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Cheatography

Otology + Otoscopy findings

History

Pain Location, quality, course, aggrev­ati­ng/­rel­ieving factors
Discharge (frequ­ency, colour, consis­tency, odour)
Feeling of fullne­ss/­pre­ssure
Hearing loss (uni/b­ila­ter­al/­par­tia­l/c­omplete
Tinnitus
Vertigo
Loud noise exposure
Injury to the ear
Recent swimmi­ng/air travel
Infection
Past Ear surger­y/t­rea­tment
Past serious illness
Family history of hearing problems/ ear conditions
Cold water sports

Hearing Loss

Types
Age
Congenital
Infant - Young children
Serous Otitis Media
Infant - Young children
Postin­fective
Young children - Teenag­ers­/ad­ole­scents
Noise Induced
Teenag­ers­/ad­ole­scents - Over 60
Otoscl­erosis
20-60yo
Acoustic Neuroma
20-60+yo
Meniere's Disease
20-60 yo
Early Prebycusis
40-60 yo
Prebycusis
60+

Tinnitus Classf­ica­tions

Subj­ect­ive
Obje­ctive
Most common
Can be heard by patient and examiner - Rare
Sound can only be heard by patient - caused by abnormal activity in inner ear/CNS
Vascular Abnorm­ali­ties, muscle related
Prim­ary
**Seco­ndary
Idiopathic + sensor­ineural Hearing loss
Underlying cause - not sensor­ineural
Consta­nt/­int­erm­itt­ent­/un­ila­ter­al/­bil­ateral:
Buzzing, Whistling, Hissing, Ringing, Roaring, Clicking, Pulsing (vascu­lar), Whooshing, Humming

Causes of Subjective Tinnitus

Infections
Ear wax
Inner ear noise damage
Meniere's disease
Otoscl­erosis
Acoustic Neuroma
MS
Ototoxic drugs
Metabolic disorder
Psycho­logical disorders
Mechanical disorders
If unilateral + sensor­ineural hearing loss consid­er:
Meniere's disease + Acoustic Neuroma

If Bilateral consid­er:
Age related hearing loss
Noise induced hearing loss
Drug induced ototox­icity


Subj­ective tinnitus + conductive hearing loss consid­er:
Disorders of middle­/outer ear
Otoscl­ero­sis­(family hx)
 

Examin­ation

External Ear
Auscultate periau­ricular area, temporal bone, orbit, vascular structures of the neck
Otoscopy
TMD Exam
CN Exam (VII, VIII)
Check for anaemia, thyroid, hyperl­ipi­demia +diabetes
Assess for other causes of pain, tinnit­us/­hearing loss
Regional lymphnodes
If Tinnitus is pulsatile - head, neck exam, blood pressure + CV system (Murmurs, carotid + temporal artery bruits

Red Flags

EMER­GENCY REFERRAL
Sudden onset pulsatile tinnitus
Tinnitus with associated signif­icant neuro symptoms
Tinnitus Secondary to head trauma
Tinnitus associated with sudden hearing loss
All patients with tinnitus should be referred to their GP - non-em­erg­encies only
Referred to ENT - audiol­ogical assessment

URGENT REFERRAL - Same day to GP

Object­ive­/pu­lsatile tinnitus
Unilateral tinnitus
Tinnitus with unilat­era­l/a­sym­metric hearing loss
Tinnitus with persistent otalgi­a/o­tor­rhoea that does not resolve with treatment
Tinnitus with vestibular symptoms -dizzi­ness, vertigo

LESS URGENT

Tinnitus of unknown cause - not associated with hearing loss, ear pain, drainage or malodour, vestibular symptoms or facial weakness or hearing loss that cannot be distin­guished
Tinnitus that is causing distress - despite primary care management

Otoscopy

Before inserting Otoscope, observe the outside of the ear - hearing aid, shape, discharge, deform­ities, skin
Pull the pinna up and back for adults, up for children
Slowly insert no more than 0.5cm in

Ear disorders

Acute Otitis media
S&S
Otoscopy Findings
 
Fullness in the ear
Retracted, pink/red tympanic membrane
 
Fever
Pus and membrane can bulge
 
Vomiting
 
Headache
 
Hearing loss
 
Fluid coming from the ear
 
Diarrhoea
Serous Otitis media
 
Fullness, pressure, popping in the ear
Retracted Tympanic membrane - yellow­ish­/bl­ueish in colour
 
Hearing loss
Bubbles/ air/fluid level can be seen
 
Pain
Chronic suppur­ative otitis media
Painless otorrhea
Defects in tympanic membrane
 
Bacterial or fungal
Ear full of pus
Perf­orated Eardrum
Painful
 
Hearing loss
Hole in eardrum with redness
 
Caused by: Repeated infections + trauma
Exos­tosis
Surfer's ear - cold water
Nodular bony outgrowths covered with skin
 
Can occlude ear canal
Tymp­ano­scl­ero­sis
Hearing loss if affects ossicles
White plaques in tympanic membrane /middle ear cavity
 

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