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Flashcards in Ear Deck (73):
1

Clinical presentation of cerumen impaction

1. Hearing loss
2. Earache or fullness
3. Reflex cough

2

What is first line treatment for cerumen impaction?

Irrigation using body temperature water

3

What are considered urgent foreign bodies?

1. Button batteries
2. Live insects
3. Penetrating FB

4

How do you remove live insects?

First immobilize with lidocaine

5

Complications of foreign bodies in the ear?

1. Perforated TM
2. Infection

6

Etiology of otitis externa

Infection:
1. Pseudomonas: Gram (-) rod
2. Fungi: Aspergillus, candida

7

Clinical presentation of otitis externa

1. Otalgia
2. Purulent discharge
3. Hearing loss
4. Fullness
5. Hx recent water exposure or mechanical trauma
6. Pruritis

8

What symptom of otitis externa likely suggests a fungal infection?

Pruritis

9

Physical exam findings in otitis externa

1. Erythematous ear canal
2. Edema of ear canal
3. Purulent exudate
4. Tenderness
5. Mobile TM

10

What is the most common neoplasm of the ear canal?

Squamous cell carcinoma of external canal

11

Ramsay Hunt Syndrome

-Herpes Zoster optics
-Rare
-Vesicles on outer ear
-Facial paralysis on same side
-Exquistely tender

12

Otitis externa treatment

Topical amino glycoside OR Fluoroquinolone x7-10 days

13

When would you refer a patient to ENT in the setting of otitis externa?

Persistent otits externa who is immunocompromised/DM
=increased risk for malignant otitis externa

14

List the 3 complications of otitis externa

1. Periauricular cellulitis
2. Contact Dermatitis
3. Malignant otitis externa

15

What disorder of the ear does this clinical presentation suggest?
1. Foul-smelling discharge
2. Granulations in ear canal
3. Deep otalgia
4. CN palsies
5. HA

Malignant (necrotizing) otitis externa
-Osteomyelitis of temporal bone/skull base

16

What organisms are the most common causes of acute otitis media?

1. Streptococcus pneumoniae
2. H. Influenza

17

Acute Otitis media is most common in children of what ages?

4-24 months

18

acute Otits media clinical presentation

1. Otalgia
2. Pressure
3. Fever
4. URI sx's
5. Hearing loss

19

Acute Otits media physical exam findings

1. Immobile TM
2. Erythema and bulging of TM
3. Ruptured TM-possibly

20

What infecting organism does bullae suggest in acute otitis media?

mycoplasma infection

21

What is first line treatment in acute otitis media?

Amoxicillin

22

If the patients has a PCN allergy, what do you prescribe them for an acute otitis media?

1. Cephalosporin OR
2. Macrolide

23

What is second line treatment in acute otitis media?

High dose Amoxicillin-clavulanate, 2nd or 3rd generation

24

When can the patient expect to see improvement in sx's after initiating treatment?

48-72 hrs

25

Treatment for perforated TM

1. Topical abx with low ototoxicity: Ofloxacin
2. Analgesics: Tylenol/Ibuprofen
3. Prevention: Vaccination

26

Who receives immediate abx treatment in acute otitis media?

1. Children <6 months
2. Children <24 mons if severe:
-Moderate or severe pain
-Pain > or equal to 48 hrs
-Temperature > or equal 102.2
-Bilateral AOM

27

Complications of acute otitis media

1. Labyrinthitis
2. Hearing loss
3. Mastoiditis

28

Mastoiditis sx's

-Spiking fevers
- Postauricular pain
-Erythema

29

Serous otitis media physical exam findings

1. TM is dull and hypomobile
2. Bubbles visible
3. Conductive hearing loss

30

Define cholesteatoma

Specific type of chronic otitis media

31

What is the most common cause of cholesteatoma

Prolonged Eustachian tube dysfunction

32

cholesteatoma physical exam findings

1. TM pocket
2. TM perforation exuding debris

33

cholesteatoma complications

Erosion into inner ear, facial nerve, brain abscess

34

Etiology of Eustachian tube dysfunction

-Edema of tubal lining
-Air trapped in middle ear causing negative pressure
-->viral URI, allergies

35

Eustachian tube dysfunction clinical presentation

1. Fullness
2. Fluctuating hearing
3. Pain with pressure change
4. Popping or crackling sensation

36

Eustachian tube dysfunction physical exam findings

1. TM retraction
2. Decreased TM mobility on pneumatic otoscope

37

Eustachian tube dysfunction treatment

1. Decongestants
2. Autoinflation
3. Intranasal corticosteroids
4. Desensitation therapy (allergies)

38

What is a precursor to otic barotrauma?

Poor Eustachian tube dysfunction

39

otic barotrauma treatment

Enhance Eustachian tube function
1. Take systemic decongestant a few hours before air travel
2. Take nasal decongestant one hour before descent

40

What are the consequences if a diver does not descend slowly an equilibrate their middle ear?

1. Hemotympanum
2. Perilymphatic fistula: rupture of oval window, sensory hearing loss, acute vertigo, vomiting

41

Complications of otic barotrauma

TM rupture

42

What is the most common allergy that causes contact dermatitis?

Neomycin

43

List the four mechanisms in conductive hearing loss and their examples

1. Obstruction-cerumen impaction
2. Mass effect-tumor
3. Otosclerosis
4. Discontinuity- Head trauma, fracture

44

What are the two most common causes of conductive hearing loss in adults

1. Cerumen impaction
2. Eustachian tube dysfunction

45

What is the most common cause of sensorineural hearing loss

Presbycusis= Age-related hearing loss

46

At what threshold is it considered abnormal hearing?

Threshold>25 dB

47

At what age should you go see an audiologist?

Age 65 years and older

48

How can you treat idiopathic sudden sensorineural hearing loss if you catch it early?

Corticosteroids

49

What can pulsatile tinnitus indicate?

Vascular abnormality- Refer right away!!!

50

Staccato tinnitus

Rapid series of pops or clicks with sensation of ear fluttering

51

Labyrinthitis presentation

-Acute onset of continuous , severe vertigo
-Nausea

52

Labyrinthitis etiology

-Inflammation of inner ear
-Tends to occur after viral URI

53

Labyrinthitis treatment

1. Anticholinergicc/Antihistamines
-Dimenhydrinate/Dramamine
-Meclizine/Antivert
2. Anti-emetics
3. Oral steroids

54

What is Labyrinthitis also called?

Vestibular neuritis

55

What is another name for Meniere's Disease

endolymphatic hydros

56

Define Meniere's Disease

A vertigo syndrome due to a peripheral lesion (outside the brain)

57

Clinical presentation of Meniere's Disease

1. Vertigo
2. Hearing loss (sensorineural)
3. Tinnitus

58

Meniere's Disease treatment

Reduce endolymph fluid pressure in inner ear:
1. Diuretics
2. Low salt diet

59

Meniere's Disease EXTREME treatment

1. Vestibular ablation with Gentamycin (ototoxic)
2. Vestibular nerve labyrinthectomy

60

Acoutic Neuroma (vestibular schwannoma)

Benign intracranial tumor of CN VIII

61

Acoutic Neuroma presentation

1. UNILATERAL hearing loss
2. Disequilibrium
3. Tinnitus

62

Acoutic Neuroma diagnosis

MRI with contrast

63

Central Vertigo

=Brain
-Gradual onset
-NO auditory sx's (tinnitus)

64

Peripheral Vertigo

=Balance organs of inner ear
-Sudden onset
-Nystagmus
-Tinnitus
-Hearing loss
-N/V
-Difficulty walking

65

What is the most common cause of peripheral vertigo?

Benign Paroxysmal Positional Vertigo (BPPV)

66

How do you diagnose Benign Paroxysmal Positional Vertigo (BPPV)?

Dix-Hallpike maneuver

67

What is a positive Dix-Hallpike maneuver?

Delayed onset fatiguable nystagmus=peripheral cause

68

What indicates a central cause on a Dix-Hallpike maneuver?

Non-fatiguable nystagmus
Starts immediately

69

Treatment for vertigo

Epley maneuver

70

Most common age of onset in vertigo?

50 y.o.

71

How much money is spent a year on vertigo?

2 billion dollars

72

How many patients received a CT scan for vertigo?

Nearly half

73

What was the mean time of initial presentation of sx's to treatment of vertigo?

92 weeks