BMS 200: HEENT Overview Quiz

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Questions and Answers

What is the most common bacterial cause of otitis externa?

Bacillus cereus

Pseudomonas aeruginosa (correct)

Haemophilus influenzae

Streptococcus pneumoniae

Which of the following is NOT a risk factor for developing otitis externa?

Excessive cerumen (correct)

Exposure to water

Increased pH

Humidity

Severe infections of otitis externa can lead to which of the following complications?

Acute otitis media

Mastoiditis

Eustachian tube dysfunction

Cellulitis (correct)

Which variant of otitis externa is characterized by chronic drainage from a middle ear infection?

Chronic otitis externa Signup and view all the answers

What is the primary organism responsible for otomycosis?

Aspergillus species Signup and view all the answers

Malignant otitis externa is particularly concerning for which of the following outcomes?

Intracranial infection Signup and view all the answers

What typically leads to the recurrent episodes of acute otitis media in children?

Abnormal eustachian tube anatomy and blockage Signup and view all the answers

What physical change occurs in the middle ear due to obstruction of the auditory tube in AOM?

Fluid accumulation and negative pressure Signup and view all the answers

In which patient population is otomycosis most likely to occur?

Diabetic patients and the elderly Signup and view all the answers

Which bacteria are commonly implicated in acute otitis media?

Haemophilus influenzae and Streptococcus pneumoniae Signup and view all the answers

What is a hallmark clinical feature of acute otitis media (AOM)?

Triad of otalgia, fever, and conductive hearing loss Signup and view all the answers

Which factor is most associated with the development of otitis media with effusion (OME)?

Untreated acute otitis media Signup and view all the answers

Which type of otitis media is characterized as 'dry' with no active infection?

Benign chronic otitis media Signup and view all the answers

What is a common cause of tympanic membrane perforation?

Scuba diving Signup and view all the answers

Which of the following describes a cholesteatoma?

Cystic lesion filled with debris and lined by keratinizing epithelium Signup and view all the answers

What is a typical clinical feature associated with chronic otitis media?

Sensation of fullness in the affected ear Signup and view all the answers

Which common complication of tympanic membrane perforation needs urgent referral?

Postero-superior perforation affecting ossicles Signup and view all the answers

What characterizes acute otitis media (AOM) on otoscopy?

Bulging, red TM with limited mobility Signup and view all the answers

Which of the following is NOT a common clinical feature of otitis media with effusion (OME)?

Severe pain Signup and view all the answers

What is a typical characteristic of Benign Paroxysmal Positional Vertigo (BPPV)?

Symptoms are initiated by changing head positions. Signup and view all the answers

Which diagnostic method is used to confirm Benign Paroxysmal Positional Vertigo (BPPV)?

Dix-Hallpike Positional Testing. Signup and view all the answers

What is a significant risk associated with otitis media, especially in children?

Language development delay Signup and view all the answers

What triad of symptoms is critical for the diagnosis of Meniere’s disease?

Rotational vertigo, hearing loss, and tinnitus. Signup and view all the answers

Which factor is NOT known to trigger Meniere’s disease episodes?

Vestibular rehabilitation exercises. Signup and view all the answers

Which statement best describes Vestibular Neuronitis?

It is viral and often follows an upper respiratory tract infection. Signup and view all the answers

What defines labyrinthitis in the context of inner ear health?

It can be both viral and bacterial in origin. Signup and view all the answers

How is the acute phase of Vestibular Neuronitis characterized?

Severe vertigo along with nausea and vomiting lasting several days. Signup and view all the answers

What is the predominant symptom experienced during an episode of Meniere’s disease?

Rotational vertigo lasting from minutes to hours. Signup and view all the answers

What is the primary characteristic of conductive hearing loss?

Impaired sound transmission in the external or middle ear Signup and view all the answers

Which condition is considered a type of sensorineural hearing loss?

Acoustic neuroma Signup and view all the answers

What is a common cause of presbycusis?

Combination of neuronal and hair cell loss Signup and view all the answers

What is the normal response for a tuning fork test using the Rinne method?

Hears air conduction after bone conduction is over Signup and view all the answers

Which statement accurately describes ototoxicity?

Many substances can damage the outer hair cells or stria vascularis Signup and view all the answers

What distinguishes the audiometry testing method from tuning fork tests?

It better characterizes hearing loss at specific tones Signup and view all the answers

What phenomenon occurs in conductive hearing loss during the Weber test?

Sound is louder in the affected ear Signup and view all the answers

Which frequency range does the human ear primarily excel at detecting?

1000 – 4000 Hz Signup and view all the answers

Which pathological condition is characterized by a collection of skin cells and other debris in the middle ear?

Cholesteatoma Signup and view all the answers

What is the main effect of otosclerosis on hearing?

Impedes sound transmission leading to conductive hearing loss Signup and view all the answers

What is the primary complication associated with cholesteatoma?

Conductive hearing loss Signup and view all the answers

Which cells primarily undergo implantation leading to primary acquired cholesteatoma?

Keratinized epithelial cells Signup and view all the answers

What is one potential severe consequence of cholesteatomas if left untreated?

Meningitis Signup and view all the answers

Where do cholesteatomas most commonly develop in the tympanic membrane?

Pars flaccida Signup and view all the answers

Which of the following contributes to the growth of a cholesteatoma?

Osteoclast activation Signup and view all the answers

What is the hallmark clinical feature of cholesteatoma?

Painless otorrhea Signup and view all the answers

What structural change occurs to the tympanic membrane in primary acquired cholesteatoma?

Formation of a cystic structure Signup and view all the answers

Which of the following is NOT typically associated with cholesteatoma?

Chronic otitis externa Signup and view all the answers

What is often implicated in the bacterial infection associated with cholesteatomas?

Pseudomonas aeruginosa Signup and view all the answers

What is a key characteristic of primary acquired cholesteatoma regarding age onset?

Rare in young children Signup and view all the answers

Study Notes

HEENT 2 - Overview

Topics covered include ear and vestibular apparatus pathologies, general mouth and sinus anatomy, and the neurology of olfactory and gustatory pathways.
This is a BMS 200 course.

Ear Pathologies

Conductive vs. sensorineural hearing loss: Distinguishing between types of hearing loss.
Otitis externa & otomycosis: Ear canal infections.
Otitis media: Inflammation of the middle ear.
- Acute otitis media (AOM): Rapid onset of symptoms.
- Otitis media with effusion (OME): Fluid buildup in the middle ear.
- Chronic otitis media: Long-term inflammation.
Cholesteatoma: A non-cancerous cyst with keratin debris.
Tympanic membrane perforations: A hole in the eardrum.

Hearing Loss - Generalities

Incidence of hearing loss: About 15% of people between 20 and 69 years old experience some degree of high-frequency hearing loss, often due to noise.
Outer hair cell vulnerability: Outer hair cells are more susceptible to noise damage than inner hair cells.
Presbycusis: Age-related hearing loss caused by a combination of neuronal and hair cell loss.
Ototoxic substances: Antibiotics and other drugs can damage the inner ear.

Hearing Loss - Generalities (Conductive and Sensorineural)

Conductive hearing loss: Impaired sound transmission in the outer or middle ear. Impacted by trauma, infection, plugging of the ear canal, otosclerosis, or cholesteatoma. This affects all frequencies.
Sensorineural hearing loss: Loss of higher frequencies more than lower ones. This is often caused by presbycusis, ototoxic agents, or noise. Also involves endolymph problems, labyrinth or CN 8 infections/tumors.

Tuning Fork Investigation of Hearing

Weber test: Tuning fork placed on the head to assess bone conduction hearing. If sound is louder in one ear, it might suggest conduction hearing loss in that ear. Sound is heard equally in both ears if normal.
Rinne test: Tuning fork placed on mastoid then near ear to assess both air and bone conduction. Air conducted sound is heard after bone conduction stops if normal.

Audiometry

Frequency range: Human hearing range from 20 to 20,000 Hz, though best between 1000-4000 Hz for speech (500-2000Hz).
Audiometry assessment: Measures hearing at specific frequencies to characterize hearing loss better than tuning forks.
Different forms of audiometry: Includes speech audiometry.

Otitis Externa

Causative agent: Bacterial (90%) - mainly staphylococcal, Pseudomonas aeruginosa, or E. coli.
Risk factors: Humidity, cerumen loss (trauma/Q-tip use), heat, increased pH, ear canal obstruction, and exposure to water (especially colonized).
Clinical features: Otalgia (pain in ear), movement of pinna can elicit pain, otorrhea (ear discharge) - can be purulent, itching of external canal, edema/occlusion of ear canal, conductive hearing loss.
Treatment: Topical antibiotics.

Otitis Externa - Variations

Furunculosis: Staphylococcal infection in outer 1/3 ear canal. Often painful.
Chronic otitis externa: Repetitive trauma cause, more itchy, chronic drainage.
Malignant/necrotizing otitis externa: Progressive, serious, often damaging temporal bone/cranial nerves.
Otomycosis: Fungal infection (usually 80% Aspergillus, remaining common species Candida).

Otitis Media

Acute otitis media (AOM): Rapid onset of symptoms (fever, otalgia), typically lasting less than 6 months, recurrent is ≥ 3 episodes within 6 months with complete resolution in between episodes or ≥ 4 in 12 months.
Causes: Auditory tube dysfunction, blocked tube due to adenoid swelling/URTI. Bacteria often from upper airway/oral flora.
Symptoms: Rapid onset and severity of otalgia, fever, and sometimes conductive hearing loss. Possible otorrhoea (possible).
Clinical features: Bulging, redness in tympanic membrane, often opaque, loss of bony landmarks, limited mobility (especially with effusion behind membrane) on pneumatoscopy.
OME (Serous Otitis Media): Unresolved AOM, persistent effusion in affected ear. 3 months of persistent effusion.
Clinical features: Conductive hearing loss, fullness in ear (possible tinnitus or low-grade fever).
Otoscopic features: Translucent/gray TM, possibly fluid behind TM visible as air/fluid levels or bubbles. Loss of light reflex/reduced mobility.

Tympanic Membrane Perforations

Causes: Middle ear infections, trauma (barotrauma or physical injury).
Clinical features: Sudden onset of pain, hearing loss, might be bloody otorrhoea, dizziness, or tinnitus.
Healing: Often self-heals spontaneously.
Importance of location: Posterio-superior damage to TM more likely to damage ossicles, needing urgent referral.

Chronic Otitis Media

Causes: Recurrent or chronic ear infections, Eustachian tube dysfunction (approximately 70% of patients observed after middle ear surgery).
Types: Suppurative or serous, described by chronic drainage through perforated TM, Benign - no active infection "dry". Inflammatory effect, both middle ear and affected mastoid.
Clinical features: Otorrhoea. Possible conductive hearing loss, tinnitus and fullness in ear.

Cholesteatomas

Definition: Non-neoplastic cysts lined with keratinizing epithelium. Filled with debris.
Location: Mostly in the posterior-superior region (attic) of the middle ear.
Size: Typically 1-4 cm.
Types: Congenital (rare). Primary acquired, Secondary acquired.
Complications: Conductive hearing loss (most minor), bony erosion, temporal bone infections, meningitis, intracranial involvement, deep neck infections, possible rupture resulting in life-threatening problems.

Dizziness

Classification: Vertiginous (vertigo-environment moving) or Non-vertiginous (organic or functional).
Vertiginous/vertigo: Caused by issues with inner ear or brainstem-cerebellar disorders (peripheral/central).
Non-vertiginous: Usually organic disorders involving vision compromise or low blood pressure, or functional disorders related to mood.

Benign Paroxysmal Positional Vertigo (BPPV)

Description: Short-lasting episodes of vertigo triggered by head position changes (especially when getting out of bed, turning head), typically not involving spontaneous nystagmus.
Presentation: Quick onset, usually <1 minute, of rotatory nystagmus (movement of eyeball), often accompanied by nausea or vomiting.
Cause: Free-floating otoliths in semicircular canals causing sensory disruption.
Diagnosis: Dix-Hallpike test, showing nystagmus when turning head in specific positions.

Meniere's Disease

Symptoms: Episodic attacks of tinnitus, hearing loss, and vertigo lasting minutes to hours.
Mechanism: Endolymphatic over-accumulation in the membranous labyrinth may result in distorting inner ear.
Triggers: High salt intake, caffeine, stress, nicotine, alcohol
Diagnostics: Two spontaneous episodes of rotational vertigo lasting > 20 minutes. Associated to sensorineural hearing loss.

Vestibular Neuronitis

Description: Sudden onset of disabling vertigo, often accompanied by nausea/vomiting, and imbalance. Hearing loss is usually absent.
Presentation: Acute phase: severe vertigo, nausea, vomiting, and imbalance lasting 1-5 days, nystagmus. Convalescent phase: imbalance, motion sickness lasting days to weeks, gradual vestibular adaptation for weeks-months.

Labyrinthitis

Description: Acute infection of the inner ear resulting in vertigo and hearing loss. Infection can be viral (serous) or purulent/bacterial (often a complication of acute or chronic otitis media).
Presentation: Sudden onset of vertigo, nausea/vomiting, tinnitus, hearing loss (unilateral). May be associated with fever/pain(uncommon), bacterial may involve meningitis.
Causes: Bacterial (S. pneumoniae, H. influenzae, M. catarrhalis, etc.), viral (rubella, CMV, measles, mumps, varicella zoster), and possible autoimmune cause; meningitis could be complication.

Acoustic Neuroma

Description: Intracranial tumor that develops from Schwann cells in vestibular and/or cochlear nerve. Often observed in the cerebellopontine angle with ~ 80% of tumors in the area being related to acoustic.
Presentation: Imparting hearing, sometimes facial nerve symptoms via tumor expansion. May have elevated intracranial pressure if tumor progresses enough.
Diagnosis: MRI imaging of the relevant area of the brain.
Treatment: Surgical removal/radiation.

Studying That Suits You

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Description

Test your knowledge on the anatomy and pathologies of the ear, mouth, and sinus as covered in the BMS 200 course. This quiz focuses on various types of hearing loss, infections, and the neurological pathways related to taste and smell. Dive into the details of otitis and other key topics.