Ear

Question 1

What is tinnitus?

Answer 1

ringing in the ears

Question 2

What is presbyscusis?

Answer 2

age related sensorineural loss of hearing

Question 3

What questions do you ask a patient with hearing problems?

Answer 3

• How long?
• Gradual or sudden onset?
• Are some sounds harder to hear?
• One ear or both?
• Previous head injury, ear infections, allergies?
• Occupation and hobbies with loud noises?
• Vertigo, dizziness?

Question 4

What is otitis externa?

Answer 4

• inflam. of external ear canal skin
• any skin diseases can cause this
• exacerbated by water, sweating, trauma

• FROM: Infective, Seborrhoeic, Allergic

• pruritus, pain (canal, nodes) worse by movement of pinna or tragus
• discharge maybe
• canal can block -> deafness

Question 5

What is bad about using cotton buds?

Answer 5

damages the epithelium -> impairs the self cleaning mechanism of the external ear

-> can lead to otitis media

Question 6

What is the aetiology of Otitis externa (infective)?

Answer 6

• bacterial-Gram negative rods
• fungal
• viral-herpes
• furunculosis-staph inf. of hair follicle

Question 7

What is the aetiology of Otitis externa (seborrhoeic)?

Answer 7

comes with dermatitis of scalp)

Question 8

What is the aetiology of Otitis externa (allergic)?

Answer 8

from treatments

Question 9

Acute suppurative otitis media

Answer 9

• 2nd most common childhood disorder
• viral or bacterial
• microorganisms enter from nasopharynx
• neonates: E. coli, S. aureus
• older kids: Strep. pneumonia, H. influenza
• > 14yrs: strep. pneumoniae, Beta hemolytic strep, S aureus
• earache, fever, hearing loss, vomiting, diarrhoea
• erythematous, buldging tympanum

Question 10

What are the complications of Acute suppurative otitis media?

Answer 10

• possible otorhoea if tympanic membrane is ruptured

• glue ear (very common)
• acute mastoiditis
• labyrinthitis
• meningitis or intracranial infection
• hearing loss

Question 11

Barotitis media

Answer 11

• damage as result of sudden elevations in environmental pressure
• plane, deep-sea diving
• air can’t move from nasopharynx into auditory tube to equalize pressure on both sides of tympanic membrane
• FROM: allergies, inflammation, damage to middle ear
• severe ear pain
• conductive hearing loss

• tympanum may rupture

Question 12

What are all the synonyms for glue ear?

Answer 12

• secretory otitis media
• otitis media with effusion
• serous otitis media

Question 13

What is serous otitis media?

Answer 13

• effusion in middle ear
• FROM: unresolved acute otitis media or obstruction of the auditory tube (allergy, inflammation, enlarged adenoids) -> relative negative pressure in middle ear -> retraction of tympanic membrane and transudation of fluid from blood vessels in middle ear -> fluid up in middle ear -> impaired sound conduction
• variable conductive hearing loss
• often presents as learning difficulties and behavioural problems

Question 14

What is mastoiditis?

Answer 14

• bacterial infection of mastoid process
• extension of middle ear infection, by same causative agent
• coalescence of mastoid air cells
• Hx of acute otitis media not well treated (2 weeks after)
• increasing aural pain (persistent and throbbing)
• fever, otorrhoea,
• redness, swelling, tenderness over mastoid process

Question 15

What is otosclerosis?

Answer 15

• bony ossicles disorder
• conductive hearing loss
• hereditary
• foci of new, irregularly arranged bone develop within ossicles -> ankylosis -> impaired vibration of ossicles
• late teens or early adulthood
• slowly progressive
• sensorineural hearing loss if ankylosis adjacent to Scala media

Question 16

What is Acoustic neuroma?

Answer 16

• tumour of Schwann cells of vestibulocochlear nerve
• unknown aetiology

Pathology: tumour encapsulated -> distorts and compresses nerves V and VII -> compress pons, medulla, obstruct flow of CSF

• gradual sensorineural hearing loss
• tinnitus
• dizziness and unsteadiness

Question 17

What is Benign paroxysmal positional vertigo (BPPV)?

Answer 17

• severe vertigo >30 seconds
• granular masses in posterior semicircular canal
• result of trauma, infection, degeneration or vascular occlusion
• episodes precipitated by head movements
• lasts weeks-months, may recur

Question 18

What is Labyrinthitis?

Answer 18

• usually bacterial infection
• often secondary to acute otitis media or purulent meningitis
• severe vertigo, nausea, vomiting
• nystagmus
• hearing loss

Question 19

What is Menieres disease?

Answer 19

• paroxysmal episodes of vestibular function with increasing deafness
• from increased amount of endolymph
• progressive deafness and tinnitis
• episodes of sudden vertigo (with tinnitus, nausea, vomiting, sweating, weakness, fainting) lasting min-hrs
• frequency of attacks decreases, can last years
• nystagmus and ataxia

Question 20

What is Noise induced hearing loss?

Answer 20

• sensorineural hearing loss as a result of intense noise
• isolated event or ongoing
• > 85dB damages (industrial, shooting, concerts)
• damages hair cells in Organ of Corti

Features:
• first loose 4kHz, then higher and lower
• high frequency tinnitus

Question 21

What is Presbycusis?

Answer 21

• age related sensorineural hearing loss
• exposure or genetic
• men > women
• loose high frequency sounds first
• hard to hear when background noise

Question 22

What is Vestibular neuritis?

Answer 22

• viral infection
• sudden severe vertigo, nausea, vomiting, nystagmus
• episode of 7-10 days
or recurrent

Question 23

Using your understanding of the conduction of sound through the ear, describe possible causes of hearing loss involving the ear or the vestibulocochlear nerve.

Answer 23

• External auditory canal: blockage (wax, bug), tympanic membrane damage (pressure)
• Middle ear: ossicles (sclerosis, degeneration with age), fluid,
• Inner ear: hair cells in cochlear (loud sounds, old age), nerve (acoustic neuroma, neuritis), tumour

Question 24

What is the relation between Acute suppurative otitis media and Serous otitis media?

Answer 24

Serous otitis media may be the consequence of repeated or poorly treated Acute suppurative otitis media