Flashcards in CM: Ear Dz Deck (21):
What are worrisome ear findings?
unilateral middle ear effusion
unilateral sensorineural hearing loss
How can myofascial pain dysfxn be recognized?
sense of pressure or fullness in affected ear, occasionally subjective sense of hearing loss
occasionally feel light headed and off balance
What are syndromes that can present w ear pain but are easy to diagnose?
tonsillitis - look at tonsils
throat cancer - look for mass or ulcerative lesions
*unexplained otalgia should be assumed to be neoplastic lesion until proven otherwise
How can external otitis (swimmer's ear) be recognized?
dev of intense throbbing pain over several hrs-1 day
ear is very tender, any manipulation painful
often obvious mucopurulent exudate
hearing loss if canal sufficiently swollen
What is the pathophysiology of acute otitis externa?
normally outer ear is acidic - water can alkalanize it (>6.5) and allow bacteria (like pseudomonas (staph, strep)) to grow
can be caused by trauma from Q tips
What is the pathophysiology of acute otitis media/middle ear effusion?
eustachian tube dysfxn leads to obstruction, TM gets sucked into middle ear (causes hearing loss)
negative pressure in middle ear sucks fluid in = middle ear effusion
when bacteria infect = acute otitis media
How can acute otitis media be recognized?
severe pain but not tender over tragus
fever, bulging TM
TM can rupture - exudate will leak out and pain will abate
What consideration should all unilateral otologic symptoms be given?
considered to represent cerebellopontine angle tumor (most commonly acoustic neuroma) until proven otherwise
When should an otolaryngologist be consulted?
all unexplained unilateral hearing losses
unilateral middle ear effusion that does not clear in 4-6 weeks in an adult - may indicate serious condition like tumor in nasopharynx causing eustachian tube dysfxn
How can you tell the difference between neurosensory hearing loss and conduction hearing loss?
Weber test: louder sound on side w conductive hearing loss or opposite side of sensorineural
Rinne: louder on bone = conductive loss in that ear
How can you differentiate objective from subjective tinnitus?
objective can be heard and appreciated by examiner (w stethoscope) = vascular, sounds made by blood rushing through vessels
subjective - only pt hears, most common, most frequently hearing loss
Until proven otherwise, all pts with unilateral tinnitus should be assumed to have...
and internal auditory canal or cerebellopontine angle tumor
When is the etiology NOT from the ear with regards to vertigo?
if pt has syncope
What is peripheral vertigo?
arises from SCC, CN VIII, or brainstem vestibular nuclei
severe rotational movement w associated visceral autonomic symptoms
may be hearing loss, but not usually
symptoms abate over period of hrs-days
What is viral labyrinthitis?
cause of sporadic severe paroxysmal PERIPHERAL vertigo, unremitting N/V
subsides in 24-48 hrs
no associated hearing loss, tinnitus, aural fullness
What is Meniere's Dz?
tetrad of symptoms: severe paroxysms of overwhelming vertigo lasting 20 min-4hrs and low pitched roaring tinnitus, marked aural fullness/pressure, fluctuating neurosensory hearing loss
caused by inner ear fluid imbalance and rupture of membranes
What is central vertigo?
arises from supranuclear pathways or cerebellum, less severe than peripheral
accompanied by other signs of CNS dysfxn
no other otologic symptoms
What does physical exam of vertigo show?
nystagmus - named for direction of fast phase - in viral labyrinthine and meniere's
When should pts with vertigo be referred?
any pt with true vertigo, peripheral or central
otolaryngologist or neurologist for central
How can CSF otorrhea be diagnosed?
clear fluid, test for beta-2-transferrin = unique to CSF
commonly follows trauma or surgery
may have hearing loss, balance disturbance, facial paralysis