The Ear

Ear pain

100

This commonly presents with minimal discharge, itch and pain due to acute inflammation of the skin of the external auditory meatus.

Otitis Externa

200

This causes deep seated pain, impaired hearing with systemic illness and fever.

Otitis media

300

This is how mastoiditis presents.

This can present with swelling, erythema and tenderness behind the ear often following an episode of otitis media. The external ear may protrude outwards.

400

This is the first-line management for otitis externa.

Topical antibiotic or a combined topical antibiotic with a steroid

500

The two most common causes of bacterial otitis externa

Staphylococcus aureus, Pseudomonas aeruginosa

Hearing loss

100

This is an example of an ototoxic drug

Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin, cisplatic

200

These are the three causes of a perforated tympanic membrane

The most common cause of a perforated tympanic membrane is infection. Other causes include barotrauma or direct trauma.

300

These are the features of glue ear and how it can be managed

Features

• peaks at 2 years of age
• hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
• secondary problems such as speech and language delay, behavioural or balance problems may also be seen

Treatment options include:

• grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. 
• adenoidectomy

400

These are the symptoms impacted earwax may cause and how it is treated

Symptoms:

• pain
• conductive hearing loss
• tinnitus
• vertigo

Treatment

The main treatment options in primary care are ear drops or irrigation ('ear syringing').  The following drops may be used:

• olive oil
• sodium bicarbonate 5%
• almond oil

500

This test is part of the Newborn Hearing Screening Programme

Otoacoustic emission test- A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

Vertigo

100

These are three causes of vertigo:

Any three of:

Meniere's disease

Viral labyrinthitis

Vestibular neuronitis

Benign paroxysmal positional vertigo

Acoustic neuroma

Stroke

200

This is the difference between viral labyrinthitis and vestibular neuronitis

• The term 'vestibular neuritis' is sometimes used interchangeably but should be confined to cases where only the vestibular nerve is involved. In practice, acute labrynthitis and vestibular neuritis can be distinguished by the presence and absence of hearing dysfunction.
• Therefore, acute labrynthitis can present with hearing loss and tinnitus, whereas vestibular neuritis does not.

300

These are the features, diagnostic test and management for benign paroxysmal positional vertigo (BPPV)

• The presence of debris in the semicircular canals of the ears causes vertigo upon head movement.
• These sudden attacks of rotational vertigo last for 30s to 1 minute
• Episodes will usually abate and disappear within a few weeks or months, but they often recur.
• The Hallpike manoeuvre is diagnostic, where certain movements of the head causes fatiguable nystagmus.
• Epley manoeuvres treat BPPV by clearing the debris.

400

These are the features and management for Meniere's disease

• Endolymphatic system pressure increases causes recurrent episodes of vertigo, sensorineural hearing loss, tinnitus, and a feeling of aural fullness.
• Treatment involves antihistamines and bed rest.

500

Features of a vestibular schwannoma (acoustic neuroma) can be predicted by the affected cranial nerves, which cranial nerves are these and what are these features?

• cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
• cranial nerve V: absent corneal reflex
• cranial nerve VII: facial palsy

Mixed

100

These are the differences between Rinne's and Weber's test

Rinne's test

• tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus
• 'positive test': air conduction (AC) is normally better than bone conduction (BC)
• 'negative test': if BC > AC then conductive deafness

Weber's test

• tuning fork is placed in the middle of the forehead equidistant from the patient's ears
• the patient is then asked which side is loudest
• in unilateral sensorineural deafness, sound is localised to the unaffected side
• in unilateral conductive deafness, sound is localised to the affected side

200

Difference between conductive and sensorineural hearing loss

Sensorineural hearing loss is caused by malfunction or disease within the cochlea or auditory nerve.

Conductive hearing loss is caused by the obstruction of sound waves at any point in the outer ear and the foot plate of the stapes in the middle ear.

300

Three causes of conductive hearing loss

Any of three of:

•Wax impaction

•Otitis media with effusion (glue ear)

•Eustachian tube dysfunction

•Ear infections

•Perforations of the tympanic membrane

•Chronic suppurative otitis media

400

Three causes of sensorineural hearing loss

Any three from: 

• Presbycusis (most common)
• Noise-induced hearing loss
• Congenital infections (e.g. rubella, CMV)
• Neonatal complications (e.g. kernicterus or meningitis)
• Drug induced deafness (aminoglycosides).
• Vascular pathology (stroke, transient ischaemic attacks)

500

This is how one describes tinnitus and these are three causes of tinnitus

A sensation of noise in the ear or head usually subjective in association with deafness

Any three of:

Presbycusis

Meniere's disease

Noise-induced hearing loss

Ototoxicity