Ear Flashcards
(146 cards)
1
Q
What is conductive hearing loss?
A
anything that blocks sound from access to inner ear
occurs when sound is inadequately conducted through the external or middle ear to the sensorineural apparatus of the inner ear (through round window)
2
Q
Main causes of conductive hearing loss
A
- obstruction (cerumen impaction, foreign body)
- mass loading (middle ear effusions (OM), benign tumors of the middle ear, cholesteatoma)
- stiffness effect - bones don’t move (otosclerosis, Eustachian tube disorders)
- discontinuity (ossicular disruption)
3
Q
What is sensorineural hearing loss?
A
Occurs when sound is carried normally through the external and middle ear, but there is a defect in the inner ear – nerve impulses from the cochlea to the auditory cortex are impaired
4
Q
Main causes of sensorineural hearing loss
A
- Sensory
- deterioration of the cochlea
- ototoxicity
- noise exposure (acoustic trauma)
- mammalian hair do not regenerate - Neural
- lesions involving CNVIII, auditory nuclei, ascending, tracts, or auditory cortex
5
Q
What is presbycusis?
A
loss of hair cells from the organ of corti
most common of ARHL
hallmarks: bilateral, symmetric, high frequency sensorineural hearing loss
6
Q
hearing loss screening
A
Birth to 4 months
Loud noise should startle infant
4 months to 2 years
Developmental delays
7
Q
when to refer after a hearing loss test
A
- Any at risk child
- Any deficit or developmental delays
- Conditions that predispose child to hearing loss
8
Q
acoustic trauma
A
- Single exposure to an intense sound (damage to cochlear hair cells) will cause (SNHL)
- Hearing loss is permanent (b/c hair cells do not regenerate)
9
Q
how do you diagnose acoustic trauma?
A
Diagnosed with audiogram
10
Q
acoustic trauma treatment
A
Hearing aid may be beneficial or cochlear implants
PREVENTION
11
Q
how does acoustic trauma develop
A
- Years of exposure to chronic industrial or non-industrial noise will cause SNHL
- Starts at 85 db
- Nearly always bilateral and symmetric
12
Q
T/F: acoustic trauma produces profound hearing loss
A
FALSE - no hearing loss
13
Q
Maximum loss of acoustic trauma seen after _____ of exposure
A
10-15 years
14
Q
T/F: Continuous noise more damaging than intermittent noise
A
TRUE
15
Q
weber test in conductive hearing loss
A
Sound will lateralize and be louder in the affected ear – bone cond. louder bc air conduction is blocked
16
Q
rhinne test in conductive hearing loss
A
In the affected ear, sound will be louder on mastoid than beside ear (BC>AC)
17
Q
sensorineural hearing loss in weber test
A
Sound will lateralize and be louder in the unaffected ear – bone/nerve is damaged in bad ear so BC louder good ear
18
Q
sensorineural hearing loss in rhinne test
A
In the affected ear, sound will be louder beside the ear than on the mastoid (AC>BC) bc bone/nerve damaged
19
Q
functions of pinna
A
acts as a funnel, amplifies the sound and directs it to the ear canal
20
Q
function of tragus
A
Collects sound from behind and directs it into the ear canal
21
Q
accessory auricle
A
skin tag
benign skin growth, may necessitate excision
22
Q
microtia/anotia
A
abnormal development of auricle creating EAC stenosis; congenital, requires surgical/cosmetic correction
23
Q
preauricular pit
A
- cystic tract unclosed from embryologic development
- May develop infection and require drainage and antibiotic therapy
- Can excise if recurrent or abnormally enlarged
24
Q
types of external ear trauma
A
- Simple (skin +/- cartilage)
- Blunt/crush
- Avulsion (tear or separation)
25
treatment of external ear trauma
* Deep cleaning
* Debridement
* Surgical repair
* Pressure Dressing
* Antibiotics
26
hematoma treatment
* I&D
* Through & through suture
* Pressure Dressing
* Antibiotics
* Repeat aspiration
27
complications of hematoma treatment
* Fibrosis
* Cauliflower ear
28
what is cerumen
substance produced in the ear canal to protect from infection, trauma, water damage, etc
29
treatment of cerumen impaction
Detergent drops to soften
Colace to soften
Mechanical removal
Suction
Irrigation
30
what is the most common cause of conductive hearing loss
cerumen impaction
31
symptoms of cerumen impaction
hearing loss, otalgia, drainage, dizziness, tinnitus (ringing in the ear)
32
management of cerumen impact
* In-office debridement
* Debrox (H202 and warm water)
* Vosol-Hc: wet EAC
* Derm-otic: eczematous EACs
* Mineral oil or baby oil for mildly eczematous
33
foreign body
* BEST PERFORMED UNDER A MICROSCOPE WITH TWO HANDS
* Alligator forceps
* Small suction
* Curette
* Otoscope
* Suction
* Mineral Oil / Viscous Lidocaine to kill the bug
* Irrigation / Angiocath
* REPEAT EXAM
Risk – TM Perf
34
what is Acute Otitis Externa (AOE) also called
Swimmer’s Ear
35
what is Acute Otitis Externa (AOE)
Bacterial infection of external auditory canal
P. aeruginosa 38%, S. aureus 8%, Strep Pneumo 6%
36
signs and symptoms of otitis externa
* Pain, worse with auricle or tragus
movement
* Pruritus of canal
* EAC edema/swelling
* Otorrhea
* Involvement of periauricular soft tissue
* Erythema and edema of the canal
37
risk factors for otitis externa
* Swimming
* Trauma
* Diabetes
* Immunocompromised Conditions
38
management of otitis externa
* Serial removal of debris (may need referral)
* Antibiotic otic drops (i.e. Ciprodex-bacterial; Clotrimazole-fungal)
* Oral antibiotics helpful in severe cases or in the immunocompromised patient
* For those with allergic or eczematous otitis, may need regular debridement and preventive management with DermOtic or other emollient-based drops
39
otitis externa treatment
* topical!
* Fluoroquinolone gtts is safest (no ototoxicity)
Polymyxin B with Neomycin gtts
Most also have a corticosteroid component
* clean canal +/- wick placement
* if invasive infection → culture drainage, oral MRSA/pseudomonas ABO and topical
* Pain control → OTC
* prevention!
* no moisture for 4-6 weeks
* 2-3 drops of vinegar/alcohol after water exposure
* ear plugs for swimming
40
malignant otitis externa
Infection of the external auditory canal that progresses to osteomyelitis of the temporal bone
41
what is malignant otitis externa caused by
pseudomonas
42
common population malignant otitis externa affects
elderly with diabetes
HIV
43
does malignant otitis extern improve with topical ABO
NO!
44
treatment malignant otitis externa
fluoroquinolone ABO
45
location of malignancy
May arise within EAC or extend from pinna, post-auricular sulcus, or parotid
46
radiographic appearance of malignancy
Involvement or invasion of soft tissue with destruction of bony cortex
47
T/F: low mortality rate of malignant ear infection
FALSE - high because of early invasion of lymphatics, skull, brain
48
treatment for malignant ear
surgery and radiation
49
functions of eustachian tube
* Equalization of pressure across the TM
* Protect middle ear from reflux from nasopharynx
* Clearance of middle ear secretions
50
eustachian tube dysfunction
Failure of any of the functions of the ET caused by the functional valve not opening or closing properly.
51
what is ET common associated with
URI
52
causes of ETD
virus
attitude makes it worse
53
symptoms of ETD
Fullness
Muffled sounds
Popping sound
Pain
Tinnitus
Vertigo
54
treatment of ED
Swallow/yawn/chew-”pop”
Decongestants
Antihistamine
Surgery – Tubes? / Adenoids?
55
exam findings of ED
* Retracted TM if a Chronic Cause
* If an acute cause, such as associated with a virus, the TM might be erythematous and bulging.
56
barotrauma
difference in pressure between the external environment and the internal parts of the ear
57
symptoms of barotrauma
* “clogging” of the ear
* ear pain
* hearing loss
* Dizziness
* ringing of the ear (tinnitus)
* hemorrhage from the ear
* Vertigo
58
risk of barotrauma
TM rupture - damage to the middle and inner ear
59
treatment of barotrauma
prevention/surgery
60
otitis media types
1. Serous otitis media
2. Acute otitis media
3. Chronic otitis media
61
O\_\_\_\_\_ M\_\_\_\_ preceded by a ____ URI
otitis media; viral
62
otitis media
Inflammation of the middle ear and mucosal lined air-spaces of the temporal bone
This causes inflammation of Eustachian tube and decreased drainage of middle ear
63
predisposing medical conditions to otitis media
genetic
immune
obstruction
64
acute serous otitis media
* **_NON-Infectious_** fluid accumulation in middle ear space
* Usually from Eustachian tube obstruction from upper respiratory infection (URI) of nasopharynx
65
who is acute serous otitis media more common in
children
66
T/F: acute serous otitis media is painful
FALSE. painless hearing loss after URI
67
physical exam of acute serous otitis media
TM is dull and hypomobile
may see air bubbles
68
color of TM in acute serous otitis media
amber or blue NOT white or pale yellow hue
69
\_\_\_\_\_\_\_\_\_\_ is commonly misdiagnosed as acute serous otitis media
otitis media WITH **_effusion_**
70
treatment of acute serous otitis media
antibiotics if meets standard
Amoxicillin is gold standard
71
children and acute otitis media
For children younger than two years, ***_follow-up of AOM can typically occur_*** at the next scheduled wellness visit or three months after completing treatment to ensure resolution of middle ear fluid.
*_For children two years and older without an upcoming_* visit or children with recurrent AOM, reevaluation within three months of completing treatment should be considered to ensure resolution of middle ear effusion.
72
signs and symptoms of acute otitis media
* Otalgia
* aural pressure
* hearing loss
* fever
73
signs and symptoms of acute otitis media
* Otalgia
* aural pressure
* hearing loss
* fever
74
do you treat pain in acute otitis media
YES with ibuprofen or acetaminophen
75
what happens in refractory cases of acute otitis media
Tympanocentesis or myringotomy
76
treatment for adults acute otitis media
considering adding decongestant and/or steroid
77
how long does the fluid in ASOM last?
* Usually self-limiting
* Fluid can last 4-6 weeks.
* Bulb suction nose, saline spray to nose, steam
* Nasal decongestant (Afrin) and/or steroids for adults
* If greater than 3 months, myringotomy and tube insertion should be done to prevent long-standing trauma and hearing loss.
78
child with AOM findings
Tugging at ears
Fussy
Fever
Decreased appetite, not eating well
Hearing loss.
Capillary injection and Erythema of TM
Bulging TM
Possible purulent fluid
Immobility on bulb insufflation
May see micro-perforation with drainage
79
guidelines for acute otitis media
* Bulging of the Tympanic Membrane – Moderate to Severe
* Signs of Acute Inflammation AND middle Ear Effusion
* TM Erythema, Fever, Ear Pain
* Bulging TM, decreased TM mobility, air-fluid level behind TM, otorrhea from perforation
* Acute Perforation of the TM w/ Acute purulent otorrhea (assuming Acute otitis externa has been excluded as the cause for the otorrhea)
* Must have at least one!
80
tools to use to diagnose AOM
pneumatic otoscopy
tympanometry
81
T/F: Antibiotic treatment of AOM in children decreases early pain (before 24 hours), hearing loss at three months, or recurrence within 30 days
FALSE: does NOT
82
T/F: Antibiotic treatment has some beneficial effect on pain after 24 hours (up to 12 days), number of tympanic membrane perforations, and contralateral otitis media
TRUE
83
T/F: Adults with bilateral otitis media or otitis media with otorrhea benefit most from antibiotics
FALSE - Children younger than two years
84
Initial antibiotic treatment for AOM
* infants \<6 months,
* children 6 months to 2 years with unilateral or bilateral AOM of any severity, and
* children ≥2 years who appear toxic, have persistent ear pain for \>48 hours, had temperature ≥102.2°F (39°C) in the past 48 hours, have bilateral AOM or otorrhea, or
* have uncertain access to follow-up
85
chronic otitis media
Chronic **_(usually longer than 3 months)_** inflammation of the middle ear and/or mastoid cavity, which presents with recurrent ear discharges or otorrhea through a tympanic perforation
86
what do you consider in nasopharyngeal mass obstructing the Eustachian tube for adults
Unilateral OM
87
when does chronic otitis media occur
as a result of recurrent AOM
88
what is common COM
perforations
89
pathogens of COM
P. aeruginosa
90
signs and symptoms of COM
Purulent aural discharge +/- otalgia
Conductive hearing loss is present
91
treatment for COM
* Surgical repair of perforation
* Ciprofloxacin
92
indications of tympanostomy tube placement
* number/episodes
* age of diagnosis
* persistence
* documented hearing loss
93
Tympanostomy Tube Complications
Otorrhea
Occlusion
Premature displacement
Persistent perforation
94
water precautions of otitis media
lake vs pool vs tub
ear plugs
95
complications of OM
* TM perforation
* Mastoiditis
* Cholesteatoma
* Facial Nerve Palsy
* Meningitis
96
TM perforations
* Infection
Bacteria, Mycobacterium, Viruses
* Trauma
Penetrating trauma – NO Q-TIPS!
* Blunt trauma
Temporal bone fractures, Slap injury
* Explosion Injury
* Thermal injury
Welders, steelworkers, lightning
97
TM evaluation
* Facial nerve
* External ear
* Otoscopy
* Ear canal
* TM Perforation
* Audiometry
* +/- CT of maxillary/facial bones
98
what is Tympanic Membrane Perforation
Negative pressure within middle ear causes the tympanic membrane to perforate- will see a hole in the TM on exam
99
TMP may be a _____ sequalae
sinusitis
100
symptoms of TMP
otalgia, hearing loss, otorrhea, possible secondary otitis externa
101
management of TMP
Otic drops susp. twice with oral antibiotics
102
when to refer for TMP
present for more than 6 weeks
103
what is mastoiditis
Spectrum of disease that ranges from inflammation of the mastoid periosteum to bony destruction of the mastoid air system and abscess development
Rare complication due to antibiotic vigilance
104
mastoiditis is most common in ___ years of age
children \<2
105
acute mastoiditis signs and symptoms
Retroauricular pain/tenderness
Fever
Ear protrusion
Conductive hearing loss
Leukocytosis
106
what exam to confirm acute mastoiditis
CT
107
treatment of acute mastoiditis
* Antibiotics to cover Staph Aureus, Pseudomonas, and H. Influenza x 14 days
* Cephalosporins
* Myringotomy for C&S
* Mastoidectomy if:
* Medical failure
Abscess
Intracranial complications
108
Cholesteatoma
Epidermal inclusion cyst of squamous epithelium containing desquamated keratin debris
Caused by chronic negative pressure in middle ear from eustachian tube dysfunction or direct growth from TM rupture and trapped flap of the TM
109
what is the result of cholesteatoma
conductive hearing loss
110
cholesteatoma morphology
Greasy-looking, white mass behind TM
+/- malodorous discharge
111
treatment of cholesteatoma
antibiotics, surgical drainage & removal
If untreated the erosion can lead thrombosis, sepsis, brain abscess and even death
112
otosclerosis
* Genetic disease characterized by abnormal spongy and sclerotic bone formation in the temporal bone around the footplate of the stapes – covers oval window.
Prevents normal ossicle movement of the stapes
113
T/F: otosclerosis is autosomal recessive
Autosomal dominant with incomplete penetrance and variable expression
⅔ positive family history
114
T/F: otosclerosis can have conductive hearing loss, but may have have sensorineural component
true
115
population impacted by ostosclerosis
CHL in 15-50 age group
More common in women
116
otosclerosis is _____ progressive
slowly
117
T/F: otosclerosis is unilateral but asymmetric hearing loss
FALSE, bilateral with asymmetric hearing loss
118
otosclerosis may experience
experience disequilibrium with occasional attacks of vertigo & rotatory nystagmus
119
\_\_\_\_ sign in otosclerosis
Schwatze's signs - erythema around stapes from hypervascularity of new bone formation
120
do we use a tuning fork for otosclerosis
yes, progressive HL from low to high 256-512-1021 Hz TF
121
treatment of otosclerosis
Medical –Sodium fluoride
Helps reduce ossification of ossicles
Surgery- Stapedectomy
122
when does sensorineural hearing loss occur
Occurs when sound is carried normally through the external and middle ear, but there is a defect in the inner ear – nerve impulses from the cochlea to the auditory cortex are impaired
123
causes of SNHL
sensory (deterioration of cochlea, ototoxicity, noise exposure)
neural (CN VIII)
124
can infections occur with viruses?
obviously, CMV, mumps, rubella, rubeola, influenza, varicella-zoster, EBV, poliovirus, RSV, adenovirus, parainfluenza, HSV, HIV
may occur with. meningitis and encephalitis infection including syphilis
125
what is ototoxicity?
Damage to the cochlea or vestibular apparatus from chemical exposure
varying levels of SNHL
May be associated with tinnitus, dizziness
Ototoxic medications:
* Antibiotics
Vancomycin, Aminoglycosides
* Diuretics
Furosemide
* Chemotherapeutic agents
Aspirin
126
ototoxicity increases incidence with….
exposure greater than 10 days
preexisting hearing loss
concurrent exposure to noise
other ototoxic agents
127
treat ototoxicity
with serial audiometric evaluation and removal of offending drug
128
can hearing loss occur with ototoxicity
may be permanent or return with discontinuing drug
129
Acute Labyrinthitis / Vestibular Neuritis
Acute inflammation of vestibular nerve and labyrinth
Unknown etiology, presumed to be viral
COMMONLY OCCURS AFTER A VIRAL URI
130
signs and symptoms of Acute Labyrinthitis / Vestibular Neuritis
Single, acute onset of vertigo, lasting days to weeks
Associated with N&V, nystagmus, gait instability
+/- Hearing loss
131
why do may we need a CT/MRI for Acute Labyrinthitis / Vestibular Neuritis
cerebellar infarction may mimic it
132
treatment of Acute Labyrinthitis / Vestibular Neuritis
Bed rest, meclizine, antiemetics, +/- corticosteroids
133
Acoustic Neuroma
Vestibular Schwannomas
Benign tumor of 8th CN
Most common intracranial tumor
Usually unilateral
134
how does acoustic neuroma present
with progressive dizziness, disequilibrium, unilateral tinnitus, SNHL
135
T/F: acoustic neuroma is common with neurofibromatosis type 1
false, type 2
136
treatment of acoustic neuroma
Surgery
Radiotherapy
Chemotherapy
137
how to diagnose acoustic neuroma
MRI
138
what is meniere syndrome
Endolymphatic Hydrops
Disturbance of salt and water balance in endolymphatic space & degeneration of vestibular hair cells in one ear so ears are getting different inputs
139
signs and symptoms of meniere syndrome
Intermittent, sudden onset of vertigo
Episodic
Aural fullness
Tinnitus
SNHL – low frequency
N&V lasting 1-2 hours.
140
classic triad
recurrent vertigo
fluctuating SNHL
tinnitus
141
meniere and neurosyphilis
Otosyphilis - inner ear communicates with spinal fluid via the cochlear aqueduct
Tullio’s Phenomenon – Induction of vertigo by loud noise
142
Tullio’s Phenomenon
Induction of vertigo by loud noise
143
treatment of meniere
* Bed rest, antiemetics, dietary salt restriction & diuretics
* For disabling vertigo or failure of medical therapy, can treat with:
* Labyrinthectomy: 80% success, destroys all residual hearing
* Intratympanic gentamicin or corticosteroids
144
Meniere's Pearls
SNHL
Tinnitus
Intermittent vertigo
145
Labrinthitis Pearls
+/- hearing loss
vertigo
preceding URI
146
acoustic neuroma
presents with progressive dizziness
disequilibrium
unilateral tinnitus
SNHL
