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FA17 HEENT > Ear Disorders > Flashcards

Ear Disorders Flashcards

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1
Q

cerumen impaction

A

pushing back the cerumen of the ear causing hearing loss, pruritis, fullness, odor, etc.

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2
Q

how do you treat cerumen impaction?

A

dx with direct visualization

removal with cerumenolytic + manual removal or office irrigation

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3
Q

temperature of fluid used in cerumen irrigation

A

tepid/warm

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4
Q

cerumenolytics are CI in who?

A 
TM damage
freq. infection 
TM perforation
Otolgic surgery 
Drainage from ear + ear pain
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5
Q

drug name used for cerumenolytic

A

Carbamide Peroxide 6.5% (Debrox)

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6
Q

cerumen patient education

A

clean only external ear, use wash cloth or finger

DONT use Q Tips

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7
Q

otitis externa signs

A

inflammation and edema in the ear canal
purulent exudate

manipulation of auricle or triages elicits pain

may be hard to visualize TM due to exudate

typically suspected in patients who have recently been sum urged in water

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8
Q

treatment for otitis externa

A

protection from moisture/drying agent *alcohol)

ciprodex drops

remove purulent debris (wick)

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9
Q

pathogens typically causing otitis external

A

gram negative rods (PSEUDOMONAS), staph aureus or fungi (immunocompromised)

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10
Q

malignant otitis externa (MOE)

A

EO that progresses into osteomyelitis of temporal bone

can be life threatening (get into skull.bone, nerve damage)

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11
Q

hallmark finding of MOE

A

granulation tissue at the floor of osseocartilaginous junction

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12
Q

treatment of MOE

A

Emergent ENT consult, CT scan, admission

start ABx immediately (gives better results) and surgically remove damage tissue

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13
Q

eustachian tube

A

connection between middle ear and throat that opens to equalize pressure in cavity with that of atmosphere

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14
Q

eustachian tube dysfunction

A

occurs when air trapped in the middle ear is absorbed and negative pressure results

typically caused by URI and allergies

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15
Q

eustachian tube dysfunction treatment

A

Sudafed
oxymetazoline (farina and nostrilla)

auto-inflation (yawning, chewing)
corticosteroids for allegires

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16
Q

barotrauma

A

patient with poor eustachian tube function are unable to equalize under pressure

can be caused by air travel or diving

suggest chewing, yawning, decongestant use

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17
Q

TM perforation

A

can be caused by any ear ache

may present with acute pain that subsides quickly, hearing loss

be sure to avoid water and tx topical flouroquinalones

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18
Q

Serous otitis media

A

prolong eustachian tube dysfunction with negative pressure causes accumulation of fluid

mc in children or following allergies, URI and barotrauma in adults

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19
Q

Serous otitis media symptoms

A

hearing loss
tugging or pulling at one or both ears
loss of balance
delayed speech impairment

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20
Q

Serous otitis media exam findings

A

tm is dull and hyper mobile

with air bubbles and conductive hearing loss

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21
Q

Serous otitis media treatment

A

short course of oral corticosteroids +/- ABX

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22
Q

acute otitis media

etiology

A

bacterial colonization of middle ear in eustachian tube dysfunction

typically precipitated by URI that causes obstruction

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23
Q

MC pathogens in acute otitis media

A

Strep pneumonia

H flu (AOM + conjunctivitis)

strep pyogenes

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24
Q

criteria for AOM diagnosis

A

acute onset
presence of middle ear effusion

signs of middle ear inflammation (red TM, pain, and fever)

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25
what is NOT AOM?
erythema of TM without middle ear effusion ear pain with normal TM
26
AOM treatment
antibiotics (if age appropriate) also use pain management agents (ibuprofen or tylenol) decongestants are discouraged DOC: Amoxicillin (unless H Flu) 10 days
27
AOM medication ADR
rash, headache, eosinophilia/anemia, GI upset
28
AOM in adults
first line: Amoxicillin first line if PCN allergic : Azithromycin or Claritohrmycin
29
chronic supperative otitis media (CSOM)
develops after recurrent AOM typically has TM perforation ** Purulent discharge ** conductive hearing loss
30
bacteria pathogens in CSOM
P. aeruginosa, propus, staph aureus, anaerobic
31
CSOM treatment
removal of pus topical ABx drops (cipro + desmethasone) definitive tx - surgical TM repair
32
complications of otitis media
myringosclerosis/tympanosclerosis cholestoma acute mastoiditis
33
myringosclerosis/tympanosclerosis
large, chalky white patch on TM with irregular margins scar tissue typically due to recurrent OM
34
cholesteatoma
destructive epithelial cyst in mid ear that may extend to mastoid air cells (cyst) causes erosion of bones typically caused by repeated ear infection can be filled with keratin and chronically infected
35
cholesteatoma symptoms
persistent infection, foul drainage, pressure, pain worse at night can have CNS symptoms develop possible as it grows intracranially may see perforation in TM that leaks keratin debris or granulation tissue
36
cholesteatoma treatment
surgical marsupialization or complete removal may require creation of mastoid bowl joined into large common cavity that must be cleaned
37
mastoiditis
extension of infection into the air cells complication of AOM pain and tenderness over the mastoid, edema, and erythema of post auricular soft tissues and fever s. pneumo, h. flu, s. pyogenes coalescence of mastoid air cell
38
mastoiditis tx
broad spectrum Abx esp. Ancef
39
Equilibrium
done by dynamic equilibrium semicircular canals -- three loops respond to changes in angular motion moving fluid in these canals disturbs crust ampullaris - detects rotational motion
40
vestibule and equilibrium
between conceal and semicircular canals contains static equilibrium receptors (maculae) linear acceleration
41
proprioceptors that control balance
``` semi-circular canals crista ampullaris rotational motion vestibule maculae static equilibrium ```
42
vertigo
perceived sensation of moving can be peripheral, CNS, or systemic
43
peripheral vertigo s/s
sudden onset may have N/V hearing loss tinnitus unable to walk or stand
44
peripheral vertigo cause
``` BPPV labyrinthitis Meniere''s disease positional vertigo vestibular neuoritis ```
45
central vertigo
slow onset motor, sensory, or cerebellar defects
46
central vertigo cause
brainstem vascular disease, arteriovenous malformation, tumors of brainstem of cerebellum, MS
47
vertigo PE
look for nystagmus pneumatic otoscope cause nystagmus and vertigo in perilymph fistula
48
BPPV
mc cause of peripheral vertigo otoconia particles from utricle or scull lodge in posterior semicircular canal typically cured by Epley Maneuver
49
labyrinthitis
acute onset of continuous usually severe vertigo lasting several days to a week hearing loss and tinnitus
50
labyrinthitis treat
meclizine (Antivert) cyclizing (Marezine) dimenhydrinate (Dramamine) motion sickness tx
51
vestibular neuronitis
paroxysmal single attack of vertigo (w/o auditory impairment) nystagmus present
52
Meniere's Disease
disorder of the inner ear distention of the endolymphatic compartment
53
triad of Meniere's disease
low frequency hearing loss episodic vertigo and tinnitus (aural pressure)
54
Meniere's disease management
primary treatment involves low salt diet, diuretics endolympatic sac decompression typically gives symptom free periods between a cluster of episodes
55
mechanisms of hearing
1. stirrup vibrates oval window causes cochlear fluids to start moving stimulates organ of court in central canal of choclea 2. organ of court has three parts - tectoral membrane bends and pulls hairs 3. nerve impulses travel from cochlea to brain via cochlear nerve to medulla oblongata to midbrain to auditory context
56
hearing loss
may be acute or chronic weber and rinne tests differentiate
57
conductive hearing loss
caused by impaired transmission of sound along external canal, across the ossicles and thru oval window TEMPROARY abnormalities in middle or external ear
58
mechanisms of conductive hearing loss
``` obstruction (cerumen impaction) mass loading (middle ear effusion) stiffness effect (otosclerosis) discontinuity (ossicular disruption) ```
59
conductive hearing loss tx
application, fluoride treatments, stapedectomy
60
sensorineural hearing loss
disruption in nerves or mechanics of hearing loss hair cell function caused by neural degeneration, decrease cilia, ossicles not correctable
61
weber test and hearing loss results
lateralizes teste conductive loss - sound to bad ear sensorineural loss - sound to good ear
62
rinne test and hearing loss test results
conductive loss: good ear AC > BC and bad ear BC > AC sensorineural loss: AC > BC
63
acoustic neuroma pathophys
Schwann cell derived benign tumors vestibular portion of eighth cranial nerve asymmetrical hearing loss, tinnitus, instead walking
64
acoustic neuroma nerves effected
``` cochlear nerve vestibular nerve trigeminal nerve facial nerve tumor progression ```
65
cochlear nerve acoustic neuroma symptoms
hearing loss (unilateral and chronic) can be sudden tinnitus
66
vestibular nerve acoustic neuroma symptoms
unsteady walking
67
acoustic neuroma symptoms trigeminal nerve
facial numbness (paresthesia), hypethesia, and pain
68
acoustic neuroma symptoms facial nerve
facial paresis
69
acoustic neuroma symptoms tumor progression
brainstem compression cerebellar tonsil herniation hydrocephalus and death

FA17 HEENT (8 decks)

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