Disorders of the ear

Question 1

Otitis Media Otoscope Exam

Answer 1

Decreased visibility of landmarks
TM mobility decreases
Bulging TM, opaque, red
Pus in middle ear (bacteria in the middle ear effusion)

Question 2

Otitis Media Bacterial culprits

Answer 2

Streptococcus pneumoniae (30-35%)
Haemophilus influenzae (20-25%)
Up to 50% produce beta-lactamases
Moraxella catarrhallis (10-15%)
90% of these produce beta-lactamases

Question 3

Otitis Media Antibiotic Treatment

Answer 3

Amoxicillin
Augmentin
Cephalosporins
Erthyromycin, Azithromycin

Question 4

Serous Otitis Media “Glue ear” Otoscope Exam

Answer 4

TM is dull and retracted (usually not bulging).
No mobility of TM
Straw or tan color of ear drum or translucent gray
Sterile fluid in middle ear

Question 5

Serous Otitis Media “Glue ear” Bacterial culprits

Answer 5

Pseudomonas aeruginosa (50-98%)
Staph Aureas (15-30%)
Klebsiella and Proteus

Question 6

Cholesteoma Definition

Answer 6

A skin growth that occurs in the middle ear behind the eardrum
Takes the form of a cyst or pouch
Sheds layers of old skin
Increases in size and destroys surrounding delicate bones of the middle ear.

Question 7

Otitis Externa Bacterial culprits

Answer 7

Staph aureus
Pseudomonas aeruginosa (swimmers ear)
Proteus

Question 8

Otitis Externa Treatment

Answer 8

Cleaning of ear canal

Irrigate with 1:1 dilution of 3% hydrogen peroxide AT BODY TEMPERATURE (GENTLY – No high pressure if you cannot see TM!)

Question 9

Necrotizing Otitis Externa Treatment

Answer 9

Ciprofloxin 750mg PO BID for 6-8 weeks

No role for topical abx

Question 10

Mastoiditits Patient admission for IV abx

Answer 10

Immediate antibiotic treatment (21 days)
Ceftriaxone (Rocephin)
Piperacillin and tazobactam sodium (Zosyn)  
Oxacillin (Bactocill) 
Gentamicin (Garamycin)

Question 11

Central Vertigo

Answer 11

Onset is gradual
Nystagmus usually vertical
Visual fixation does not stop nystagmus
Other signs of brainstem dysfunction.
instability
Double vision (diplopia)

Question 12

Peripheral Vertigo

Answer 12

Sudden onset
Nystagmus is usually horizontal
Visual fixation inhibits nystagmus
Blurred vision

Question 13

Sensory presbycusis

Answer 13

This refers to epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti.

Question 14

Neural presbycusis:

Answer 14

This refers to atrophy of nerve cells in the cochlea and central neural pathways.
Atrophy occurs throughout the cochlea, with the basilar region only slightly more predisposed than the remainder of the cochlea.