Flashcards in Ear Deck (73)
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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
