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Flashcards in Ear Diseases Deck (89):

What are the 5 ways in which an ear can manifest disease?

1. hearing loss
2. otalgia or pressure
3. tinnitus
4. veritgo2
5. drainage


___ occurs with trauma to the pinna between the ___ and ___


cartilage and the perichondrium

aka cauliflower ear (commonly seen in wrestlers)


how do you treat a hematoma on the pinna from trauma

must be drained and pressure dressing or bolster applied for

*considered a medical emergency--> if you fail to get the fluid out, it will parotid, calcify and be deformed forever


skin ulceration on the pinna that persist may be due to __


*beed biopsy


when do you treat the pre-auricular pits?

no need for intervention until its infected

*will require excision w/ tissue behind the superior pinna if it becomes repeatedly infected (Goes all the way around the pinna) --> need to remove it COMPLETELY or it will return


what is perichondritis and how do you treat it?

inflammation of the CT around the cartilage (often on pinna) (often caused by infected ear piercing)

-requires ORAL or IV antibiotics w/ good cartilage penetration


what is otitis externa and what is it commonly caused by

-bacterial (Psuedomonas) or fungal infection of the external ear canal


how do you tx otitis externa

dramatic resolution after topical drops (given for every day draining ear) even in the setting of tubes or perforation

**Drops can be ototoxic in the setting of a perforation


types of boney ear growths

1. osteoma- benign boney tumor
2. exostoses- benign


what is an osteoma

Benign bony tumor causes problems if grows to touch TM or occlude canal impeding epithelial migration

*needs to be removed


what is exostoses

-Benign bony growth
-Usually multiple
-normal hearing
-Cold water exposure:
aka Surfer’s ear, kayakers

*can get big enough and trap wax in ear--> requires surgery


what do kayakers or surfers often get in their ear?

exostosees (from cold water)


when do you need urgent removal of foreign bodies in the ear?

when it is organic material

especially food material!


what does tympanosclerosis look like

-bright white, surrounded by normal appearing TM*** (aka rim of normal ear drum)
-move w/ pneumotoscopy


what is tympanosclerosis

aka scar plaque

-Calcified mass between the layers of the membrane (often seen after PE tubes)

*does not effect hearing


what does a perforated TM look like

shiny middle ear mucosa visible through perforation

*be able to draw quadrant location and give percentage


how do you treat TM perforations?

-Refer immediately if vertiginous after injury or infection
-Even large perforations can spontaneously heal
-Refer if not healed after two weeks


what is epithelial migration?

a process that serves as a self-cleaning and repair mechanism for the external auditory canal and tympanic membrane

*Epithelial migration of the lining of the EAC is essential for self-cleansing


what direction does epithelial migration occur in

-occurs in a lateral direction from the tympanic membrane to the external auditory canal.

-The underlying mechanism, which determines the direction of this laterally directed movement has not been elucidated


The epicenter of this epitheliam migration process appears to reside in the vicinity of the ___



the epithelial migration takes place at a rate of approximately ___



Middle ear gasses resorb , and creates negative pressure

*par flaccida is the first to retract


complications that can occur from TM retraction

-it can put pressure on the ossicles leading to bony erosion and conductive hearing loss
-Can get a sudden drop in hearing (30%) if incus erodes a lot and incus and stapes touch

*Skin must be able to slough and move out the canal with the cerumen


what is a cholesteatoma

-Trapped epithelium cannot properly migrate out the ear canal. Inflammation present.
-Skin trapped in deep retractions cannot slough properly (Primary Cholesteatoma)
-drainage from infected debris


complications of cholesteatoma

-continues to enlarge and acts like tumor- tx is surgery (NEED TO REFER)
-can lead to hearing loss with deep retractions
-erode bones of hearing
-erode ear canal-
-can grow into TMJ
-can grow into the facial nerve and get paralysis
-can grow right up into the brain

-if left alone,pressure and enzymes cause erosion of bone


Four basic theories present the pathogenesis of ACQUIRED cholesteatoma:

-Invagination of the tympanic membrane (retraction pocket cholesteatoma)
-Basal cell proliferation
-epithelial in-growth through a perforation (the immigration theory)
-Squamous metaplasia of middle ear epithelium


what is the difference between primary acquired and secondary acquired cholesteatoma

-Primary acquired results from retraction pockets
-Secondary Acquired results from ingrowth from a pre-existing perforation


what is congenital cholesteatoma

-Can arise from epithelial rests in the middle ear without a retraction behind an intact tympanic membrane (do not drain)

-whitish mass noted behind intact TM

*mostly in 5y/o boys


complications of congential cholesteatoma

-hearing loss (slight to moderate)
-mastoid extension
-possible bilateral disease


what is the spontaneous resolution rates of AOM from different pathogens

90% spontaneous resolution when infected with M. catarrhalis,
50% with H. influenza,
10% with S.pneumonia,
overall 80% resolve within 2-14 days


sx of AOM

Irritability, fever, hearing loss with TM appearance including hyperemia, purulence, inflammation


when does AOM develop an effusion

After purulence resolves, it will leave an effusion which takes weeks to months to resolve


what is the most common cause of conductive hearing loss in children?



what is the percent of resolution of acute otitis w/ effusion at different months out

50% at 1 month
75% at 2 months
90% at 3 months


Fluid in middle ear without evidence of infection (often orange color)



Do zinc supplements have benefit in healthy children



Amoxicillin use between ages 20-24 months may cause

dental enamel defects


Multiple exposures to Halothane anesthesia associated with __

learning disabilities


what is glomus tympanicum

-Benign tumor of paraganglion
-reddish mass behind the TM
-freq. presents w/ a pulsatile tinnitus


-Brown’s sign-blanching of the reddish TM with pressure

glomus tympanicum


Glomus tumors

glomus tympanicum
glomus jugulare


what is glomus jugulare

Benign tumor of paraganglion arising in the jugular forament


what is considered mild, moderate, severe or profound bilateral hearing loss

mild (20-30 dB),
moderate (30-50 dB),
severe (50-70 dB), or
profound (more than70 dB)


types of hearing loss

1. conductive hearing loss (CHL)


what is conductive hearing loss (CHL) caused by

caused by dysfunction in the transmission of sound through the external or middle ear or by abnormal transduction of sound energy into neural activity in the inner ear and the 8th nerve


most common type of hearing loss in children and

conductive hearing loss

*occurs when sound transmission is physically impeded in the external and/or middle ear


Common causes of CHL in the ear canal include _____.
In the middle ear , ____
and ___

atresia or stenosis, impacted cerumen, or foreign bodies

-perforation of the tympanic membrane (TM), discontinuity or fixation of the ossicular chain, otitis media (OM) with effusion, otosclerosis,

-and cholesteatoma can cause CHL.


what is sensorineural hearing loss

Damage to or maldevelopment of structures in the inner ear


causes of sensorineural hearing los

hair cell destruction from noise, disease, or ototoxic agents; cochlear malformation; perilymphatic fistula of the round or oval window membrane; and lesions of the acoustic division of the 8th nerve


what is mixed hearing loss

a combination of CHL and SNHL


what is central (or retrocochlear) hearing loss?

-An auditory deficit originating along the central auditory nervous system pathways from the proximal 8th nerve to the cerebral cortex

-Tumors or demyelinating disease of the 8th nerve and cerebellopontine angle can cause hearing deficits but spare the outer, middle, and inner ear.


difficult even for children with normal hearing to listen selectively in the presence of noise, to combine information from the 2 ears properly, to process speech when it is slightly degraded, and to integrate auditory information when it is delivered faster although they can process it when delivered at a slow rate

central auditory processing disorders


what it the most common cause of CHL

middle-ear fluid


what in utero infections can cause hearing loss

Herpes Simplex



craniofacial anomalies associated w/ hearing loss

morphologic abnormalities of the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies


why is catching hearing loss at such a young age so important?

if hearing-impaired infants are identified and treated by age 6 mo, these children (with the exception of those with bilateral profound impairment) should develop the same level of language as their age-matched peers who are not hearing impaired.


how do multichannel cochlear implants work?

-These implants bypass injury to the organ of Corti and provide neural stimulation by way of an external microphone and a signal processor that digitizes auditory stimuli into digital radiofrequency impulses


benefits of multichannel cochlear implants

Cochlear implantation before age 2 yr (and even 1 yr) improves hearing and speech, enabling more than 90% of children to be in mainstream education. Most develop age-appropriate auditory perception and oral language skills.


what is the Y part of ear

-if it is not there, the ear sticks WAY out (can be fixed-- considered cosmetic)


-Cartilage can die if blood supply is cut off (similar to wrestlers ear)
-Can see where the infection stops-where cartilage ends (lobule looks normal)



what is salmon colored tissue in the ear canal?

-granulation tissue
-Chopped full of blood vessels, if you touch it, it bleeds

-1st try to calm it down via topical steroids (ciprodex drops)
-if the granulation tissue is there, refer to ENT for further investigation


-Appears with black dots
-Sx: some pressure and DRAINAGE

fungal otitis externa

*tx w/ antifungal drops


what is the difference between an osteoma and exostoses

Osteoma- Single lesion/bump, red in color, filling the ear canal

Exostoses- multiple lesions/bumps, light in color, if you touch it it will hurt and be very hard


how can you differentiate between a hard bone bump (exostose) and a cyst in the ear

If you touch it w/ a probe it will hurt if it is bone -->if you touch it and it doesn’t hurt it is soft (possibly a cyst) and not an exostoses


what is the number one foreign body that gets stuck in kids ears

popcorn kernel

*use right angle to slip behind it and pull it out


what is the most reliable landmark of the ear

lateral process of the malleus


what is the darkest and lightest thing youll see when looking in a ear

darkest: opening of the eustachian tube (anterior superior quadrant)

lightest: promontory of the cochlea (right under the umbo)


things to look at in the ear

1. Lateral process of malleus
2. Pars flaccida
3. Pars tensa
4. Umbo
5. Light reflex (suppose to be anterior-inferior quadrant)
6. Promontory of the cochlea (lightest)
7. Opening of Eustachian tube (darkest- anterior superior quadrant)
8. Incus
9. Anterior over hang
10. chorda tympani nerve (part of facial nerve- right under malleus)


what should the relationship be with the malleus and incus

parallel to each other

*these bone are fused together so when one moves so does the other


how can a TM joint disorder effect the ear

Any TM joint disorder (ie. inflammation) will give you ear pain
-AKA anterior over hang (part of TM joint)


EVERY draining ear gets ___

ear drops (even w/ perforations)

*use ciprodex if they can afford it-- for inflammation and possible infection


sx of retractions

-often none
-can feel "full" in ear
-pain on planes or at high altitude
-can see round window if retracted far enough


the indications for ENT referral of ear disorders

1. Auricular Hematoma: Need to refer due to potential deformity if not corrected immediately
2. Otitis Externa: May need ENT referral
3. Granulomas: Refer to ENT if cannot be resolved in primary care
4. Exostosis: Refer if cerumen trapped
5. Osteoma: Refer to ENT
6. TM Perforation: Refer to ENT if vertiginous after injury or infection
7. TM Retractions: If retractions are too great (visualization of incus and stapes), refer to ENT
8. Cholesteatoma: Always refer to ENT


what do you do if hearing loss is from persistent/recurrent OM

put in PE tubes


once hearing loss is identified what do you need

full developmental, speech, and language evaluation


Counseling and involvement of parents are required in ___ stages of evaluation and treatment and rehab with hearing loss



management of conducted hearing loss

often corrected through treatment of middle ear effusion (ear tube placement) or surgical correction of the abnormal sound-conducting mechanism


hearing aid can be fitted in children as young as

2 months of age


Infants and young children with profound congenital or prelingual onset of deafness need

mutichannel cochlear implants


Sensorineural hearing loss is associated w/ excessively high risk of

pneumococcal meningitis--> must be vaccinated with PCV 13


what is the immunization schedule for PCV 13

1st: 2-6 months
2nd: 7-11 months
3rd: 12-23 months
4th: 24-59 months


Total communication therapy approach includeds

mixture of sign language, lip reading, hearing aids, and speech


tx of idiopathic sudden SNHL

1. oral prednisone
2. Intratympanic dexamethosone perfusion
3. combo of both


when can genetic counseling be beneficial w/ hearing loss

-should be completed in diagnosis of SNHL or syndrome associated with SNHL and/or CHL in the case of future pregnancies and how baby might be effected
-Can also help evaluate child with hearing loss to potentially guide treatment based on establishing a dx


Pericondrium of the cartilage has been separated away from the cartilage and fluid is filling the space (pericondrium gives the nutritional support to the cartilage

auricular hematoma


-Pool of “goo” (infection)
-salmon colored red thing (tissue)-



treatment of granulomas

-topical steroids
-Ciprodex ear drops
-refer to ENT if you can't get granulation to resolve


potential complications of TM perforation

perilymphatic fistula


sx of perilymphatic fistula

vertignious after injury or infection that resulted in TM perforation