Ear Disorders

Question 1

What are some defenses of the ear?

Answer 1

• ear flap/tragus
• hair follicles
• cerumen

Question 2

How does cerumen protect the ear?

Answer 2

• “washes” the ear

- creates acidic environment

Question 3

What is perichondritis?

Answer 3

infection of the ear CARTILAGE
-serious
(usually unilateral)

Question 4

What is perichondritis caused by?

Answer 4

• usually secondary to trauma

- usually caused by pseudomonas

Question 5

Why is perichondritis difficult to cure?

Answer 5

poor vascularity

Question 6

What is a big difference between cellulitis and perichondritis?

Answer 6

• cellulitis is an infection of the SKIN

- might see lobe involvement with cellulitis

Question 7

What is relapsing polychondritis?

Answer 7

• relapsing
• bilateral
• probably autoimmune

Question 8

What is Otitis Externa?

Answer 8

Generic term for generic disorders of the EAR CANAL

Question 9

Culprits/causes of otitis externa

Answer 9

• pseudomonas
• fungus
• staph aureus
• seborrheic dermatitis

Question 10

How does Hadley describe swimmer’s ear?

Answer 10

dishwasher’s hands of the ear

Question 11

What otitis external might you see in DM?

Answer 11

malignant external otitis

-requires referral!

Question 12

If an otitis external is vesicular, what should you consider?

Answer 12

consider a herpes zoster outbreak

*ENT emergency

Question 13

sx of otitis externa

Answer 13

• otalgia
• pruritis
• discharge

Question 14

exam findings on otitis externa

Answer 14

• erythema
• edema
• pain tugging on pain
• can’t really see TM

Question 15

Tx of otitis externa

Answer 15

• for the most part treated topically, not oral abs usually
• otic drops (usually steroidal for swelling)
• abx if bacterial (vs. purulent)
• isopropyl alcohol for drying (swimmer’s ear)
• acetic acid for fungal or pseudomonal

Question 16

How can you get drops deeper?

Answer 16

wick left in for a few days

Question 17

If you prescribe abs for otitis external what should you consider?

Answer 17

• bacterial

- must cover for pseudomonas (cipro or cortisporin)

Question 18

What could you use to treat fungal or pseudomonal otitis external?

Answer 18

2% HAc (acetic acid/half strength vinegar)

Question 19

What is creaminess?

Answer 19

• excess, accumulation of cerumen

- clogs ear and affects hearing

Question 20

Tx of ceruminosis

Answer 20

• gently irrigate/ ear lavage

- cerumenex to soften wax before irrigation

Question 21

What is acute otitis media

Answer 21

-bacterial infection of the middle ear

Question 22

What are the bacterial causes of acute otitis media?

Answer 22

• *S. pneumo
• M. cat
• H. flu

Question 23

What is acute otitis media usually precipitated by?

Answer 23

a URI which causes cascade of congestion which obstructs ET drainage

Question 24

What is the single best predictor of acute otitis media?

second best?

Answer 24

• TM immobility

- “cloudiness”

Question 25

AAP update for acute otitis media | notes about what should be present/ what you should see

Answer 25

- moderate to severe TM bulge - Mild TM bulge AND ear pain or intense TM erythema - no effusion, no AOM

Question 26

According to the AAP, what 3 things does a dx of AOM require?

Answer 26

- hx of acute onset s/s - presence of MEE (middle ear effusion = fluid) - s/s middle ear inflammation

Question 27

Is Acute otitis media more common in children or adults? and why?

Answer 27

children | -because of angle of eustachian tube

Question 28

sx of acute otitis media

Answer 28

- otalgia - fever - cough - runny nose - decreased hearing

Question 29

Exam findings of AOM

Answer 29

- bulging TM - decreased, distorted, or absent light reflex - redness - DOCUMENTED EVIDENCE OF TYMPANIC IMMOBILITY (AAP guideline)

Question 30

Normal TM looks/findings

Answer 30

- translucent/transparent - gray or pink color - neutral position - fully mobile with pneumatic otoscope - no effusion

Question 31

What is tympanometry

Answer 31

- distinguishes between retracted and distended TM | - can help distinguish b/t AOM and OME

Question 32

TM characteristics of AOM

Answer 32

- opaque - red, yellow, white color - BULGING or full position - reduced mobility but may respond to POS press on pneumatic otoscope - effusion present

Question 33

TM characteristics of Otitis Media with Effusion (OME)

Answer 33

- transluscent or opaque - gray or pink color - neutral or RETRACTED position - reduced mobility which responded to NEG press on pneumatic otoscope - effusion present

Question 34

Tx goals of AOM

Answer 34

-decrease pain and fever

Question 35

Tx of AOM

Answer 35

- tx pain with tylenol/ibuprofen (because it's an inflammatory problem) - auralgan (antipyrine, benzocaine, dehydrated glycerin)

Question 36

abs treatment of AOM

Answer 36

- amoxicilin first line | - Augmentin second line (amox-clav)

Question 37

Should see improvement in _____ (with AOM abx)

Answer 37

in 72 hrs - if not, change antibiotic - effusion can persist for 12 wks

Question 38

when do you recommend tubes?

Answer 38

more than 3 in 6 months

Question 39

What had led to a pathogen shift from pneumococcus to H flu?

Answer 39

pneumococcal conjugate vaccine

Question 40

55% of H. flu from children with AOM that doesn't resolve from oral abx are________ producers

Answer 40

B-lactamase

Question 41

Otitis Media with Effusion (OME)

Answer 41

- effusion w/o acute sx - no infection!! - fluid in middle ear without s/s of acute ear infection

Question 42

concerns of OME

Answer 42

hearing loss, effects on speech, language, learning

Question 43

what is the preferred initial procedure for persistent OME

Answer 43

tympanostomy tube insertion

Question 44

______ testing should be conducted for children who have hearing loss

Answer 44

language testing

Question 45

dix-hallpike maneuver

Answer 45

to localize labyrinthine dysfunction

Question 46

epley maneuver

Answer 46

to reposition otoliths | -habituate vertigo by performing movements that reproduce sx

Question 47

classic triad of meniere disease?

Answer 47

- hearing loss - vertigo - tennitus

Question 48

Meniere disease s/s

Answer 48

- hearing loss - vertigo - tinnitus - usually unilateral - intermittent attacks

Question 49

What distinguishes Meniere disease from BBPV

Answer 49

-hearing loss | no hearing loss in BBPV

Question 50

cause of miner disease

Answer 50

- buildup of endolymph pressure | - idiopathic

Question 51

meniere disease treatment

Answer 51

scopolamine, diuretics, meclizine/antivert

Question 52

vestibular neuronitis

Answer 52

- sudden onset vertigo - due to imbalance in vestibular syst - may involve latent herp v1

Question 53

labyrinthitis

Answer 53

- inflammatory disorder of INNER ear/labyrinth - hearing loss always present - does NOT tend to recur (unlike vestibular neuronitis)

Question 54

What is a variant of labyrinthitis?

Answer 54

- Herpes zoster Oticus (Ramsay-hunt syndrome) - reactivation of latent varicella zoster - initial sx deep burning auricular pain followed by vesicular rash in external canal