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Flashcards in Week 208 - Glue Ear Deck (52):
1

Week 208 - Glue Ear: How much does the Pinna and concha amplify sound by?

20dB

2

Week 208 - Glue Ear: What is the name of surfer's ear?

Exostoses.

3

Week 208 - Glue Ear: What are the components of the middle ear cleft?

• Osicles
• Eustachian Tube
• Ear drum
• Mastoid

4

Week 208 - Glue Ear: What are the two components of the tympanic membrane?

• Pars Tensa
• Pars Flaccida (Attic)

5

Week 208 - Glue Ear: What are the causes of perforation?

• Trauma
• Infection
• Surgery

6

Week 208 - Glue Ear: How can perforation lead to hearing loss?

Without the tympanic membrane, sound is able to travel via two paths.
• The first is through the remnants of the ear drum and along the ossicles.
• The second is straight onto the round window.
These two pathways can interfere with each other or even cancel each other out.

7

Week 208 - Glue Ear: What effect on hearing can retractions cause?

Reduction in conductive hearing since they limit the vibration of the ossicles.

8

Week 208 - Glue Ear: What is the difference in sound energy between that which reaches the eardrum and that which reaches the round window?

The sound is amplified about 20x as it gets to the round window.

9

Week 208 - Glue Ear: What are the two mechanisms leading to the formation of a cholesteatoma?

• Retraction of the eardrum.
• The normal migration of epithelium from the umbo. (In a cholesteatoma this gets stuck leading to a build-up of skin tissue)

10

Week 208 - Glue Ear: What are the characteristics of cholesteatoma?

• Painless
• Conductive hearing loss
• Foul, scanty green discharge

11

Week 208 - Glue Ear: What are some of the complications of cholesteatoma?

• Mastoiditis
• Meningitis
• Facial nerve paralysis
• Brain abscess

12

Week 208 - Glue Ear: What is otosclerosis?

• Thickening of the bone near the footplate of the stapes that spreads across the stapes and fixes it in place.
• Autosomal dominant inherited disease.

13

Week 208 - Glue Ear: What are the symptoms of otosclerosis?

• Conductive hearing loss. (85% bilaterally)

14

Week 208 - Glue Ear: How is otosclerosis diagnosed?

• Family history
• Audiology (the hearing loss pattern has a very distinct pattern)

15

Week 208 - Glue Ear: From what does the spongy bone leading to otosclerosis first grow from?

fissula ante finestram

16

Week 208 - Glue Ear: What is the best treatment for otosclerosis?

Hearing-aids.

17

Week 208 - Glue Ear: What is presbyacusis?

Age-associated hearing loss, it is a near inevitability in western culture.
• Loss of hair cells and spiral ganglion cells.
• High-frequency hearing is lost first.

18

Week 208 - Glue Ear: What are some of the iatrogenic causes of inner ear damage?

• Surgery
• Aminoglycosides, loop diuretics, chemotherapeutics.

19

Week 208 - Glue Ear: What are the individual hearing organs inside the cochlear called?

• Organ of corti

20

Week 208 - Glue Ear: Aminoglycosides can damage the inner ear, give some examples.

Gentamicin, Streptomicin.

21

Week 208 - Glue Ear: What are the three sensory inputs for maintaining balance?

• Vestibular
• Vision
• Proprioception / Somatosensation

22

Week 208 - Glue Ear: What are the components of the vestibular system? What does each part sense?

• Semicircular canals - rotational movement.
• Utricle and Saccule, detect linear movements.

23

Week 208 - Glue Ear: Vertigo that occurs in isolation is likely to originate from where? Why is this?

• Inner ear.
• The pathway that balance takes is through the brainstem, if there was to be a problem here it is very likely that there would be other neurological defects (slurring speech, facial weakness etc.).
• Vice versa vertigo that occurs with other symptoms is likely not to be a problem with the inner ear.

24

Week 208 - Glue Ear: What is the most common ear cause of vertigo?

Benign paroxysmal Positional Vertigo

25

Week 208 - Glue Ear: What are the characteristics of BPPV?

• No deafness, no tinnitus, no otorrhhoea, no otalgia.
• Vertigo lasts for seconds.
• Occurs only after specific movements. (e.g. rolling over in bed)

26

Week 208 - Glue Ear: What is the pathophysiology of BPPV?

• There are free otoconia in the labyrinthe, when they lie down they migrate down one of the semicircular canals.
• If the patient then stands up the otoconia may become trapped behind the crista.
• This results in incorrect signals being sent, upon particular movements.

27

Week 208 - Glue Ear: What is the diagnosis manoeuvre for BPPV? What is used for the treatment?

• Diagnosis - Dix-hallpike manoeuvre.
• Treatment - Epley manoeuvre, Brandt-Daroff exercises.

28

Week 208 - Glue Ear: What is the theory of pathophysiology behind Meniere's Disease?

• Excess endolymph volume.
• Drainage to endolymph sac is hindered.
• Causing distension of neuroepithelia causing malfunction.

29

Week 208 - Glue Ear: What is a typical attack of Meniere's disease?

• Aural pressure
• Tinnitus
• Hearing loss
• Vertigo (May last for hours or a day)
• Nausea, vomitting, sweating.

30

Week 208 - Glue Ear: How is Meniere's Disease diagnosed?

Typical history and absence of other causes.

31

Week 208 - Glue Ear: What investigation must be performed before a diagnosis of Meniere's can be ruled in?

• MRI - To exclude acoustic neuroma / posterior fossa disease.

32

Week 208 - Glue Ear: What are the treatment options for Meniere's?

• Diet - reduce salt.
• Medical - Acute and preventative.
• Conservative surgery - Grommets, chemical labyrinthectomy, Vestibular nerve section.
• Ablation surgery - Bony labyrinthectomy.

33

Week 208 - Glue Ear: What are the symptoms of vestibular neuritis?

• Severe vertigo, nausea and vomiting for a few days followed by gradual resolution within 6 weeks.

34

Week 208 - Glue Ear: What factors can prevent full recovery from vestibular neuritis?

• Elderly
• Medication
• Poor eyesight
• Poor joint mobility or muscle weakness.

35

Week 208 - Glue Ear: What is the treatment of vestibular neuritis?

• Acute use of vestibular sedatives.
• Early mobilisation.
• Vestibular rehabilitation.

36

Week 208 - Glue Ear: Labyrinthitis has the same symptoms as which inner ear disease? What are the symptoms? What additional symptoms does labyrinthitis have?

• Vestibular neuritis.
• Nausea, severe vertigo, vomiting lasting for days.
• As labyrinthitis affects the whole labyrinth there is also cochlear involvement, leading to permanent changes in hearing with tinnitus.

37

Week 208 - Glue Ear: What is the treatment for labyrinthitis?

• Vestibular sedatives, during attacks.
• Early mobilisation
• Vestibular rehabilitation.
• Possible hearing aids.

38

Week 208 - Glue Ear: What are the red flags for acute vertigo?

• Dysarthria, diplopia, facial weakness, facial numbness, dysphagia, blurred vision.

39

Week 208 - Glue Ear: What is a inflammation of the middle ear cleft called, that lasts >6wks, and is forming pus?

• Chronic suppurative otitis media.

40

Week 208 - Glue Ear: What is Acute suppurative otitis media?

Infection of the middle, with exudate, that has lasted less than 6 weeks.

41

Week 208 - Glue Ear: What is glue ear?

Chronic, inflammation of the middle ear, that is NOT forming pus.

42

Week 208 - Glue Ear: What are some of the risk factors for developing glue ear?

• Down's Syndrome.
• Smoking parents.
• Low socio-economic status.

43

Week 208 - Glue Ear: What is the natural history of acute suppurative otitis media?

•Glue > Pus forming > Pain and fever > Rupture.

44

Week 208 - Glue Ear: What are the complications of CSOM, ASOM?

• Mastoiditis
• Labyrinthitis
• Meningitis / Brain abscess
• VII paralysis

45

Week 208 - Glue Ear: Describe the nystagmus involved with labyrinthitis.

Fast phase to the opposite ear.

46

Week 208 - Glue Ear: Describe how nystagmus occurs. (With reference to the the labyrinth.)

• Ocular position is maintained by tonic outflow from the labyrinth driving the extra-ocular muscles.
- Each labyrinth controls the the muscle from each eye, that is the same as it's side. I.E. The right labyrinth exerts control over the muscle for abduction in the right eye and adduction in the left eye.
• When one of the labyrinths is damaged it upsets this balance causing the eyes to drift towards the unaffected side.
• Central control then kicks in causing the eyes to snap back.
• This is slow and fast phase of nystagmus.

47

Week 208 - Glue Ear: What are projected from hair cells (balance)?

Cilia and one long kinocilium.

48

Week 208 - Glue Ear: What effect on the neuronal firing rate do the cilia have when they are distorted towards the kinocilium?

Increased firing rate, membrane channels are opened mechanically.

49

Week 208 - Glue Ear: What effect on the neuronal firing rate do cilia have when they are distorted away from the kinocilium?

Decreased firing rate.

50

Week 208 - Glue Ear: What are the name of the particles in the inner ear that give the gel layer weight?

Otoconia.

51

Week 208 - Glue Ear: What part of the vestibule is responsible for rotational movements?

Semi-circular canals.

52

Week 208 - Glue Ear: What part of the vestibule is responsible for linear movements?

Utricle and saccule.