Disorders of the Ear Flashcards

1
Q

why are kids more susceptible to ear infections?

A

their eustachian tubes are more horizontal

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2
Q

what does cerumen do in the ear?

A
  • “washes”- keeps clear of bacteria and microbes
  • creates acidic environment (fungus don’t like this)
  • vinegar to clean fungus in ear
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3
Q

what is perichondritis? usually due to? Why is it hard to cure?

A

rare but serious

infection of ear cartilage; usually trauma and pseudomonas; doesn’t respond well to injury b/c bad blood supply

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4
Q

Dx perichondritis vs cellulitis

A

cellulitis will infect soft tissues as well (ear lobes)

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5
Q

what is otitis externa? Types?

A

generic term for inflamm disorders of EAR CANAL

  1. swimmer’s ear (H2O dries out canal, like irritation contact derm )
  2. often fungal infection
    3) . malignant- DM
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6
Q

txt for OE? fungal, bacterial, swimmers

A

lidocaine to numb then wick to get drops in
fungal: 2%HAc aka half strength vinegar
bacterial- abx w/ anti-inflamm (steroid) OR 2%HAc if pseudomonas
swimmers: alcohol

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7
Q

ceruminosis

A

excessive cerumen production

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8
Q

what is AOM? what are the three common bugs? usually precipitated by what?

A
  • bacterial infection of the middle ear
  • S. Pneumo, M. Cat, H. Flu
  • usually preceded by URI (congestion obstructs ET drainage)
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9
Q

what is required to diagnose AOM?

A

effusion

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10
Q

AOM vs OME in terms of effusion?

A

AOM: purulent effusion, S/S of inflammation
OME: serous effusion, S/S of inflammation

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11
Q

when looking at TM, Dx of AOM?

A

mild TM bulge AND ear pain or intense TM erythema

  • may respond to POSITIVE pressure on pneumatic otoscopy
  • should see altered position of cone of light
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12
Q

those at risk for AOM?

A
6m-18m
males 
daycare
pacifier user 
parents who smoke
bottle-feeder (instead of breast)
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13
Q

what must you document for AOM according to the AAP?

A

evidence of TM immobility (by tympanogram or pneumatic otoscopy)

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14
Q

a flat Tymp. test result means what?

A

immobile TM?

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15
Q

meds for AOM: ibuprofen vs tylenol?

A

ibuprofen: anti-flamm
tylenol: just for pain

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16
Q

when looking at the TM, Dx of OTE?

A

TM: neutral or retracted

-responds to NEGATIVE pressure on pneumatic otoscopy

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17
Q

2 AOM txt goals

A
  1. decrease pain and fever
  2. prevent developmental delays
    most heal spontaneously, if not give abx (75% do well regardless of txt)
18
Q

Hadley’s “SNAP”

A

“safety net abx prescription”
tell pt, if symptoms don’t improve w/in 48-72 hrs of the onset of symp, THEN fill Rx
=reduced pointless abx usage

19
Q

AOM guidelines for txt depend on what 3 pt factors?

when to treat with abx?

A

severe or nonsevere symptoms
unilateral or bilateral
age
*otorrhea, bilat and severe symp? TREAT w/ Abx

20
Q

txt abx 1st and 2nd lines for AOM?

A

1st: Amox
2nd: Augmentin

21
Q

pt should improve after how many days on abx for AOM?

if they dont?

A

3 days

if not- give broad spectrum ABX

22
Q

how long can effusion last for AOM?

A

12 wks

23
Q

what can help prevent ear infections?

A
NOT chemoprophalaxis (no longer reccomended) 
Vaccines do! against invasive pneumococcal disease (H.Flu) and influenza 
-tymp tubes
24
Q

H. Flu txt?

A

it is BetaLact. resistant. txt w/ augmentin

25
Q

better name for OME would be? why?

A

MEE (middle ear effusion)
there is NO infection, fluid is serous
effusion w/out acute symptoms

26
Q

what meds are of no value for OME?

A

Abx: b/c it is not an infection

Anti-histamines and decongestants: no longterm value

27
Q

OME concerns

A

hearing loss–>effect on speech, language and learning
-at-risk populations need to be evaluated sooner
(young-speech delay, development disorder)
-non at-risk: 3 months is ok to go w/out hearing

28
Q

primary diagnostic method to distinguish OME from AOM?

A

pneumatic otoscopy

-tympanometry is an option as well (more expensive)

29
Q

hearing test guidelines: level of decibels for normal or not normal

A

0-20dBs = normal hearing (this refers to the amount of volume raised in order to hear the sound)
21-39dB is abnormal (mild hearing loss)
>40dB is abnormal (moderate hearing loss)

30
Q

what is BPPV?dx? txt?

A
benign paroxysmal (comes and goes) positional vertigo 
Dx: positional change = nausea
 txt: antiemetics, otolith repositioning, habituation
31
Q

what is vertigo?

A

brain is getting mixed signals from inside the semicircular canals (rocks moving around and bending cilia- they get stuck and continuously stimulate cilia cells)

32
Q

what is the dix-hallpike maneuver?

A

to localize labryinthe dysfunction

-positive test w/ affected ear down = nystagmus (lateral eye twitch) towards affected ear

33
Q

what is the epley maneuver?

A

to fix vertigo - reposition otoliths

* you can also habituate vertigo by performing movements that produce symptoms over and over

34
Q

what is the pathophys cause of meniere’s disease?

A

inner ear disorder aka idiopathic endolymphatic hydrops (extra endolymph fluid in cochlea)= pressure=vertigo

35
Q

what is the triad of symptoms with meniere’s disease? what about w/ back attacks?

A
  1. hearing loss
  2. tinnnitus
  3. vertigo
    * fall-down with bad attacks, difficulty walking
36
Q

Ddx for meniere’s should include what disease that is commonly included in many Ddx?

A

syphilis

37
Q

txt for meniere’s ?

A

send to ENT
-meclizine for nausea
-scolpolamine patch behind ear
diuretics and low sodium diet (reduce fluid)
endolymph shunt (surgical- drain in cochlea)

38
Q

what is vestibular neuronitis?

A

suddent onset of vertigo related to neural afferents W/OUT inflamm.

  • possible HSV cause (in vestibular ganglia)
  • may have hearing loss
39
Q

what is labyrinthitis?

A

inflamm disorder of inner ear or labyrinth

  • URI preceding- but can be bacterial or viral
  • ALWAYS has hearing loss but does NOT recur (unlike Vest. N)
40
Q

BEST predictor of AOM?

A

TM with impaired mobility