Flashcards in Ear Deck (73):
Clinical presentation of cerumen impaction
1. Hearing loss
2. Earache or fullness
3. Reflex cough
What is first line treatment for cerumen impaction?
Irrigation using body temperature water
What are considered urgent foreign bodies?
1. Button batteries
2. Live insects
3. Penetrating FB
How do you remove live insects?
First immobilize with lidocaine
Complications of foreign bodies in the ear?
1. Perforated TM
Etiology of otitis externa
1. Pseudomonas: Gram (-) rod
2. Fungi: Aspergillus, candida
Clinical presentation of otitis externa
2. Purulent discharge
3. Hearing loss
5. Hx recent water exposure or mechanical trauma
What symptom of otitis externa likely suggests a fungal infection?
Physical exam findings in otitis externa
1. Erythematous ear canal
2. Edema of ear canal
3. Purulent exudate
5. Mobile TM
What is the most common neoplasm of the ear canal?
Squamous cell carcinoma of external canal
Ramsay Hunt Syndrome
-Herpes Zoster optics
-Vesicles on outer ear
-Facial paralysis on same side
Otitis externa treatment
Topical amino glycoside OR Fluoroquinolone x7-10 days
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
List the 3 complications of otitis externa
1. Periauricular cellulitis
2. Contact Dermatitis
3. Malignant otitis externa
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
Malignant (necrotizing) otitis externa
-Osteomyelitis of temporal bone/skull base
What organisms are the most common causes of acute otitis media?
1. Streptococcus pneumoniae
2. H. Influenza
Acute Otitis media is most common in children of what ages?
acute Otits media clinical presentation
4. URI sx's
5. Hearing loss
Acute Otits media physical exam findings
1. Immobile TM
2. Erythema and bulging of TM
3. Ruptured TM-possibly
What infecting organism does bullae suggest in acute otitis media?
What is first line treatment in acute otitis media?
If the patients has a PCN allergy, what do you prescribe them for an acute otitis media?
1. Cephalosporin OR
What is second line treatment in acute otitis media?
High dose Amoxicillin-clavulanate, 2nd or 3rd generation
When can the patient expect to see improvement in sx's after initiating treatment?
Treatment for perforated TM
1. Topical abx with low ototoxicity: Ofloxacin
2. Analgesics: Tylenol/Ibuprofen
3. Prevention: Vaccination
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
Complications of acute otitis media
2. Hearing loss
- Postauricular pain
Serous otitis media physical exam findings
1. TM is dull and hypomobile
2. Bubbles visible
3. Conductive hearing loss
Specific type of chronic otitis media
What is the most common cause of cholesteatoma
Prolonged Eustachian tube dysfunction
cholesteatoma physical exam findings
1. TM pocket
2. TM perforation exuding debris
Erosion into inner ear, facial nerve, brain abscess
Etiology of Eustachian tube dysfunction
-Edema of tubal lining
-Air trapped in middle ear causing negative pressure
-->viral URI, allergies
Eustachian tube dysfunction clinical presentation
2. Fluctuating hearing
3. Pain with pressure change
4. Popping or crackling sensation
Eustachian tube dysfunction physical exam findings
1. TM retraction
2. Decreased TM mobility on pneumatic otoscope
Eustachian tube dysfunction treatment
3. Intranasal corticosteroids
4. Desensitation therapy (allergies)
What is a precursor to otic barotrauma?
Poor Eustachian tube dysfunction
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
What are the consequences if a diver does not descend slowly an equilibrate their middle ear?
2. Perilymphatic fistula: rupture of oval window, sensory hearing loss, acute vertigo, vomiting
Complications of otic barotrauma
What is the most common allergy that causes contact dermatitis?
List the four mechanisms in conductive hearing loss and their examples
1. Obstruction-cerumen impaction
2. Mass effect-tumor
4. Discontinuity- Head trauma, fracture
What are the two most common causes of conductive hearing loss in adults
1. Cerumen impaction
2. Eustachian tube dysfunction
What is the most common cause of sensorineural hearing loss
Presbycusis= Age-related hearing loss
At what threshold is it considered abnormal hearing?
At what age should you go see an audiologist?
Age 65 years and older
How can you treat idiopathic sudden sensorineural hearing loss if you catch it early?
What can pulsatile tinnitus indicate?
Vascular abnormality- Refer right away!!!
Rapid series of pops or clicks with sensation of ear fluttering
-Acute onset of continuous , severe vertigo
-Inflammation of inner ear
-Tends to occur after viral URI
3. Oral steroids
What is Labyrinthitis also called?
What is another name for Meniere's Disease
Define Meniere's Disease
A vertigo syndrome due to a peripheral lesion (outside the brain)
Clinical presentation of Meniere's Disease
2. Hearing loss (sensorineural)
Meniere's Disease treatment
Reduce endolymph fluid pressure in inner ear:
2. Low salt diet
Meniere's Disease EXTREME treatment
1. Vestibular ablation with Gentamycin (ototoxic)
2. Vestibular nerve labyrinthectomy
Acoutic Neuroma (vestibular schwannoma)
Benign intracranial tumor of CN VIII
Acoutic Neuroma presentation
1. UNILATERAL hearing loss
Acoutic Neuroma diagnosis
MRI with contrast
-NO auditory sx's (tinnitus)
=Balance organs of inner ear
What is the most common cause of peripheral vertigo?
Benign Paroxysmal Positional Vertigo (BPPV)
How do you diagnose Benign Paroxysmal Positional Vertigo (BPPV)?
What is a positive Dix-Hallpike maneuver?
Delayed onset fatiguable nystagmus=peripheral cause
What indicates a central cause on a Dix-Hallpike maneuver?
Treatment for vertigo
Most common age of onset in vertigo?
How much money is spent a year on vertigo?
2 billion dollars
How many patients received a CT scan for vertigo?