.

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3
Q

Causes, symptoms and treatment of tympanic membrane perforation

A

Direct or indirect trauma, otitis media
Pain, discharge from ear, possible conductive hearing loss
Most heal by themselves, if does not heal in 6 month: surgical intervention = myringoplasty

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4
Q

What is a Haemotympanum and how is it be treated?

A

Blood in the middle ear
Caused by trauma, associated with temporal bone fracture
Can be seen through tympanic membrane, possible conductive hearing loss
Should settle with time, follow up patients to ensure no residual hearing loss from damage to the ossicles

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5
Q

Causes and symptoms of otitis externa

A

Inflammation of the skin lining external canal due to bacterial or fungal infection.
Painful discharging ear, history of an itchy ear, hearing may be muffled from the discharge present

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6
Q

What is malignant otitis externa?

A

Aggressive external ear infection, seen in diabetics or immune compromised patients. Infection spreads from soft tissue into the bone.
Presents with chronic ear discharge, severe ear pain, possible cranial nerve palsies (CNVII)
Mortality rate 10%

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7
Q

Management of otitis externa

A

Topical ear drops empirically eg. Gentamicin
Micro suction of pus/debris
In severe infection use wick to hold canal open
Malignant otitis externa needs IV antibiotics

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8
Q

What epithelium lines the middle ear?

A

Respiratory epithelium - Pseudostratified columnar

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9
Q

Why is acute otitis media more common in children?

A

Shorter, narrower Eustachian tube

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10
Q

Common pathogens of AOM

A

Streptococcus pneumoniae
Haemophilus Influenzae
Moraxella species

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11
Q

Symptoms of AOM

A

Ear pain due to increased pressure in tympanic cavity
Discharge due to rupture of membrane - causes pain to settle
Fever

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12
Q

Management of AOM

A

Conservative - pain relief
Medical - in severe cases give oral antibiotics
Surgery - recurrent AOM may be helped by grommet insertion

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13
Q

What distinguishes active COM from inactive COM?

A

Active - ear is discharging, associated with conductive hearing loss
Inactive - not discharging

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14
Q

How is chronic otitis media classified?

A

Active/inactive

Mucosal/squamous

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15
Q

What is cholesteatoma?

A

Active squamous disease, build up of keratinised squamous cells on tympanic membrane

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16
Q

Treatment of cholesteatoma

A

Surgery is required, mastoidectomy if it has spread to mastoid bone.

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17
Q

What is inactive squamous COM?

A

No cholesteatoma, but a retraction pocket which may develop into active disease

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18
Q

What is mucosal COM?

A

Develops from an episode of AOM where tympanic membrane ruptures and fails to heal

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19
Q

Complications of COM

A

Spread of disease to mastoid bone

Spread of disease intracranially

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20
Q

Risks of mastoidectomy

A 
Facial nerve palsy
Altered taste due to chorda tympani damage
CSF leak
Tinnitus
Vertigo
Hearing loss
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21
Q

What is glue ear?

A

Otitis media with effusion

Due to Eustachian tube dysfunction, negative pressure in middle ear draws transduction fluid, may become infected

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22
Q

What is a possible cause of unilateral Eustachian tube dysfunction in adults?

A

Tumours in the post nasal space

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23
Q

Clinical features of glue ear

A

Ear pain
Conductive hearing loss
Middle ear effusion on otoscopy - tympanic membrane is retracted

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24
Q

Investigations and management of glue ear

Study These Flashcards
A

Investigations: Tympanogram gives flat Type B trace, PTA shows conductive hearing loss (air-bone gap)

Management:
Conservative - most settle in three months
Hearing aid
Surgery - grommets, adenoidectomy

25
What is otosclerosis and who does it affect?
Disease affecting ossicles: mature bone is replaced with woven bone and stapes footplate becomes fixed to oval window Can be genetic (autosomal dominant) or environmental Occurs in 1-2% population, twice as many females
26
Clinical features of otosclerosis
Progressive hearing loss, tinnitus, improved hearing in noisy surroundings during early stages, family history Pink hue to tympanic membrane on examination - Schwartzes sign
27
Investigations and management of otosclerosis
Investigations: Tympanogram - normal type A trace PTA - conductive hearing loss, characteristic Carhart notch at 2000Hz Management: Conservative - hearing aid Surgery - stapedectomy
28
Describe the structure and function of the cochlea
2.5 turns around a bony core, the modiolus Responsible for the perception of hearing: stapes articulates with oval window causing movement of perilymph Vibrations transmitted through endolymph to tectorial membrane Causes movement of hair cells and depolarisation of neuronal fibres, transmitted via cochlear nerve
29
Where in the cochlear are different frequency sounds heard?
Low frequency sounds detected at apex of cochlear | High frequency sounds detected at base of cochlear
30
Name the three semicircular canals
Posterior Lateral Superior/anterior
31
What movements are detected by different parts of the vestibular system?
Semicircular canals - rotational movements Utricle - linear/horizontal movement Saccule - vertical movement
32
What makes up good balance?
Input from vestibular system Proprioception Visual inputs
33
Define vertigo
The hallucination of movement
34
Possible causes of vertigo (Central/peripheral)
Central = stroke, migraine, neoplasms, demyelination eg. MS, drugs Peripheral = Ménière's disease, BPPV, vestibular neuronitis
35
What is BPPV and what is the underlying cause?
Benign Paroxysmal Positional Vertigo = vertigo occurring with particular head movements Caused by displacement of otoliths to semicircular canals (usually posterior) causing abnormal stimulation of hair cells
36
Symptoms, diagnosis and treatment of BPPV
Vertigo lasting seconds with particular head movements Diagnosis: Dix-Hallpike manoeuvre Treatment: Epley manoeuvre
37
Cause of Ménière's disease
Increased endolymph fluid in the membranous labyrinthe
38
Symptoms of Ménière's
``` Tinnitus Vertigo lasting minutes to hours Associated nausea and vomiting Fluctuating sensorineural hearing loss Aural fullness ```
39
What is the burnt out stage of Ménière's?
Over time the vertigo episodes settle, but patient has reduced hearing and may be generally unbalanced
40
Management of Ménière's
Dietary - reduce salt, alcohol, caffeine Medical - thiazide diuretics, betahistine, vestibular sedatives Surgical - grommet insertion, dexamethasone middle ear injection, edolymphatic sac decompression, surgical labryrinthectomy
41
What is vestibular neuronitis?
Inflammation of the inner ear due to viral infection of vestibular nerve and ganglion
42
Symptoms of vestibular neuronitis
Vertigo lasting several days Associated nausea and vomiting Horizontal nystagmus Usually preceded by URTI
43
Treatment of vestibular neuronitis
Vestibular sedatives, usually resolves in 3-7 days | Vestibular rehabilitation exercises if there is long term vestibular deficit causing generalised unsteadiness
44
Prognosis of sudden onset sensorineural hearing loss
1/3 recovery to normal 1/3 some recovery 1/3 no recovery
45
Investigations and management of sudden onset sensorineural hearing loss
Investigations: PTA MRI scan to exclude lesion along central auditory pathway eg. Acoustic neuroma Management: Steroids, Antivirals,
46
Describe Webers test and typical findings
Place tuning fork on patients forehead, ask if noise is heard on left, right or centre Normal - tone is heard centrally Sensorineural - tone heard on opposite side Conductive - tone heard on same side as background noise has been blocked out
47
Describe Rinnes test and typical findings
Tuning fork placed on mastoid bone, then external to EAM, ask patient which is louder Normal - louder when lateral to EAM (Rinne positive) Sensorineural - Rinne positive Conductive - louder when placed on temporal bone (Rinne negative)
48
What does a Tympanogram measure?
Compliance of the tympanic membrane (y axis), against varying amounts of pressure on the EAM (x axis)
49
What is a Type A trace Tympanogram?
Normal result, peak is centred at 0 | Extremely high peak can indicate ossicular chain disruption
50
What is a Type B trace Tympanogram?
Flat trace
51
What is a type C trace Tympanogram?
The peak of the tracing has negative pressure | Suggests Eustachian tube dysfunction
52
What does a pure tone audiogram measure?
Air conduction and bone conduction of sound
53
What are the markings used in a PTA?
Black line = air conduction (O is right ear, X is left ear) | Red line = bone conduction ( [ is right ear, ] is left ear)
54
Give possible causes of conductive hearing loss
Wax Otitis media with effusion Otosclerosis
55
Describe a typical PTA in conductive hearing loss
Normal bone conduction, but reduced air conduction (black line is lower) i.e. An air bone gap
56
Possible causes of sensorineural hearing loss
Caused by a problem anywhere from cochlear to auditory cortex of the brain Ménière's disease, acoustic neuroma
57
Describe a typical PTA in sensorineural hearing loss
Reduced bone and air conduction | No air bone gap
58
Nerve supply to the pinna
Upper lateral surface - Auriculotemporal nerve (CN V3) Lower lateral and medial surface - Greater auricular nerve (C3) Superior medial surface - Lesser occipital nerve (C2/3) EAM - Auricular branch of vagus (CN X)

Clinical Anatomy (6 decks)

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