What are the different types of hearing loss?
- Conductive
- Sensorineural
When does the presentation of hearing loss need immediate referral to ENT?
- Sudden onset not explained by ex or middle ear causes
- Unilat hearing loss w focal neurology
- Hearing loss w head or neck injury
- Otalgia or otorrhoea that hasn’t responded to treatment w/i 72 hrs in immunosuppressed person
What are some of the causes of conductive hearing loss?
- Wax impaction
- Otitis externa or media or media w effusion
- Necrotising otitis externa
- TM perforation
- Otosclerosis
- Cholesteatoma
- Paraganglioma
What are some of the causes of sensorineural hearing loss?
- Presbycusis
- Noise related hearing loss
- Labyrinthitis
- Meniere’s disease
- Vestibular schwannoma
- Ototoxin exposure
- Infection eg. meningitis or measles
What is conductive hearing loss?
Abnormalities in outer or middle ear impairing sound wave conduction through the cochlea
What is sensorineural hearing loss?
Abnormalities in cochlea, auditory nerve or structures from inner ear to auditory cortex
What are the different balance disorders?
- Benign proximal vertigo
- Labrynthitis
- Meniere’s disease
What is Meniere’s disease?
- Spont vertigo, no N+V, unsteadiness can last for days
- Tinnitus = roaring
- Hearing loss
- Sensations of pressure in ear
- Due to disorder of the inner ear
How is Meniere’s disease managed?
- Refer to ENT
- Advise on attacks - keep meds close
- Advise on not driving
- Prochlorperazine
What is labrynthitis?
Inflam of inner ear, can be viral or bacterial - dizziness, vertigo, N+V, hearing loss
What are the sx of acute sinusitis?
- Nasal blockage/discharge
- Reduced sense of smell
- Alt speech
- Tenderness and face pain
When should you suspect acute bacterial sinusitis?
- Sx >10 days
- Purulent discharge
- Fever >38
- Severe local pain
What is the management of acute sinusitis? What do you do if there are symptoms for >10days?
- Reassure likely viral - self care measures
- If >10 days = nasal corticosteroid or abx = co amox or clarithromycin
What are the CF of chronic sinusitis?
- Nasal blockage/discharge/reduced sense of smell >12 weeks
What is the management of chronic sinusitis?
- Admission if orbital involvement/intracranial involvement
- Check if have associated disorder eg. allergic rhinitis, asthma, dental infection
- Avoid triggers, stop smoking, good dental hygiene
- Nasal irrigation w saline
- Intranasal corticosteroids
- ENT referral
- Need microbiology advise for long term abx
What is a cholesteatoma?
Accumulation of keratinising squamous epithelium due to Eustachian tube dysfunction - TM retracted creating a sac and keratin gets stuck in the sac.
What is the presentation of cholesteatoma?
- Repeated purulent otorrhoea
- Abx don’t resolve the problem
- Hearing loss possible
- Red flags - vertigo, headache, facial nerve palsy = risk intracranial abscess or meningitis
What are some causes of congenital deafness?
Prenatal - infections eg. rubella, drug and alcohol use in pregnancy, genetic causes, preeclampsia
Perinatal - hypoxia at birth
Postnatal - meningitis in early life
How do you test hearing in neonates and when?
Automated otoacoustic emission test
Test baby’s hearing on birth and then 8 months later, tell parents to keep an eye on baby’s development, if slow alert health visitor.
What is allergic rhinitis? What are the CF?
Inflam of the nasal mucosa = sneezing, itchiness and a blocked/runny nose.
How do you manage allergic rhinitis?
- Long acting non sedating antihistamines
- Nasal saline can remove irritants
- Corticosteroid spray for persistent symptoms
What are nasal polyps and what are the CF?
Benign growths inside the nose.
- Get blocked/runny nose
- Post nasal drip
- Reduced smell or taste
- Nosebleeds and snoring
What is the treatment of nasal polyps?
- Steroid nose drops to shrink polyps
- Can be PO steroids is polyps large and not responding to sprays/drops
- No improvement after 10 weeks - surgery but recurrence is common
What is BPPV?
Benign paroxysmal positional vertigo. Vertigo w head movements, caused by movements of crystals in the inner ear which create sensation of moving.
