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Clinical med > HEENT ears > Flashcards

HEENT ears Flashcards

1
Q

weber test, unilateral conductive HL…. and SNHL goes to which ear

A

affected ear … unaffected ear

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2
Q

Tympanograms measures

type a
type b
type C

A

ear drum pressure and used for otitis media

a - normal
b - flat = when ear has fluid, hole, wax
c- ET dyfunction = pressure not equalized

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3
Q

most common cause of SNHL is

A

presbycusis (age related)

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4
Q

destruction of the cochlear hair cells and CN8 pathway will lead to

A

SNHL

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5
Q

otoxic medications like …..5…. can lead to SNHL

A

amingolycosides, cisplatin, furosemide, vancomcin, aspirin

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6
Q

autoimmune diseases like MS, SLE,

meniere’s disease

acoustic neuroma (vestibular schwannoma)

A

SNHL

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7
Q

why would you get MRI with and without contrast for SNHL

A

to see if its MS, acoustic neuroma

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8
Q

sudden sensorineural HL

occurs when:
associated symptoms

A

within hours or days, and its unilateral

tinnitus, dizziness

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9
Q

what causes sudden SNHL

A

idiopathic, vascular, autoimmune, viral infections

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10
Q

even though sudden SNHL can improve by itself, you still give high oral dose of…

A

oral steroid taper, or intratympanic steroid injection

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11
Q

no improvement after medication for Sudden SNHL, you get the following tests done

A

MRI of the brain with IAC with contrast to R/O acoustic neuroma

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12
Q

tinnitus, which is ringing in the ears, is very common if it is…… and concerning if it is…

A

subjective, bilateral, constant or intermed, non pulsatile

objective, pulsatile, unilateral, constant

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13
Q

medications that can cause tinnitus is

A

NSAIDs

loop dieutics

chemotherap.

amingolycoside antibiotics

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14
Q

for tinnitus, you will start with an audiogram, and then order the follow lab work up

A

Sed rate, CBC, lyme, thyroid function, rheumatoid factor, FTA-ABS, ANA

MRI with contrast and MRA if unilateral, vertigo, and pulsatile

CT - cholesteatoma

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15
Q

impaired transmission of sound along the EAC, ossicles, and oval window can cause

A

CHL

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16
Q

common causes of CHL is

A

cerumen impaction **
E.T dysfunction
middle ear infection
otosclerosis
tm perforation
cholesteatoma
ossicular disruption/ trauma

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17
Q

to imagine for CHL, get

A

CT scan the temporal bone WITHOUT to look behind the TM

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18
Q

abnormal bone growth around stapes, which causes CHL, is called … and you have to refer to ENT

A

otosclerosis . tympanogram will look normal

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19
Q

auricular hematoma is trauma to the … ear, which results in ….

A

outer eat

swelling, tenderness

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20
Q

if you do not treat auricular hematoma by making an incisions, draining, and compressing with dressing to prevent reaccumlation, the ear will become

A

cauliflower ear

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21
Q

pt has a history of ear fullness, hearing loss, and discomfort. exam reveals CHL. the pt has

A

cerumen impaction

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22
Q

cerumen ipaction treatment consist of

A

olive oil to soften wax

ear curette, warm water and peroxide

NEVER irrigate if TM is perforated

23
Q

t/f small batteries causes necrosis in the ear

A

true

24
Q

FB in the ear can lead to the following complications

A

infection

granulation tissue

laceration of ear canal

rupture of TM

25
Q

otitis externa is known as the …

cause

history

PE

A

swimmers ear

cause: fungal, moisture, trauma, dermatitis

history: ear pain, otorrhea, hearing changes

tenderness with auricle movement, TM moves normal, erythema and edema, otorrhea

26
Q

which organisms cause OE

A

Pseudomonas **
Staph Aureus
Fungal- candida, aspergillus niger (otomycosis)

27
Q

treatment for OE is

A

Topical Antibiotic/
+/-Corticosteroid
Acetic Acid Otic
Clotrimazole
Oral Antibiotics?
Debridement
Ear Wick

28
Q

can you give antibiotics to treat fungal OE (otomycosis)

A

no, bc its fungal. send to ent

29
Q

why should you not give cortisporin gtts to a patient

A

bc it contains neomycin, which is ototoxic and can cause itching if allergic

30
Q

is acetic acid bad for the ear?

A

no, but avoid if TM if perforated

31
Q

what med is safe for the middle ear?

A

FQ type drops

floxin (ofloxacin)

ciprofloxacin

Ciprodex

32
Q

how do you treat OE

A

NO ORAL Abx unless you see celluitis of the face, neck, auricle. NO ORAL alone

ORAL and topical Otics to increase efficacy

Intact TM: FQ -/+ corticosteroid

unknwn TM status: FQ + topical steroid

consider ear wick if sig edema

No water in ear. use cotton ball with vasline

33
Q

OE Tx

A

abx 7-10d

dry ear/ no manipulation

recheck ears 1-2 weeks

no improvement: culture and sens
* consider psuedomonas or mrsa

34
Q

OE fungal Tx

A

clean ear canal

several appts

vosol otic drops - acetic acid in propolyene glycol
vosol HC otic drops if swelling +fungal

Lotrimin solution (clotrimazole)

35
Q

what can you do to prevent swimmers ear or fungus?

A

50% white vinegar and 50% rubbing alcohol

36
Q

if you see eczematous OE, you can use

A

OTC 1% hydrocortisone to outer ear canal with Q-tip when ear itches

37
Q

what is a complication of OE?

A

Malignant OE / AKA necrotizing OE

38
Q

Malignant OE / AKA necrotizing OE

is..
seen in which group of people…
caused by …
S/S….
diagnosis…
treatment…

A

osteomyelitis of temporal bone
pseudomonas

IC ppl, diabetic, elderly

foul discharge , deep ear pain, cranial nerve palsies

CT/ MRI

IV cipro, debridement

39
Q

Viral OE / Herpes zoster oticus

A

severe pain
+/- SNHL
herptic vesciles in EAC

Treatment: acyclovir +/- steriods

40
Q

what syndrome can you get with viral OE and CNVII, and what are the Symptoms of it

A

ramsey hunt syndrome

pain, rash, facial nerve palsy, SNHL

41
Q

complications for Ramsey hunt syndrome is

A

permanent HL
permanent facial never weakness
eye damage
post herpetic neuralgia

42
Q

TM perforation can be caused by

A

trauma, barotrauma, acute infection, cholesteatoma

43
Q

tympanosclerosis will look like and be from..

A

a white warm

be due long standing ear infection = scarring of ear drum

44
Q

blood in the ear drum is called

A

hemotympanum

45
Q

barotrauma

is:
happens when:
prevent/treat:
could result in

A

inability to = barometric stress on middle ear
secondary to diving/flying

swallow, yarn, systemic, or topical decongestants

hemotympanum, TM perforation, middle ear infection

46
Q

fluid filled hemorrhagic blebs on the TM that causes sever pain is called

A

bullous myringitis

treatment = I & D

caused by mycoplasma pneumoniae

47
Q

E.T dysfunction, inflammation of E.T = negative pressure in ear

cause

history

PE

treatment

A

cause: viral, allergies, sinusitis

history: decreased hearing, discomfort, fullness

PE: retracted TM

treatment: decongestants and valsalva

48
Q

E.t dysfunction treatment

A

correcting rhinities: smoking, pregnancy, allergies, sinnuties, decongestant spray abuse, reflux

meds: oral/nasal steriod/ antihistamine … short term decongestants

valsalva and otovent

PE tubes not recom.

49
Q

serous otitis media is a middle ear effusion that results from E.T dysfunction

cause

history

pe

A

cause: URI

history: hearing loss , ear pain, pressure

pe: translucent effusion, immobile tm, flat tympanogram, CHL, weber to the affected ear

50
Q

treatment for serous OM / OME

A

NO antihistamine

oral/intranasal steroid

expectorants, decongestants

chronic: myringotomy with and without PE tubes

51
Q

AOM is a bacterial infection of middle ear due to viral URI

cause

history

pe

treatment

A

cause: viral URI
* m. cat, H. flu, strep pneumonia, group A strep, staph aureus, pseudomonas

history : acute, ear pain, hearing loss

pe: TM erythema/bulging, immobile tm, flat tympan., weber to affected ear bc CHL

treatment: abs and drainage.

52
Q

treatment for AOM

A

no treatment unless mild –> analgesics

antibotic -oral only if rupture of TM
INITAL - amoxicllin

doesnt work –> high dose oral amoxicillin/clavulanate (augmentin).
oral cefuroxime
IM ceftrixone

PNC allergy: bactrim, azithromycin, clindamycin

53
Q

Chronic OM

definition
history
cause

treatment

A

happens when fail to response to meds/ untreated

speech/blanace delay
hearing problems

staph aureus , pseudomonas
(allergies, smoking, daycare)

myringtomy with pe tubes
adenoidectomy

54
Q

reasons to place a PE tube (for ventilation to = pressure)

A

recurrent AOM

hearing loss and speech delay

failure for OME to resolve

Clinical med (6 decks)

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