Ear Disease

Question 1

can otitis external affect hearing?

Answer 1

yes

discharge and increased ear wax can cause blockage causing a temporary conductive hearing loss

Question 2

investigation of otitis externa?

Answer 2

can swab

Question 3

management of otitis externa?

Answer 3

topical aural toilet

topical clotrimazole if fungal

Question 4

what is ramsey hunt syndrome?

Answer 4

shingles of the facial nerve affecting the outer ear

Question 5

how might ramsey hunt syndrome present?

Answer 5

hearing loss
vertigo
facial nerve palsy

Question 6

how is ramsey hunt syndrome managed?

Answer 6

systemic anti-herpetic therapy

Question 7

signs of otitis media?

Answer 7

fullness
bulginess
cloudiness
redness of tympanic membrane

Question 8

symptoms of otitis media?

Answer 8

otalgia
fever
irritability
can get some conductive hearing loss

Question 9

investigation of otitis media?

Answer 9

history
otoscopy
audiometry

Question 10

management of acute otitis media?

Answer 10

80% resolve in 4 days without antibiotics
1st line = amoxicillin
2nd line = erythromycin

Question 11

describe aetiology of otitis media with effusion (OME)

Answer 11

more common in males

more common in children

Question 12

signs of OME?

Answer 12

fluid line present on tympanic membrane
retraction of tympanic membrane
altered motility

Question 13

symptoms of OME?

Answer 13

conductive hearing loss

could have poor performance at school, behavioural issues and speech delay

Question 14

how is OME investigated?

Answer 14

otoscope
audiometry
tympanometry

Question 15

how is OME managed?

Answer 15

watch and wait - most resolve within 3 months

Question 16

management of OME if not resolving after 3 months?

Answer 16

1st occurrence = grommet insertion

2nd occurrence = grommet and adenoidectomy

Question 17

what is cholesteatoma and what causes it?

Answer 17

abnormal production of keratin in the middle ear

idiopathic or result of chronic otitis media and perforated tympanic membrane

Question 18

symptoms of cholesteatoma?

Answer 18

hearing loss
discharge
visible keratin in middle ear

Question 19

how is cholesteatoma diagnosed?

Answer 19

diffusion weighted MRI

Question 20

how is cholesteatoma managed?

Answer 20

surgery

Question 21

what is otosclerosis and what causes it?

Answer 21

abnormal thickening of the osicles

idiopathic

Question 22

signs and symptoms of otosclerosis?

Answer 22

gradual onset conductive hearing loss

Question 23

how is otosclerosis managed?

Answer 23

stepedectomy

Question 24

how is vertigo examined?

Answer 24

otoscopy
neurological
blood pressure including lying/standing
balance system
audiometry

Question 25

what is BPPV and what causes it?

Answer 25

benign paroxysmal positional vertigo calcified otolith becomes dislodged from utricle into semi-circular canal can be caused by head trauma, ear surgery or can be idiopathic

Question 26

signs/symptoms of BPPV?

Answer 26

position triggered vertigo that lasts seconds (e.g looking up, turning in bed)

Question 27

how is BPPV investigated?

Answer 27

dix-hallpike manoeuvre

Question 28

how is BPPV managed?

Answer 28

epley manoeuvre | brandt daroff manoeuvre

Question 29

what causes menieres?

Answer 29

idiopathic

Question 30

signs/symptoms of menieres?

Answer 30

history of recurrent, spontaneous, rotational vertigo with at least 2 episodes lasting >20 mins (often hours) prodromal vomiting feeling of fullness in affected ear sensorineural hearing loss - before or during

Question 31

how is menieres investigated?

Answer 31

head CT to exclude other causes

Question 32

how is menieres managed?

Answer 32

supportive treatment during episodes | grommets or vestibular suppressors if severe or continuous

Question 33

what usually causes vestibular neuritis/labrynthitis?

Answer 33

usually viral

Question 34

symptoms of vestibular neuritis/labrynthitis?

Answer 34

``` vertigo for hours/days nausea vomiting no associated tinnitus or hearing loss in vestibular neuritis hearing loss is seen in labrynthitis may have viral prodromal symptoms ```

Question 35

how is vestibular neuritis/labrynthitis managed?

Answer 35

``` usually self limiting may need further investigation/rehabilitation if prolonged or atypical rule of 3s: - in bed 3 days - off work 3 weeks - off balance for 3 months ```

Question 36

what is an acoustic neuroma/vestibular schwannoma?

Answer 36

rare benign tumour arising in vestibular portion of vestibulocochlear nerve within the temporal bone

Question 37

describe the tumours in acoustic neuroma/vestibular schwannoma?

Answer 37

95% are sporadic and unilateral

Question 38

if a in acoustic neuroma/vestibular schwannoma was bilateral and occurring in a young person, what might this suggest?

Answer 38

Neurofibromatosis 2

Question 39

signs/symptoms of in acoustic neuroma/vestibular schwannoma?

Answer 39

absent corneal reflex hearing loss tinnitus imbalance

Question 40

how is in acoustic neuroma/vestibular schwannoma diagnosed?

Answer 40

MRI

Question 41

noise induced hearing loss has a classical dip at what frequency?

Answer 41

5Hz

Question 42

what is prebyscuis?

Answer 42

age related hearing loss usually at high frequency can treat with hearing aids