Ch. 14 Aural Fullness, Tinnitus, Hearing Loss Flashcards
Differential dx for hearing loss in a child
Additional diagnoses needed to be considered in an adult with hearing loss
What is the implication of the presence or absence of otalgia (ear pain)?
Otalgia, along w/ other acute signs or symptoms of infection (e.g., bulging and erythematous TM, fever, leukocytosis), is more consistent with AOM and less so with OME.
Pain w/ manipulation of the outer ear suggests external canal inflammation (otitis externa).
What is the importance of otorrhea (ear discharge)?
Otorrhea is concerning for middle ear disease + TM performation
On H&P, distinguish between External Otitis and Otitis Media
External Otitis (“swimmers ear”) typically occurs in pts following exposure to warm water but may also appear after recent ear instrumentation
- Otalgia upon manipulation of external ear
- Pruritis
- Hearing loss
- TM = intact and freely mobile with no evidence of air-fluid levels (i.e. normal)
Otitis Media with Effusion (OME)
- What is it?
- What is the main symptom seen with OME?
Otitis Media with Effusion (OME)
- Middle ear effusion without signs of acute infection; commonly follows episode of AOM but may develop in isolation;
children with OME may present with parental concerns about hearing, language development, behavior, or school performance; immobile TM with air-fluid levels
- Conductive hearing loss 2/2 fluid within middle ear space
Also: sleep disturbance, ear fullness, tinnitus, balance problems
What is the most likely etiology for sudden deafness?
Most often due to viral infections –> sensorineural hearing loss
Most common viruses = herpes simplex / herpes zoster
What is the role of the Eustachian Tube (ET)?
- Maintain gas pressure homeostasis within middle ear by equalizing pressure across TM
- Helps prevent infection of the middle ear and reflux of contents from the nasopharynx
- Clears middle ear secretions
Which pathogens are most commonly found in OME?
The same bacterial organisms found in patients with AOM can be isolated in patients with OME. These include:
- Strep. pneumo*
- (non-typable) H. influenza*
- Moraxella catarrhalis*
- Pseudomonas (more common with otitis externa)*
- Strep. pyogenes*
- Other anaerobes…*
Work-Up:
What does a pneumatic otoscopy allow the clinician to do? How is it used?
Finding of a middle ear effusion = key in establishing the diagnosis of OME
Yet middle ear effusion is not always obvious on otoscopy
…… Pneumatic otoscopy allows for direct, dynamic assessment of TM mobility in response to pressure changes. Immobility of the TM is most often caused by an effusion.
Rinne & Weber tests
What are the indications for tympanostomy tube insertion?
Mgmt:
AOM & OME
What organism is most likely responsible for otomycosis in a pt with AML and/or DKA?
Aspergillus niger
Otomycosis presents very similarly to otitis externa. However, pts with otomycosis will complain of an intense fullness in the ear and pruritus, and exam will be significant for a gray exudate from the affected ear.
*Normal appearing TM*
Cholesteatoma
- What is it?
- What are the causes?
- What is the appearance?
- Tx?
Cholesteatoma
- What is it? Epidermal inclusion cyst of the middle ear or mastoid, containing desquamated keratin debris; may be acquired or congenital
- What are the causes? Negative middle ear pressure from eustachian tube dysfunction (primary acquired) or direct growth of epithelium through a TM perforation (2ndary acquired)
- What is the appearance? Grayish-white, shiny keratinous mass behind or involving the TM; often described as a “pearly” lesion
- Tx? Surgery (tympanoplasty/mastoidectomy) aimed at eradication of disease and reconstruction of the ossicular chain
