Flashcards in Disorders of Ear Deck (43)
Eustachian Tube Dysfunction
-what may cause acute ETD?
-chronic ETD may cause?
-what is patulous ET?
General: blockage of the ET, it does not open or close properly in response to pressure changes within the middle ear or outside the ear.
Acute causes: pressure changes such as plane travel, upper airway inflammation such as URI or sinusitis.
Chronic may cause: serous effusions, otitis media, adhesive otitis media, cholesteatoma
Patulous ET is failure of ET to close, ET is floppy. Manifested as autophony (own breathing and voice sounds excessively loud.
ventilation/regulation of middle ear pressure
protection from nasopharyngeal secretions
drainage of middle ear fluid
*ET closed at rest and opens with yawning, swallowing, and sneezing.
pressure differences can cause what type of hearing loss by decreased motion of the tympanic membrane and ossicles of the ear.
Explain what happens when negative pressure develops in the middle ear?
serous exudate is drawn from the middle ear mucosa or refluxed into the middle ear if the ET opens momentarily if negative pressure develops in the middle ear.
infection of static fluid causes edema and release of inflamm mediators which exacerbates cycle of inflamm and obstruction.
-MC in what age? why?
-can be associated with what disorders?
MC age is less than 5 b/c their ET tube is more horizontal.
Associated with URI, adenoid hypertrophy, allergic rhinitis, GERD
ETD Risk factors
-2nd hand smoke
-prematurity and low birth weight
-prone sleeping position
-prolonged bottle use
More commonly associated conditions with ETD
-middle ear effusion
-initiate tx based upon individuals sx and cause.
first line: decongestants for less than 3 days. (avoid in pts with HTN or cardiac risk factors)
-Rhinocort (Budesonide), Beclomethasone (Beconasee), Fluticasone (Flonase)
2nd generation H1 antihistamines:
-loratadine (claritin), cetirizine (zyrtec), allegra (fexofenadine)
Antihistamine nasal spray:
Abx (not routinely used unless ETD is associated with acute OM); amoxicillin is 1st line, tx for 10days.
*if TM perforation or ventilation tube present consider topical abx drops with topical steroid (Neomycin-polymyxin-hydrocortisone suspension, ciprofloxacin-hydrocorticosone suspension/Cipro HC)
Pain control=anti inflammatory; acetaminophin, NSAIDS
-what are the 3 types?
-acute otitis media (AOM)
-Otitis Media w/ Effusion (OME)
How many middle ear infections are needed to be dx with recurrent AOM?
-3 or more in 6months or 4 or more in 1 year.
Def: infection of the middle ear with acute onset, presence of middle ear effusion, and signs of middle ear inflammation
-bottle feeds while supine
-smoking in house
-family Hx of middle ear dz
-signs and sx
-otoscopic exam findings
Signs and sx:
-earache (discomfort, pressure)
-tugging on ears
-fever (most often afebrile, not required for dx)
-decreased visibility of landmarks
-decreased TM mobility
-bulging** red, opaque TM
-pus in middle ear
Bacterial causes of otitis media
-strep pneumo *
course: sx usually spontaneously resolve in 2/3 or children by 24hrs and 80% at 2-10days
-amoxicillin if strep pneumo.
-augmentin, cephalosporins, erythro/azithro
pain & fever:
**DONT use aspirin (reyes syndrome)
-failure to improve after 48-72hrs of abx
-if sx resolve re-examine in 14-21 days after initial presentation.
what children get abx and which abx specifically with otitis media?
-all children under 23mo get abx
-between 23mo and 7yo discuss abx use with parents.
Amoxicillin is DOC!
Otitis Media w/ Effusion
-single best diagnostic method to establish this?
aka: Serous Otitis Media, ear glue
defined as the presence of middle ear effusion in the absence of acute signs of infection.
-fullness in ear
-tugging at ear
-delayed speech and language development or unclear speech
-pain rarely occurs
PE: TM is dull and retracted (usually not bulging)
-NO mobility of TM
-straw or tan color of eardrum or translucent gray
-sterile fluid in middle ear
Otitis Media with effusion
-watchful waiting, most resolve on own in 3mo.
-test hearing after 3mo of watchful waiting
-re-examine every 3-6 mo until the effusion is resolved
-surgery: tympanostomy and tube
chronic and suppurative otitis
defined as a perforated tympanic membrane with persistent drainage from the middle ear
(untreated or inadequately treated OM that leads to TM perforation, and subsequent contamination and infection leading to otorrhea.)
-hx of multiple episodes of AOM
-living in crowded conditions
Sequelae: conductive hearing loss and intracranial complications.
-otorrhea, fetid (smelling extremely unpleasant), purulent
-fever, pain, and vertigo may indicate intracranial complications
-external canal may/may not be edematous
-usually not tender
-middle ear mucosa visualized thru the perforated TM
Chronic suppurative otitis
Labs: culture the drainage for sensitivity
Imagining: CT scan, MRI, usually not done unless suspecting neoplasm, cranial complications
-remove the exudate from canal w/o pressure.
-abx otics, if these fail you give systemic ciprofloxacin PO
-what is this?
What: skin growth that occur in the middle ear behind the eardrum, increases in size and destroys surrounding delicate bones of middle ear.
-repeated infection, poor ET function
-fullness or pressure in ear
-achy ear especially at night
-facial weakness on affected side d/t CN VII dysfunction
dx: otoscopy, audiometry, XRAY and CT of mastoid may be necessary, refer to ENT.
-signs and sx
Defined as inflammation of the external auditory canal or auricle
Cause: infectious, allergic, and dermal dz
-steph, pseudomonas , proteus
Sx and signs
-pain at tragus or when auricle is pulled
-edematous and erythematous ear canal
-yellow, brown, white or grey debris
-no middle ear fluid
-TM should be mobile,
-cleaning of ear canal; irrigation w/o pressure at body temperature
-treat inflammation and infection w/ Cipro HC, cortisporin, torbadex
Malignant External Otitis/Necrotizing Otitis Externa
-PE exam findings
Defined as an invasive infection of the external auditory canal and skull base
*MC seen in elderly w/ DM and immunocompromised pts.
-SEVERE tolagia and otorrhea, much worse than external otitis
-granulation in the inferior portion of the external auditory canal.
-osteomyelitis of the basee of the skull
- elevated ESR
- positive culture
-Ciprofloxin 750mg PO BID for 6-8 weeks
-no role for topical abx
-clear, pus filled, or bloody drainage from ear
-sudden decrease in ear pain followed by drainage
- hearing loss
-middle ear infection
-acoustic trauma (direct injury, ear struck with an open hand)
-foreign objects in ear
-loud sudden noise (explosion or firearm)
-most heal on own
-usually no abx or topicals but can consider Cortisporin Otic of Cipro HC
-keep ear dry
-ear drum patch
-most frequent cause
Sx: pressure in the ear
-pain d/t stretching of the TM
Most frequent cause is flying though it could be caused by driving as well.
-myringotomy (incision into TM to relieve pressure)
-pre flight decongestants
-chewing gum, yawning, swallowing
Foreign Body in the Ear
irrigation is risky, may cause TM perforation
remove FB with loop or hook....if necessary refer to ENT.
-irrigation with water at body temperature. (so we dont induce vertigo)
-scrapings along the roof of the ear canal.
-what is this?
What: complication of otitis media, develops when middle ear inflammation spreads to the mastoid air cells resulting in infection and destruction of the mastoid bone.
Sx: post auricular pain and erythema, spiking fever, tender mass
dx & tx
-ENT consult, CT scan and MRI if intracranial involvement suspected
Patient admission for IV Abx for 21 days,
-piperacillin and tazobactam (Zosyn)