7. Ear pathology

Question 1

what is this condition

Answer 1

RAMSAY-HUNT SYNDROME: facial n palsy due to shingles by varicella zoster - can cause appearance of vesicles around auricle

Question 2

what is this condition and explain why it has occured. how should it be treated

Answer 2

PINNA HAEMATOMA with CAULIFLOWER DEFORMITY

Blunt injury to pinna… accumulation of blood between cartilage and perichondrium… cartilage deprived of blood supply… avascular and pressure necrosis of tissue… fibrosis and new asymmetrical cartilage dev.

Requires prompt drainage, measures to prevent re-accumulation and re-apposition of 2 tissue layers.

Question 3

what is this condition and what are the main symptoms

Answer 3

OTITIS EXTERNA - inflammation of EAM (can be acute, recurrent or chronic) caused by infection or eczema

Symptoms:

1- pain

2- pruritis

3- discharge

4- temporary dulled hearing

Question 4

what is otosclerosis

Answer 4

fusion of ossicles at articulations… sound vibrations cannot be transmitted… progressive hearing loss (conductive)

Question 5

what is this condition, which signs suggest this and explain how this occurs

Answer 5

OTITIS MEDIA WITH EFFUSION (glue ear): build-up of fluid and negative pressure in middle ear due to Eustachian tube dysfunction (eg enlarged pharyngeal tonsils or adenoids). Causes decreased mobility of TM (retracted inwards) and ossicles, affecting hearing.

Signs: retracted and straw-coloured TM

Question 6

describe the management of otitis media with effusion. are there any possible complications

Answer 6

Management:

• most resolve spontaneously in 2-3 mths
• some may persist - reauire grommets (tympanostomy tube) to ventilate middle ear

Complications: predisposes to otitis media as effusion allows pathogen growth

Question 7

what is this condition, suggest signs and symptoms of this

Answer 7

ACUTE OTITIS MEDIA - acute middle ear infection

Signs: red +/- swollen TM with loss of normal landmarks

Symptoms: otalgia and other non-specific symptoms, eg temp

Question 8

suggest possible complications of acute otitis media

Answer 8

1- TM perforation (due to increased pressure)

2- facial n involvement

rarer:

3- mastoiditis

4- intracranial complications (meningitis, sigmoid sinus thrombosis, brain abscess)

Question 9

why is acute otitis media more common in children than adults

Answer 9

eustachian tube is shorter and more horizontal so easier passage for infection from nasopharynx and can block more easily, compromising ventilation and drainage

Question 10

which condition is this, what are the associated signs and explain why this can occur

Answer 10

MASTOIDITIS: middle ear communicates posteriorly via mastoid antrum with mastoid air cells, providing potential route for middle ear infections to spread into mastoid bone

Signs: external rubor and swelling which pushes ear anteriorly

Question 11

what is cholesteatoma and which signs suggest this condition

Answer 11

• rare abnormal skin growth into middle ear - not malignant but slowly grows and expands, eroding into structures, eg ossicles, mastoid bone, cochlea
• usually secondary to chronic ET dysfunction or ear infections
• signs:

1- painless often smelly otorrhea

2- crusting and retraction of superior TM

3- +/- hearing loss

Question 12

what is labyrinthitis and what symptoms suggest this

Answer 12

• infection and inflammation of inner ear labyrinth, affecting hearing and balance
• symptoms (often pass within a few weeks):

1- vertigo

2- nausea and vomiting

3- hearing loss (+/- tinnitus

Question 13

what is benign paroxysmal positional vertigo and how can this be treated

Answer 13

• short episodes of intense vertigo on head movement, caused by OTOCONIA (tiny calcium carbonate crystals broken off inside lining of vestibule) entering the semicircular canals
• usually resolves after several weeks but can often be treated using the Epley manoeuvre

Question 14

what is Meniere’s disease

Answer 14

• attacks (20min - several hrs) of vertigo, nausea, hearing loss and tinnitus, variable in severity and frequency
• caused by fluid build-up in labyrinth causing increased pressure and swelling, affecting stereocilia
• hearing loss and tinnitus may become permanent over mths-yrs
• no cure

Question 15

what is the most common cause of hearing loss in >55 yo

Answer 15

PRESBYACUSIS: degeneration of cochlear stereocilia with age

Question 16

describe how to perform the 2 tests differentiating between conductive and sensorineural hearing loss

Answer 16

1. RINNE’S: strike tuning fork and place base against P’s mastoid process for 2-3 secs and then about 1 cm from EAM - better bone or air conduction?
2. WEBER’S: strike tuning fork and place base in midline, high on P’s forehead - which ear hears sound louder?

Question 17

what are the test results in conductive and sensorineural hearing loss?

Answer 17

CONDUCTIVE:

• Rinne’s: bone conduction better than air
• Weber’s: sound heard better in affected ear

SENSORINEURAL:

• Rinne’s: air conduction better than bone

Weber’s: sound heard in normal ear but not affected ear