13.03.19 ENT + Audiology notes

Tonsillitis

    • Long term effects:

      • Somnolence, FTT, Bed wetting

      • Kid with doctor dad

    • Can't operate if <15 kg

    • Things to check if you can't operate:

      • FBC

      • Ig screen for missing bands

      • Functional antibody tests (for failure of vaccination):

        • Tetanus

        • Pneumococcus

        • Haemophilus

Patterns of hearing loss

    • Low frequency

      • Otitis media

      • Wax

      • Developmental

      • Trauma

      • Collapsed canal

      • Perforations

      • Infection

      • Exostosis (benign bony outgrowth)

      • Otosclerosis

    • Carhart's notch (dip around 2 kHz)

      • Otosclerosis (often see a conductive loss elsewhere)

    • High frequency

      • Presbycusis

      • Ototoxicity

    • 4 kHz dip

      • Noise exposure (often get a compensatory tinnitus at this frequency)

    • Sensoryneural everywhere (try steroids)

      • Virus

      • Meningitis

      • Ototoxins

      • Trauma

Tinnitus

    • Associations

      • Stress

      • Anxiety

    • Mechanism

      • Unsure

      • May affect many different bits of the auditory pathway

      • Compensation for sensorineural loss?

    • Management

      • Treat the underlying cause

        • Give a hearing aid

      • Retraining therapy

        • Sound therapy

        • Low-noise generators

      • Medication (for severe cases)

        • GABA agonists (benzodiazepines, baclofen)

        • Antidepressants (SSRIs, amitryptyline)

      • Surgery (cut CN VIII) not used any more

Hearing aids

    • BAHA (bone anchored hearing aid)

    • Middle ear vibrators

    • Brainstem implants

      • Poor frequency response - Just allows awareness of sound

      • e.g. For vestibular schwannoma excision

Localising balance problems

    • Direction of veer when walking (with eyes closed): TOWARDS the problem

    • Nystagmus: AWAY FROM the problem

    • Side you lie on the causes dizziness: TOWARDS the problem

Hallpike test

    • Performed with the patient sitting upright with the legs extended

    • Rotate head 45 degrees and lie down quickly to 20 degrees head extension

    • Observe eyes for 45 seconds (characteristic 5–10 second period of latency)

    • If rotational nystagmus occurs then the test is considered positive for benign positional vertigo

      • Fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground

      • The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise

ROSIER

    • Questions:

      • Has there been loss of consciousness or syncope?

        • Yes -1

      • Has there been seizure activity?

        • Yes -1

      • Is there a NEW ACUTE onset (or on awakening from sleep) of:

        • Asymmetric facial weakness

          • Yes +1

        • Asymmetric arm weakness

          • Yes +1

        • Asymmetric leg weakness

          • Yes +1

        • Speech disturbance

          • Yes +1

        • Visual field defect

          • Yes +1

    • Stroke is likely if total scores are > 0

    • Scores of </= 0 have a low possibility of stroke but not completely excluded

Unterberger test

    • The patient is asked to walk on the spot with their eyes closed

    • If the patient rotates to one side they may have a labyrinthine lesion on that side

    • Should not be used to diagnose lesions without the support of other tests

Notes

    • Sodium bicarbonate drops for blocked grommets

    • Parental smoking => OME

    • Hyperaccusis

      • ?Pre-tinnitus

      • ++ OAEs

      • ++ Spontaneous auditory activity

    • Facial nerve ALL goes through the ear, then divides in the parotid

    • Tympanosclerosis

    • Atherosclerosis => Loss of balance (vestibular system requires good blood supply)

    • The direction of nystagmus is where the jump is to (i.e. the second, faster movement)

    • Vestibular rehab is the management for pretty much all balance problems