Week 2 Flashcards
1
Q
What is conductive hearing loss
A
Hearing loss due to sound conduction being blocked / impaired
pathology is in the external or middle ear
2
Q
What is sensorineural hearing loss
A
Hearing loss due to damage to the neural pathway
Pathology is in the inner ear / brain / nerves
3
Q
What are the causes of conductive hearing loss
A
Otitis media
Otitis externa
Otosclerosis
Perforation of the tympanic membrane
Choleastoma
Glue ear
4
Q
What will the audiometry for conductive hearing loss be like
A
Difference in air conduction level and bone conduction level where bone > air
Carhart’s notch in otosclerosis
5
Q
What will the audiometry for sensorineural hearing loss be like
A
Significant drop in hearing in all frequencies
No difference in air conduction and bone conduction
6
Q
What clinical examinations can be done to differentiate between conductive and sensorineural hearing loss
A
Rinne’s test
Weber’s test
7
Q
What is otitis externa
A
Inflammation of the external acoustic canal
8
Q
Otitis externa is most common in
A
Children and young adults
9
Q
Risk factors of otitis externa
A
Swimmers
Humid air
Obstruction of the external acoustic canal
Eczema
Psoriasis
10
Q
What can cause obstruction of the external acoustic canal
A
Use of cotton buds
Foreign bodies
11
Q
Main cause of otitis externa
A
Bacterial infection
12
Q
Causes of otitis externa
A
Bacteria
Fungal
Eczema
13
Q
What skin conditions may lead to otitis externa
A
Contact dermatitis
Seborrheic dermatitis
14
Q
What is contact dermatitis
A
Dermatological symptoms (pruritus, rash) due to direct contact with a substance
15
Q
What bacterial pathogens are the main cause of otitis externa
A
S aureus
Pseudomonas aeruginosa
16
Q
What fungal pathogens can cause otitis externa
A
Candida
Aspergillus
17
Q
Symptoms of otitis externa
A
Otalgia
Discharge
Itchiness
Swelling
Erythema
Hearing loss (In severe cases)
18
Q
Management of mild to moderate otitis externa
A
Analgesia
Topical antibiotics +/- topical steroids
Avoid swimming and keep ears dry
19
Q
Management of severe otitis externa
A
Use Pope wicks to apply topical antibiotics +/- steroids deeper
20
Q
What should you be aware of in immunocompromised patients with otitis externa
A
Malignant otitis externa
21
Q
Are oral antibiotics used for otitis externa
A
Not usually used
22
Q
Indications for used of oral antibiotics for otitis externa
A
Ear canal is occluded by swelling and cannot be treated by Pope wicks
Immunocompromised patients
Infection spreading beyond the external ear
23
Q
What is malignant otitis externa
A
Invasive infection of the mastoid and temporal bones surrounding the ear canal
24
Q
Malignant otitis externa is most commonly caused by
A
Pseudomonas aeruginosa
25
What is otitis media
Inflammation of the middle ear
26
Otitis media is most common in
Children especially after URTI
27
Why may otitis media occur after URTI
Pathogens from URTI made their way up to the middle ear through Eustachian tube
28
Why are children more susceptible to otitis media after URTI
Children's Eustachian tube is shorter and less angled, making it easier for pathogens to enter the middle ear cavity
Children have immature immune system
29
Otitis media is mostly commonly caused by
Bacteria
Virus
30
What are the bacteria responsible for otitis media
Streptococcus pneumoniae
H influenza
31
Which bacteria is the most common cause of Otitis media
Streptococcus pneumonia
32
What viruses are responsible for Otitis media
RSV
Rhinovirus
Adenovirus
Influenza virus
33
Why may children and infants present otitis media differently from adults
Because they cannot express well
34
Symptoms of otitis media in infants and children
Fever
Irritability
Difficulty feeding
Holding / tugging ear
35
Symptoms of otitis media in adults
Fever
otalgia
Hearing loss
36
Investigations for otitis media
Otoscopy
37
What may be seen through otoscope in a patient with otitis media
Erythematous tympanic membrane
Swelling
Bulging tympanic membrane
Perforation of tympanic membrane
Dilated vessels on tympanic membrane
38
What causes bulging of tympanic membrane
Pus filled in the middle ear cavity
39
Complications of otitis media
Facial nerve palsy
Mastoiditis
Meningitis
Labrynthitis
Brain abscess
Sigmoid sinus thrombosis
40
Patients with facial nerve palsy can present differently. Why is that
Because different parts of the nerve are affected - it can be upper or lower motor neurone that is affected
41
Difference in presentation between upper ad lower motor neurone facial palsy
If upper motor neurone is affected - forehead structures are not affected - furrowing of eyebrows, blinking, closing eyes are not affected
If lower motor neurone is affected - all facial muscles are weak
42
How does otitis media cause mastoiditis
Infection may have spread to the mastoid air cells via mastoid antrum which is an opening in posterior wall of middle ear cavity
43
What are the signs of mastoiditis
Postauricular swelling
Auricle pushed outwards and forwards
44
Mastoiditis tends to affect
children
45
What is labrynthitis
Inflammation of the semicircular canals
46
What can labrynthitis cause
Vertigo
Loss of balance
Nausea
Vomiting
47
Management for acute otitis media
Generally self limiting
Analgesia - paracetamol / ibuprofen
Consider antibiotics and admitting the patients under certain conditions
48
When should you consider delayed prescription of antibiotics (i.e. wait and see before giving) to patients with otitis media
If symptoms don't improve after 3 or 4 days
49
When should you consider immediate prescription of antibiotics to patients with otitis media
If systemically very unwell
If at high risk of complications
50
When should you admit a patient with acute otitis media
Children under 3 months with > 38 temperatuer
Children with suspected complications
51
What is chronic otitis media
A group of conditions that causes inflammation and infection for 3 months or more
52
What conditions are included in chronic otitis media
Otitis media + effusion (glue ear)
Cholesteatoma
Perforation
53
What is glue ear
Inflammation of the middle ear with accumulation of fluid without the signs and symptoms of acute otitis media
54
Is glue ear an infection
No, it is not an infection
55
Cause of glue ear
Eustachian tube dysfunction - fluid builds up due to blocked Eustachian tube unable to drain it from middle ear cavity to the nasal cavity
56
Glue ear can occur after certain conditions
Recurrent URTI
Recurrent otitis media
Frequent nasal obstruction
57
Risk factors for glue ear
Day care
Bottle fed (poor immunity)
Smoking household
Genetic mucociliary disorders (Cystic fibrosis, Primary ciliary dysfunction)
Genetic craniofacial disorders (Down syndrome)
58
Symptoms of glue ear in children
Learning or language difficulties
Listening to loud TV or devices
Talk loudly
Lack of concentration
Need to repeat things for them
Ear rubbing
59
Investigations for glue ear
Otoscopy
Audiometry / Weber's / Rinne's
60
What would be seen on otoscope for glue ear
Visible fluid or air bubbles due to fluid
Cloudy tympanic membrane
Immobile tympanic membrane
Retraction of the tympanic membrane
61
Management for glue ear
Generally resolves by itself after 3 months
Review at 3 months
Only perform surgery under certain conditions
Hearing aid if surgery is not appropriate
62
When is surgery for glue ear considered
If it doesn't resolve after 3 months
If the child is having learning / language difficulties
If the child is having behavioural problems
63
Surgical options for glue ear
Grommet
Grommet + adenoidectomy
64
Hearing aid instead of surgery is mostly offered to
Patients with down syndrome because complications from grommet is common
65
What are the complications of grommets
Infection
Perforation
Falls out too early / doesn't fall out
66
What can cause perforated tympanic membrane
After acute otitis media
Trauma - sudden negative pressure
Insertion of foreign objects
67
Perforation of the tympanic membrane is most common in
Children after acute otitis media
68
Symptoms of perforation
Sudden pain
Bleeding
Tinnitus
Hearing loss
69
Management of perforation
Generally heals by itself taking up to a year
Keep ears dry to prevent infection
Surgery if there is recurrent discharge
70
What is cholesteatoma
Growth of keratinising squamous epithelium in the middle ear and invading other areas such as mastoid bone
71
Causes of cholesteatoma
Perforation
Retraction
72
How does retraction of tympanic membrane cause cholesteatoma
Negative pressure pulls the tympanic membrane inwards (retraction) and create a pocket of dead epithelial cells. The pocket becomes infected / grow and erode other bones and surrounding structures
73
Most common location of cholesteatoma
Anterosuperior quadrant of tympanic membrane
74
Symptoms of cholesteatoma
Discharge
Hearing loss
Vertigo
Facial nerve palsy
75
Investigation for cholesteatoma
Otoscopy
Audiometry / Rinne / Weber
76
What will you see on otoscope in a patient with cholesteatoma
Retraction or perforation of the tympanic membrane
White material usually at anterosuperior quadrant
77
What is otosclerosis
Progressive fixation of stapes footplate so it doesn't function as a piston onto the cochlea
= no movement of perilymph
= no movement of hair cells
78
What does otosclerosis cause
Progressive conductive hearing loss
79
Cause of otosclerosis
Familial - autosomal dominant condition
80
Management of otosclerosis
Hearing aids
Stapedectomy
81
What are the causes of sensorineural hearing loss
Presbycusis
Noise induced
Drug induced
Vestibular Schwannoma
Meniere's
Trauma
82
What is presbycusis
Degenerative condition of the cochlea causing progressive sensorineural hearing loss
83
What causes presbycusis
Loss of hair cells
Loss of ganglion cells
Strial atrophy
84
What is strial vascularis
Capillary loop in in cochlear duct producing endolymph for scala media
85
Risk factors for presbycusis
Elderly
High levels of noise exposure
86
Presbycusis is most common in
Elderly
87
Management of presbycusis
High frequency hearing aid
88
What causes noise induced hearing loss
High levels of industrial noises
89
Characteristic of noise included hearing loss in audiometry
Dip at 4000Hz
90
What are the drugs that can cause drug induced hearing loss
Gentamicin
Cisplatin
Vincristine
Overdose aspirin and NSAID
91
What is Vestibular Schwannoma
Benign subarachnoid tumour arising from the vestibular portion of CN VIII in the internal acoustic meatus
92
What is CN VIII
vestibulocochlear nerve
93
Symptoms fo vestibular schwannoma
Progressive unilateral hearing loss
Progressive tinnitus (only on affected side)
Loss of balance
Facial numbness
Progressive episodes of dizziness
Headaches
94
Management fo vestibular schwannoma
If small - monitor every 6 months
If big - surgery
95
What causes facial numbness in vestibular schwannoma
Compression of trigeminal nerve
96
What is Ménière's disease
Idiopathic dilatation of the endolymphatic spaces of membranous labyrinth
97
What may be a possible reason for Ménière's disease
Due to increase in endolymphatic pressure caused by dysfunctioning of sodium channels
98
Symptoms of Ménière's disease
Episodes of vertigo - dizziness, nausea, vomiting
Unilateral hearing loss and tinnitus during the episodes of vertigo
Aural fullness on the affected side
99
How long does each vertigo episode last in Meniere's disease
Hours
100
The vertigo in Ménière's disease is in which direction
Rotational vertigo
101
Investigations for Meniere's
Audiometry
102
What is a pattern on audiometry shown in Meniere's
Low frequency hearing loss
103
Management for Ménière's disease
Betahistine for prophylaxis
Prochlorperazine for acute attacks
Reduce salt intake
Avoid chocolate, caffeine, stress
104
What is vertigo
A hallucination of movement- spinning, falling ..etc
105
What is dizziness
A non-specific term that may include vertigo, disequilibrium, pre syncope ..etc
106
Causes of vertigo
Cardiac
Neurological
Vestibular
Visual
Ototoxicity
107
What are the vestibular causes of vertigo
BPPV
Meniere's
Vestibular neuronitis
Acute labyrinthitis
Ototoxicity
108
How do you differentiate between the different types of vertigo
Through history
E.g. If present with palpitations - probably cardiac
If present with visual disturbance - probably visual
If present with paraesthesia, weakness, speech problems - probably neurological
109
How do you differentiate between the different otogenic causes of vertigo
By duration of episodes and associated symptoms
110
What is the most common otogenic cause of vertigo
BPPV
111
What is the vestibulo cochlear reflex
When your head turns one way, your eyes will turn to the opposite way to stabilise your gaze during head movement
112
What causes nystagmus
Defects in vestibulo cochlear reflex
113
When What causes BPPV
Otocania (otoliths) becomes dislodged into the semicircular canals
This causes the otocania to roll around freely in those semircular canals during head movements
As it rolls, hair cells are triggered
So inappropriate signals are sent
114
When can vertigo in BPPV occur -when they
Looking up
Rolling in bed
Getting out of bed
Bend forwards
bend backwards
115
Symptoms BPPV
Vertigo
Nausea and vomiting
no auditory symptoms
116
How long does vertigo of BPPV usually last
30 seconds to 1 minute
117
Investigations for BPPV
Dix Hallpike manoeuvre
118
What is a positive Dix Hallpike manoeuvre
Torsional geotropic nystagmus
Vertical nystagmus
Nausea and vomiting
119
Management of BPPV
Epley manoeuvre
Selmont manoeuvre
Brandt Daroff exercises - 10 reps for 3 time a day
