What is a Pure Tone Threshold (PTT)?
Softest sound audible at least 50% of time
How do you read an Audiogram?
• As Frequency increases, so does the Hearing Level in dB
- Left ear: Represented by a BLUE line or Xs
- Right ear: Represneted by a RED line or Os
Q5: Compare Normal hearing, Mild/ Moderate/ Severe/ Profound Hearing Loss
- Normal: Both ears < 20dB for every frequency
- Mild hearing loss: In 20-40 dB range
- Moderate hearing loss: In 40-70 dB range (Talks loudly, asks for things to be repeated)
- Severe hearing loss: In 70-90 dB range
- Profound hearing loss: In 90-120 dB range (Needs visual assistance
List 3 Outer Ear pathologies
- Earwax
- Foreign body
- Otitis externa (Fungal/ Bacterial, Hospitals insert a “wick’ if drops don’t work)
Compare Acute OM with and without perforation
With perforation ;
- Wet/ Dry
- Central/ Attic/ Peripheral (Central safer than Attic)
Without perforation;
- Bulging red TM due to Middle ear exudate
Why is dizziness more worrying than vertigo?
What does vertical Nystagmus indicate?
Dizziness can be caused by problems from a wider range of systems
Vertical N indicates brain problem rather than eye
When do you consider Acute Bacterial Sinusitis?
1st and 2nd line treatments?
- If >10 days and sinus pain
1: Phenoxymethylpenicillin (also in Tonsillitis) 500mg QDS for 5 days
2: Doxycycline/ Clarithromycin (Erythro- if pregnant)
List 4 tests to assess pts with Suspected Vertigo
- Head Impulse/ Thrust test
- Unterberger/ Stepping test
- Rhomberg
- Dix-Hallpike
Describe Head Impulse/ Thrust test
- To detect unilateral peripheral vestibular defects, tests VOR
- Sit in front of pt, ask them to keep focus on distant object/ examiner’s nose
- Move their head quickly to 10-15 degrees of rotation
- Abnormal: Eyes dragged ‘off target’ by head rotation, then rapid movement back to target
Describe Unterberger/ Stepping test
- Ask pt to march on spot with eyes closed
- If there is Labyrinthine damage, pt rotates to affected side
Outline Dix-Hallpike test
- While sitting on bed, turn head 45 degrees to one side
- Lower patient into Supine position ensuring head hangs over bed 30degrees below horizontal plane
- Observe for Nystamus for 30 seconds
- Repeat test turning head to other side
Outline Epley Manoeuvre
From same position, Turn patient’s head 90degrees and maintain for 30 seconds
Ask pt to roll onto side, Rotate head so they are looking directly at floor. Hold for 30-60 seconds
Sit patient up sideways, maintaining head rotation
Once sitting upright, head can be re-aligned to midline and neck flexed. Hold for 30seconds
List 7 Middle Ear pathologies
- Mastoiditis
- ET Dysfunction
- Otosclerosis
- Tympanosclerosis
- Chronic Supparative OM
- OM with Effusion
Acute OM with/ without perforation
List criteria for Tonsillectomy
- 7 episodes in 1yr
- 5 episodes in each of 2 consecutive yrs
- 3 episodes in each of 3 consecutive yrs
Describe the mechanism of BPPV
- Small fragments of debris deposited in inner ear (CaHCO3 Crystals)
- When head still, they sit at the bottom of the canal
- On movement, fragments swept along the fluid-filled canal
- This sends confusing signals to the brain, interpreted as Vertigo
