Case 16 Part 1 Otology

Jim, 59, has presented with a history of facial nerve palsy. He is now complaining of some hearing problems where the noise seems to be amplified.

Which structure of his ear is most likely to be affected?

• Tensor Tympani

• Malleus

• Stapedius

• Stapes

• Incus

An 18-month-old boy is brought to the clinic because he has been pulling on his ears. Two weeks ago, the patient was taken to an urgent care center for fever and irritability and was found to have acute otitis media of the right ear. He completed the prescribed course of amoxicillin, with resolution of symptoms.

However, for the past few days, the patient has been tugging at both of his ears, and his parents are concerned that he may have another ear infection. Temperature is 36.8 C (98.2 F). On otoscopic examination, air-fluid levels are visible posterior to both tympanic membranes, which appear translucent and gray. Pneumatic insufflation demonstrates reduced mobility of tympanic membranes bilaterally. Both external ear canals are clear. The remainder of the examination is unremarkable.

What is the first line treatment?

• Additional antibiotic course

• Glucocorticoid therapy

• Intranasal decongestant

• Conservative - observe & follow-up

• Schedule for grommet insertion

Q3 - Spot Diagnosis

• Impacted wax

• Acute otitis media

• Otitis externa

• Cholesteatoma

• Temporal bone SCC

A 60-year-old lady is brought into the clinic for dizziness.

In the Head-Impulse Test (HIT), the patient has the following result. (see video below)

Which side is the defect? Is that a central or peripheral nervous system problem? And which side?

• CNS; RIGHT

• CNS; LEFT

• Vestibular system; RIGHT

• Vestibular system; LEFT

• The presenter is not making sense here!

A 56-year-old man has a two-year history of deafness affecting his right ear. He has had intermittent episodes of vertigo, tinnitus and vomiting each lasting  a few hours. He also said he experienced fullness sensation in his right ear. The whispered voice test is diminished in his right ear. You perform tuning fork tests.

Which is the SINGLE MOST likely result of the tuning fork tests? Select ONE option only.

• Air > Bone; LEFT

• Air > Bone; RIGHT

• Bone > Air; LEFT

• Bone > Air; RIGHT

• Air same as bone; EQUAL in both ears