ear Flashcards
(142 cards)
1
Q
inflame of the middle ear, usually assoc w buildup of fluid and related to viral/bacterial infx
A
acute otitis media
2
Q
fluid in middle ear wout infx
A
otitis media w effusion
3
Q
drainage from middle ear for at least 2w usually assoc tympanic membrane perf
A
chronic supperative otitis media
4
Q
what systems are involved with otitis media
A
nares, eustation tube, mastoid air cells
5
Q
path of acute otitis media
A
- inflam response obstructs gustation tube causing neg pressure/accum of secretions
- vir/bac enter middle ear via aspiration/reflux
- organisms mult=supprative infx
6
Q
bacterial organisms of otitis media
A
strep pneumo*
h flu
m cat
7
Q
viral organisms of otitis media
A
rsv, rhinovirus, coronavirus, influenza
8
Q
path of ome
A
chronic inflame response to residual bacterial componetns
allergic rhinitis, myringotomy
9
Q
rf for otitis media
A
daycare, bottles, smoking, male, fam hx
10
Q
presentation aom and ome
A
aom- earache, +/- fever, +/- uri symp, dec hearing
ome- asymp, dec hearing
11
Q
pt presents with earache and fever. upon further exam so inflamed tm
A
otitis media
12
Q
proper dx ome
A
pneumatic otoscopy, typanometry
GS= myringotomy
13
Q
syndromes of aom
A
otitis conjunctivitis
bullous myringitis
14
Q
combination of otitis media and purulent conjunctivitis caused by H flu and seen in pt
A
otitis conjunctivitis
15
Q
inflammation of TM w bullae, painful caused by same organism as AOM
A
bullous myringitis
16
Q
what does it mean if pt has otalgia then pain suddenly goes away and followed by purulent discharge
A
aom w perforation of tm
17
Q
when will you see purulent drainage from the ear
A
aom w tm rupture
otitis externa
18
Q
causes of perforation
A
excess fluid and pressure
extreme pressure changes
trauma
19
Q
pt presents w bloody drainage, pain, and tinnitis
A
perforation of tm
20
Q
what 3 findings are needed to call it aom
A
bulging tm, middle ear effusion, inflammation
21
Q
tx aom pain relief
A
motrin/tylenol
topical benzocaine/antipyrine (auralgan) >2yo= numb
22
Q
tx aom kids
A
abx
23
Q
tx aim kids 6m-2y
A
abx if dx certain (bulging,effusion,inflam)
24
Q
tx aom >2y
A
dx certain- abx amoxil
25
if tx aom in kid with analgesics and no abx what do you do
48-72hr then reexamine
26
abx of choice tx peds for aom
amoxicillin
10d if severe
5-7d >6y
27
abx of choice tx peds for aim w resistance to amoxicillin
high dose augmentin
28
abx choice tx peds for aom w pcn allergy
mild 3rd gen- cefdinir, cefpodoxime, cefuroxime
| anaphylaxis- azithryomycin or clarithromycin
29
what is recommended for kids unable to take oral abx for tx aom
ceftriaxone 50mg/kg
30
tx aom adults
```
1st line amoxicillin
may use augmenting if severe pain/fever
mild allergy-cefdinir, cefuroxime
anaphylaxis- zithromax
maybe bactrim
```
31
tx peds and adults aom w perforation
peds- oral abx
| adults- oral and otic abx
32
tx otitis media w effusion in adults
resolve spont but attempt to correct gustation tube dysfunction- antihistamines, decongestants, nasal steroids
33
tx otitis media w effusin in kids
watchful waiting, sympt past 3 months= chromic refer to ent
34
when are tympanostomy tubes in kids indicated
>3 confirmed cases aom in 6m
| >4 confirmed cases aom in 12 m
35
pt presents w ear pain, postauricular tenderness, erythma, swelling and displacement of auricle
mastoiditis
36
primary rf for mastoiditis
aom
37
bacteria causes mastoiditis
strep pneumo, strep pyogene, staph aureus
38
complications of mastoiditis
```
facial nerve palsy
subperiosteal abscess
hearing loss
labryrinthitis (tinnitis, vertigo, n/v, nystagmus)
osteomyelitis
bezold abscess
```
39
when should you get ct w iv contrast for mastoiditis
extracranial complications (mass/abscess)
intracranial complications (neuro deficits)
severe illness/toxic appearance
aom not responding to abx
40
should cx be obtained for mastoiditis? if so when
blood if >102.2 temp
fluid strongly considered
tympanocentesis or myrinotomy
already drainage from ear
41
tx mastoiditis
ent for aspiration/drainage/mastoidectomy
admit + iv abx (vanco)
may need to add gram neg coverage
42
another name for otitis externa
swimmers ear
43
inflammation or infx of external auditory canal
otitis externa
44
origins/causes of otitis externa
infx
allergic
dermatologic
45
what ages does otitis externa most commonly occur
5-14
46
path of otitis externa
breakdown skin-cerumen barrier leads to inflam and edema of skin that causes pruritus and obstruction
the inflam changes alter cerumen prod and creates environment for breeding organisms
47
rf otitis externa
swimming/excess moisture
trauma to canal
devices- hearing aids, earphones
allergic contact dermatitis-shampoos,earrings
dermatologic issues-psoriasis, atopic dermatitis
prior radiation to ear area
48
bacteria that causes otitis externa
usually gram pos- staph aureus, staph epidermidis
**pseudomonas
candidal- check sugar
49
pt presents with pain when move tragus, pruritus, and hearing loss
otitis externa
50
on otoscopy exam what will otitis externa look like
canal erythematous, edematous
debris yellow, brown, white, gray
tm might be erythematous
no signs aom or tm rupture
51
complication of OE
malignant external otitis (necrotizing external otits)
- severe, potentially fatal
- elder diabetics and immunocompromised
- spreads from skin to bone to marrow of skull
52
pt presents with pain out of proportion, granulation tissue at bony cartilaginous junction of ear canal floor, and erythema
malignant external otitis
53
tx malignant external otitis
admit and consult ENT
IV cipro 1st line consider levofloxacin
control bs
54
tx otitis externa
1. clean debris- remove cerum/ debris
2. topical abx- fluoroquinolones (ofloxacin, cipro), polymyxin B/neomycin mix, aminoglycosides (tobramycin, gentamycin)
3. antiseptics- bacterial static agent
4. glucocorticoids to dec swelling
5. wick placement for severe/bad
55
when should you tx OE w systemic abx and what are they
severe infx and immunocomp
| cipro or ofloxacin
56
in tx oe with amino glycosides-tobramycin and gentamycin what can se be
ototoxicity
| iatrogenic hearing loss, balance dysfunction
57
follow up OE and when to refer
improve by 36-48hr
| refer not better 48-72hr
58
anatomy of eustation tube
runs from anterior wall of middle ear cavity and opens into nasopharynx
59
3 functions of eustation tube
1. equalization of pressure across tm
2. protecting middle ear from infx/ reflux of nasopharyngeal contents
3. clearance of middle ear secretions
all mediated by opening/closing eustation tube
-yawning opens=pop
60
3 pathologic process of eustation tube
1. pressure dysregulation
2. impaired protective function
3. diminished clearance
61
path of pressure dysregulation of eustation tube
failure to open and allow adequate ventilation leading to mucosal inflam and obstructed nose
62
functional obstruction w pressure dysregulation of eustation tube
neg pressures make opening of tube difficult
| ex barometric pressure changes, airplanes
63
path of impaired protective function of eustation tube
reflux of nasophar pathogens, allergy inducing proteins, and gastric secretions into tube
64
what causes impaired protective function of eustation tube
- congenital
- short/floppy tubes (craniofacial anomalies)
- abn pos pressure nasopharynx (blowing nose, crying)
- loss immune protection in tube due to secretions
- loss mucosal protection from gastric enzymes
65
path of impaired clearance of eustation tube
- inability to clear viscous material/pathogens from middle ear
- loss of mucociliary function due to bacterial toxins, viruses, smoking, allergic ds, inflam
66
pt presents w ear pain/fullness, tinnitus and popping sounds
eustation tube dysfx
67
what will otoscopy exam look like for ETD
- dull bluish gray/ yellow tm (fluid behind)
- bony structures behind tm distorted
- retracted tm
- nasal mucosal swelling/inflam/polyps
68
tx ETD
- tx underlying issue is key: rhino sinusitis, allergic rhinitis, laryngopharyngeal reflux
- decong: pseudoephedrine/phenylephrine
69
when should refer for ETD
- severe ear complaints
- no improvement
- cholestetomma, recurrent aom, tm rupture
70
abnormal growth of squamous epithelium in middle ear and mastoid
cholesteatoma
71
what 2 ways can cholesteatoma lead to hearing loss
- destroy ossicles
| - obstructs ET orifice leading to effusion
72
predisposing factors of cholesteatoma
- hx recurrent aom/middle ear effusions
- older age tympanostomy tube placement
- cleft palate
- craniofacial abn
- turner syndrome
- down syndrome
- fam hx of chronic middle ear ds/cholesteatoma
73
path of congenital cholesteatoma
squamous cysts arise from epithelium of middle ear, fail to dissipate, dev into cholesteatoma
74
path of acquired cholesteatoma
- arise form retraction pocket of TM
- invaginations of TM that form in pts w chronic ETD, neg middle ear pressure, and focal collapse of tm
- retraction poclet pulled into middle ear space creating pouch that collects desquamating cells and forms cholesteatoma
75
complications fo cholesteatoma
late stage can destroy bone and lead to deafness and paralysis of facial nerve
secondary infx- pseudomonas, proteus
76
where is acquired cholesteatoma found
posterosuperior quadrant tm
77
where is congenital cholesteatoma found
anterosuperior quadrant of tm
78
pt presents with white mass behind intact tm and focal granulation on surface of tm
cholesteatoma
79
tx cholesteatoma
refer and surgery
complete excision (tympanoplasty) and reconstruction of ossicles
exteriorization forming a skin lined cavity
80
what is acoustic neuroma known as and why
vestibular schwannomas- schwan cell derived tumors that commonly arise from vestibular portion of 8th cranial nerve
avg age 50
81
path of acoustic neuroma
genetically linked assoc w neurofibromatosis type 2- gene located on chromosome 22
82
rf of acoustic neuroma
exposure to loud noise
childhood exposure low dose radiation head/neck
hx parathyroid adema
83
pt presents with hearing loss and tinnitus, unsteadiness while walking, and taste disturbance
acoustic neuroma
cochlear nerve- hearing loss/tinnitus
vestibular nerve- unsteadiness
facial nerve- taste disturbance
84
pt presents with tinnitus, feel like tilting, and hypesthesea
acoustic neuroma
cochlear- tinnitus
vestibular- tilting
trigeminal- hypesthesea
85
pt presents hearing loss, facial numbness, facial paresis
acoustic neuroma
cochlear-hearing loss
trigeminal-numbness
facial- paresis
86
cochlear nerve invol of acoustic neuroma
hearing loss and tinnitus
87
vestibular nerve invol of acoustic neuroma
unsteadiness while walking, feeling of tilting or veering
88
trigeminal nerve invol of acoustic neuroma
facial numbness, hypesthesea, pain
89
facial nerve involve of acoustic neuroma
facial paresis, taste disturbance
90
tumor progression in acoustic neuroma is a sign of
cerebellar or brainstem compression
91
best initial test for dx acoustic neuroma
audiometry
92
tx options of acoustic neuroma
surgery- good long term control
radiation- sterotactic radiosurgery/radiotherapy and proton beam therapy
observation- slow growing, MRI every 6-12m
93
pt presents with episodic vertigo, sensorineural hearing loss, and tinnitus (age 20-40)
meniere ds
94
path of meniere ds
endolymphatic hydrops cause distortion and distention of membrane/endolymph portions of labyrinthine system
not sure why excess fluid builds up
95
how does episodic vertigo present in meniere ds
- rotatory spinning or rocking sensation
- +/- N/V
- persists for 20m to 24h
- disequilibrium sensation
96
how does hearing loss present in meniere ds
```
sensorineural
fluctuating
affect lower frequencies
progressive over time
permanent 8-10y
```
97
how does tinnitus present in meniere ds
low pitch sound
| auditory distortion
98
definitive dx of meniere ds
postmortem
99
guideline to dx meniere
2 separate episodes vertigo lasting at least 20m
audiometric confirmation of sensorineural hearing loss
tinnitus / perception aural fullness
100
what diagnostic studies should be performed w meniere ds
audiometry- normal in mid freq, low/high loss
vestibular testing
labs- rpr rule out syphilis
imaging- mdi rule out cns lesions
vestibular evoked myogenic potential (VEMP)- detect hydrops
101
lifestyle adjustments w menieres
salt restriction
| caffeine/nicotine/alcohol restriction
102
antihistamine tx menieres
meclizine (antivert)
| dimenhydrinate (dramamine)
103
anticholinergic tx menieres
scopolamine
104
antiemetic tx menieres
promethazine (phenergan)
| prochlorperazine (compagine)
105
benzo tx menieres
lorazepam (ativan)
106
types rehab menieres
hearing aids
| vestibular rehab- exercises max balance
107
what improves fluid exchange in inner ear for menieres
pos pressure pulse generator (meniett)
108
perception of sound in absence of an external source within 1 or both eyes, within or around head or as outside distant noise
tinnitus- buzzing, ringing, hissing
109
vascular disorders that can cause tinnitus
believed to be secondary to atherosclerotic narrowing of vessels
- arterial bruits
- av shunts (av fistula)
- paranganglioma: near carotid bifurcation
- venous hum: htn , inc ICP
110
path of neuralgic disorders causing tinnitus
spasm of muscles in middle ear- pulsatile tinnitus- related to cn V/VII (MS)
111
ETD path causing tinnitus
vents too much causes ocean sound; mc after sudden weight loss and improves when lie down
112
causes of tinnitus from auditory system
ototoxic meds
presbycusis-hearling loss w age
otosclerosis-bony overgrowth of stapes
acoustic neuroma- tumor compressing cochlear nerve
113
behavioral therapies for tinnitus
tinnitus retraining- suppress auditory neural connections
biofeedback/stress reduction- relaxation tech control autonomic functions
cognitive behaviroal- altering psychological response to tinnitus
114
meds to tx tinnitus
prostaglandin analogue- misoprostol (limited benefit)
| intratympanic dexamethasone
115
illusion of movement, transient sensation of spinning and can be assoc with gait, N/V, nystagmus
vertigo
116
vertigo is either 2 things in origin
central- cps issue
| peripheral- vestibular system issure
117
peripheral vestibular vertigo can sense 2 motions
semicircular canal- angular motion "spinning"
| otolith organs- linear motion
118
path of vertigo w 1 ear
dysfunction of 1 of vestibular labyrinths sends different messages to brain which doesn't match with visual data
vestibular labyrinth dysfn=peripheral vertigo
119
path of vertigo w both ears
sending appropriate msg to brain along w eyes so when brain malfunctions/misinterprets data causes vertigo
brain misinterpretation= central vertigo
120
vestibular labyrinth dysfunction = ? vertigo
peripheral
121
brain misinterpretation= ? vertigo
central
122
mc vertigo caused by Ca debris within posterior semicircular canal
benign paroxysmal positional vertigo (BPPV)
123
spinning sensation brought on when turning in bed or tilting head backward to look up
BPPV- peripheral
124
dx BPPV
horizontal/vertical/torsional nystagmus
| dix hallpike maneuver/epley maneuver
125
rapid onset severe, persistent vertigo, N/V, and gait
vestibular neuritis (labyrinthitis)- peripheral
126
acute vertigo, +/- hearing loss, facial paralysis, ear pain and vesicles in auditory canal
herpes zoster oticus "ramsay hunt syndrome"
peripheral
steroids/acyclovir
127
vertigo, n/v, gait w traumatic peripheral vestibular injury following direct concussion
labyrinthine concussion
hemotympanum/hearing loss noted
weeks- months
128
types of central vertigo
migrainous
brainstem ischemia
cerebellar infarct/bleed- sudden,intense, limb ataxia
MS-lesions near vestibular nuclei
129
recurrent vertigo lasting under 1 min
bppv
130
single episode vertigo lasting several min to hrs
migraine or transient ischemia
131
recurrent episodes w meniere ds can last how long
hrs
132
prolonges and severe episodes vertigo
vestibular neuritis
133
presentation of nystagmus w peripheral vertigo
horizontal, fast and away from affected side
134
presentation nystagmus w central vertigo
can have any trajectory
135
gait presentation w vertigo
unilateral/peripheral lean/fall to affected side
| cerebellar stroke-unable to walk without falling
136
dx testing vertigo
acute setting- ct scan, mri/mra
| ent referral- electronystagmography and video nystagmography, vestibular evoked myogenic potentials (vemp), audiometry
137
acute sump relief vertigo
iv fluids
antiemetics- zofran, reglan, phenergan
antihist- antivert, dramamine, benadryl
benzos- valium, ativan
138
vestibular neuritis (labyrinthitis) vertigo tx
```
oral steroidsantiemetics- zofran, reglan, phenergan
antihist- antivert, dramamine, benadryl
benzos- valium, ativan
anticholinergics- scopolamine
vestibular rehab
```
139
blunt trauma to outer ear
auricular hematoma
140
path of auricular hematoma
blood accumulates in subperichondrial space creating barrier and cuts off blood supply to cartilage leading to necrosis and maybe infx
141
another name for auricular hematoma
cauliflower ear
142
tx auricular hematoma
needle drainage
| I&D
