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Ear Disorders Flashcards

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1
Q

Name the Disorders of the Ear

A 
ET Dysfunction
Otitis Media
Otitis Externa
TM Perforation
Barotrauma
FB of the Ear
Cerumen Impaction
Mastoiditis
Acoustic Neuroma
Vertigo Syndromes
Presbycusis
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2
Q

How to Examine EAC?

A

Pull auricle up and back
Visualize canal
Look at the TM

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3
Q

Landmarks of the TM

A

Umbo
Handle of Malleus
Light reflex

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4
Q

Define Eustachian Tube Dysfunction

A

Failure of the system at the proximal end to regulate the middle-ear and mastoid gas cell system at its distal end

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5
Q

What system is affected by ET Dysfunction?

A

Auditory

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6
Q

Eustachian Tube Functions

A

Ventilation/regulation of middle ear pressure
Protection from nasopharyngeal secretions
Drainage of middle ear
Closed at rest
Open with yawning, swallowing, sneezing

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7
Q

What kind of hearing loss occurs with pressure differences

A

Conductive hearing loss

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8
Q

Cycle of dysfunction includes 1 of 3 functions of the system

A

Negative pressure develops in middle ear
Serous exudate drawn from middle ear or refluxed into middle ear
Infection of static fluid causes edema, inflammation, and obstruction

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9
Q

Epidemiology of ET Dysfunction

A

Children

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10
Q

Pediatric Considerations of ET Dysfunction

A

Horizontal ET
Shorter ET
Associated with URI, adenoid hypertrophy, allergic rhinitis, GERD

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11
Q

Risk Factors for ET Dysfunction

A 
Tobacco/pollutant exposure
GERD
Allergy
Chronic sinusitis
OSA with CPAP
Adenoid hypertrophy
Neuromuscular disease
Family history
Altered immunity
Early onset of ET dysfunction in siblings
Native American, Inuit, or Australian Aborigine
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12
Q

Pediatric Risk Factors for ET Dysfunction

A 
2nd-hand smoke
Prematurity/low birth weight
Young age
Craniofacial abnormalities
Daycare
Crowded living conditions
Low SES
Prone sleeping position
Prolonged bottle use
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13
Q

Common Associated Conditions with ET Dysfunction

A 
Hearing loss
Middle ear effusion
Cholesteatoma
Allergic rhinitis
Chronic sinusitis
URI
Adenoid hypertrophy
GERD
Cleft palate
Down Syndrome
Obesity
Nasopharyngeal CA
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14
Q

Avoid decongestants in which patients

A

Hypertensive

Cardiac

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15
Q

Treatment of ET Dysfunction

A 
Decongestants
Nasal steroids
2nd-generation H1 antihistamines
Antihistamine nasal sprays
Antibiotics
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16
Q

Types of Decongestants Used

A

Phenylephrine
Pseudoephedrine (Sudafed)
Oxymetazoline (Afrin)

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17
Q

Types of Nasal Steroids

A 
Beclomethason (Beconase, Vancenase)
Budesonide (Rhinocort)
Flunisolide (Nasarel, Nasalide)
Fluticasone (Flonase)
Ciclesonide (Omnaris)
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18
Q

Types of 2nd-Generation H1 Antihistamines

A

Loratadine (Claritin)
Desloratidine (Clarinex)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)

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19
Q

Types of Antihistamine Nasal Sprays

A

Olotpatadine (Patanase)

Asteline (Azelastine)

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20
Q

Antibiotic if ET Dysfunction with OM

A

Amoxicillin

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21
Q

Define Otitis Media

A

Infection of the middle ear with acute onset, presence of middle ear effusion and signs of middle ear inflammation

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22
Q

Risk Factors of Otitis Media

A 
Bottle feeds while supine
Daycare
Formula feeding
Smoking in house
Male gender
Family Hx of middle ear disease
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23
Q

Signs/Symptoms of Otitis Media

A 
Earache
Tugging on ears
Fever
Accompanying URI symptoms
Irritability 
Difficulty sleeping
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24
Q

Otoscopic Exam in OM

A 
Decreased visibility of landmarks
Decrease TM mobility
Bulging TM
Opaque
Red
Pus in middle ear
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25
Bacterial Culprits of OM
Strep pneumo (30-35%) H. flu (20-25%) M. cat (10-15%)
26
Beta-lactam Resistant OM Bacteria
H. flu | M. cat
27
Antibiotic Treatment of OM
``` Amoxicillin Augmentin Cephalosporins Erythromycin Azithromycin ```
28
Treatment of Pain/Fever in OM
Ibuprofen Tylenol Auralgan
29
Follow up
48-72 hours if failure to improve | 14-21 days if resolved symptoms
30
Management of OM
Most improve spontaneously Antibiotics Analgesics
31
When to provide antibiotics in OM
32
Define OM with Effusion
Presence of middle ear effusion in the absence of acute signs of infection
33
Symptoms of OM with Effusion
``` Hearing loss Fullness in ear Tugging at ear Delayed speech/language development Unsteady gait Pain (rarely) ```
34
Otoscope Exam in OM with Effusion
TM dull & retracted No mobility of TM Straw/tan color of TM Sterile fluid in middle ear
35
What is the single most recommended diagnostic method to establish the diagnosis of otitis media with effusion?
Pneumatic otoscopy
36
Treatment of OM with Effusion
Watchful waiting for 3 months | Then hearing test
37
What to do in the watchful waiting period for OM with effusion?
``` Speak close to the child Face the child when speaking Speak clearly Repeat phrases Preferential seating in the classroom ```
38
When should a hearing test be performed with OM with effusion?
After 3 months of watchful waiting
39
How often should you re-examine children with OM with effusion?
3-6 month intervals
40
Define Chronic Suppurative Otitis
Perforated tympanic membrane with persistent drainage from the middle ear
41
Risk Factors for Chronic Suppurative Otitis
Hx of multiple episodes of AOM Living in crowded conditions Daycare Family member of large family
42
Bacterial Culprits of Chronic Suppurative Otitis
Pseudomonas aeruginosa (50-98%) Staph aureus (15-30%) Klebsiella Proteus
43
Sequelae of Chronic Suppurative Otitis
Conductive hearing loss | Intracranial complications
44
Presentation of Chronic Suppurative Otitis
Otorrhea Edematous external canal Not tender Granulation tissue in medial canal of middle ear space Middle ear mocosa (edematous, polypoid, pale or erythematous) Discharge
45
Labs for Chronic Suppurative Otitis
Culture for sensitivity
46
Treatment for Chronic Suppurative Otitis
Removal of exudate | Ciprofloxin (failed cases)
47
Define Cholesteoma
Skin growth that occurs in the middle ear behind the eardrum
48
Cause of Cholesteoma
Repeated infection | Poor ET function
49
Presentation of Cholesteoma
``` Otorrhea Feeling of pressure in ear Hearing loss Achy ear Dizziness Facial weakness on affected side ```
50
Diagnostics of Cholesteoma
Otoscopy Audiometry Xray/CT of mastoid
51
Treatment of Cholesteoma
Surgical treatment
52
Define Otitis Externa
Inflammation of the external auditory canal or auricle
53
Causes of Otitis Externa
Infectious Allergic Dermal disease
54
Bacterial Culprits of Otitis Externa
Staph aureus Pseudomonas aeruginosa (swimmers ear) Proteus
55
Signs/Symptoms of Otitis Externa
``` Otalgia Pain at triages Pain when auricle pulled Pruritis Discharge Hearing loss ```
56
Otoscopic Exam in Otitis Externa
``` Edematous Erythematous Yellow, brown, white, or grey debris No middle ear fluid TM mobile ```
57
Treatment of Otitis Externa
Cleaning of ear canal Protect ear canal from water Treatment of inflammation and infection
58
Inflammation/infection Treatment in Otitis Externa
Cortisporin Cipro HC Tobradex
59
Define Malignant External Otitis (Necrotizing Otitis Externa)
Invasive infection of the external auditory canal and skull base
60
High Risk Patients for Malignant External Otitis (Necrotizing Otitis Externa)
Elderly with DM AIDS Immunocompromised
61
Main Bug of Malignant External Otitis (Necrotizing Otitis Externa)
Pseudomonas aeruginosa
62
Clinical Manifestations of Malignant External Otitis (Necrotizing Otitis Externa)
Otalgia | Otorrhea
63
Otoscopic Exam of Malignant External Otitis (Necrotizing Otitis Externa)
Granulation in inferior portion of the external auditory canal
64
Complications of Malignant External Otitis (Necrotizing Otitis Externa)
Osteomyelitis in base of skull Mastoiditis TMJ osteomyelitis Cranial nerve palsies
65
Diagnosis of Malignant Otitis Externa
Elevated ESR Positive culture Imaging
66
Treatment of Malignant Otitis Externa
Ciprofloxin | NO TOPICAL ANTIBIOTICS
67
Clinical Manifestations of TM Perforations
Clear, pus-filled or bloody drainage from ear Sudden decrease in ear pain Hearing loss Tinnitus
68
Causes of TM Perforations
``` Middle ear infection Airplane ear Acoustic trauma FB in ear Loud, sudden noise ```
69
Treatment of TM Perforation
``` Heal on own No antibiotics Keep ear dry Ear drum patch Tympanoplasty ```
70
Most frequent cause of Barotrauma
Flying | Diving (2nd)
71
Clinical Manifestations of Barotrauma
Pressure in the ear Pain due to stretching of TM Hearing loss Tinnitus
72
Treatment of Barotrauma
Valsalva maneuver Decongestants Myringotomy
73
Prevention of Barotrauma
``` Avoidance Pre flight decongestants Chewing gum Yawning Swallowing ```
74
Treatment of FB in the Ear
Removal
75
How to remove FB from ear
Adequate visualization Appropriate equipment Cooperative patient Skilled provider
76
Removal Techniques of Cerumen IMpactions
Hydrogen peroxide Debrox Irrigation Suction
77
When can you not irrigate for cerumen impaction?
TM not intact
78
What is mastoiditis a complication of?
Otitis media
79
Define Mastoiditis
Middle ear inflammation spreads to the mastoid air cells
80
Characteristics of Mastoiditis
Postauricular pain Post auricular erythema Spiking fever Tender mass
81
Diagnostics of Mastoiditis
ENT consult CT MRI if intracranial involvement
82
Treatment for Mastoiditis
``` IV antibiotics Ceftriaxone (Rocephin) Piperacillin & tazobactam sodium (Zosyn) Oxacillin (Bactocill) Gentamicin (Garamycin) ```
83
Why are acoustic neuroma's dangerous?
Can eventually compress the pons | Hydrocephalus
84
Risk Factor for Acoustic Neuroma
Exposure to loud noise Neurofibromatosis type 2 Hx of parathyroid adenoma Cell phones??
85
Symptoms of Acoustic Neuroma
``` Hearing loss Tinnitus Unsteadiness while walking Facial numbness Hypestesia Pain Facial paresis Taste disturbances ```
86
Diagnostics of Acoustic Neuroma
Demonstration of asymmetric sensorineural hearing loss MRI or CT ENT referrel Audiometry
87
Treatment for Acoustic Neuroma
Surgery
88
Define Vertigo Syndromes
Symptoms of illusory movement
89
How Does Vertigo Syndromes Appear?
Transient spinning dizziness Sense of swaying or tilting Sense of falling backing
90
Causes of Vertigo Syndromes
Asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem
91
Characteristics of Peripheral Vertigo Syndromes
Sudden onset Horizontal nystagmus Visual fixation inhibits nystagmus
92
Characteristics of Central Vertigo Syndromes
``` Gradual onset Any direction nystagmus Visual fixation doesn't stop nystagmus Signs of brainstem dysfunction Instability ```
93
Symptoms of Peripheral Vertigo Syndromes
``` Blurred vision Fatigue Headache Palpitations Inability to concentrate Increased risk for motion sickness N/V Reduced cognitive function Photophobia Sound sensitive Sweating ```
94
Symptoms of Central Vertigo Syndromes
``` Double vision Headache Impaired consciousness Inability to speak Lack of coordination N/V Weakness ```
95
Benign Paroxysmal Positional Vertigo
Dizziness due to debris which has collected in the inner ear | Debri derived from utricle
96
Characteristics of Benign Paroxysmal Positional Vertigo
Recurrent & brief episodes Predictable head movements/positions precipitate symptoms Horizontal nystagmus
97
Which test is best for determining benign paroxysmal positional vertigo?
Dix-Hallpike maneuver
98
What is the Dix-Hallpike Maneuver?
Person is brought from sitting to supine position with the head turned 45 degrees to the side and extended 20 degrees backward
99
What does a positive Dix-Hallpike test consist of?
Burst of nystagmus
100
Treatment for Benign Paroxysmal Positional Vertigo
Wait it out | Epley Maneuver
101
What is the Epley Maneuver?
Sequential movement of the head into 4 positions staying in each position for about 30 seconds
102
Define Labrynthitis
Inflammation of the inner ear
103
Clinical Course of Labrynthitis
Vertigo Gradually goes away Possible temporary hearing loss
104
Possible Causes of Labyrinthitis
Viral URI | Middle ear infection
105
Treatment of Labyrinthitis
Usually goes away on own (several weeks) | Medications for N/V
106
Medications for N/V in Labyrinthitis
Prochlorperazine (Compazine) Meclazine (Antivert) Diazepam/Lorazepam
107
What does Meniere's Disease result from?
Distention of the endolymphatic compartment of the inner ear
108
Clinical Presentation of Meniere's Disease
Episodic vertigo lasting 1-8 hours Low frequency sensorineural hearing loss Tinnitus Sensation of aural pressure
109
Diagnostic Criteria for Meniere's Disease
2 spontaneous episodes >20 minutes Audiometric confirmation of sensorineural hearing loss Tinnitus
110
Treatment of Meniere's Disease
Dietary restrictions | Medications
111
Dietary Restriction Treatment Options
Caffeine Tobacco Salt
112
Medication Treatment Options
``` Diuretics Antiemetics Anxiolytics Antihistamines Scopolamine ```
113
Define Presbycusis
Sensorineural hearing impairment in elderly individuals
114
What does sensory presbycusis refer to?
Epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti
115
What does neural presbycusis refer to?
Atrophy of nerve cells in the cochlea and central neural pathways
116
What does metabolic presbycusis result from?
Atrophy of the stria vascularis causing a flat hearing curve
117
What does mechanical presbycusis result from?
Thickening and secondary stiffening of the basilar membrane of the cochlea
118
Clinical Presentation of Presbycusis
Difficulty understanding rapidly spoken language, complex vocabulary, speech in noisy, distracting environment
119
Treatment of Presbycusis
Amplification devices (hearing aides) Lip reading Cochlear implants Assistive listening devices

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