Ear Disorders

Question 1

What causes otitis externa? AKA - Swimmer’s ear

Answer 1

Excess H2O or local trauma –> change in pH –> bacterial overgrowth

Pseudomonas MC

Question 2

What are s/s of otitis externa?

Answer 2

1-2 days of ear pain, pruritus

Auricular discharge, pressure/fullness

Question 3

What does otitis externa look like on PE?

Answer 3

Pain on traction of the ear canal/tragus

Erythema, edema, debris

Question 4

How do you treat otitis externa?

Answer 4

Topical cipro/dexamethasone (ofloxacin if TM perforation)

Aminoglycoside combo (neomycin/polytrimB/hydrocortisone)

Question 5

What causes acute otitis media?

Answer 5

MC preceded by viral URI

4 organisms: S. pneumo (MC), H. influenza, Moraxella catarrhalis, S. pyogenes

Question 6

What are s/s of acute otitis media?

Answer 6

Fever, otalgia, ear tugging, hearing loss, stuffiness

If perforation –> rapid relief of pain + otorrhea

Question 7

What does acute otitis media look like on PE?

Answer 7

Bulging, erythematous TM w/ effusion

Decreased TM mobility

If bullae on TM –> suspect mycoplasma pneumo

Question 8

How do you treat acute otitis media?

Answer 8

Amoxicillin = TOC! x 10-14 days.

2nd line = augmentin

PCN allergic –> erythromycin-sulfisoxazole

If severe/recurrent –> myringotomy, tympanostomy

Question 9

What causes chronic otitis media?

Answer 9

Complication of acute otitis media, trauma, or cholesteatoma

Pseudomonas, S.aureus

Question 10

What are s/s of chronic otitis media?

Answer 10

Perforated TM + persistent or recurrent purulent otorrhea +/- pain

Conductive hearing loss +/- cholesteatoma

Question 11

How do you treat chronic otitis media?

Answer 11

Topical oflaxacin or cipro 1st line

TM repair/reconstruction

If severe –> mastoidectomy

Question 12

How do you treat cerumen impaction?

Answer 12

Cerumen softening: Hydrogen peroxide, carbamide peroxide

Aural toilet: irrigation, curettage, suction

Question 13

What causes Meniere’s Disease?

Answer 13

Idiopathic distention of the endolymphatic compartment of the inner ear by excess fluid

Question 14

What are the s/s of Meniere’s Disease?

Answer 14

Episodic peripheral vertigo lasting 1-8hrs

Horizontal nystagmus

N/V

Question 15

How do you diagnose Meniere’s Disease?

Answer 15

Transtympanic electrocochleography

Loss of nystagmus w/ caloric testing

Audiometry

Question 16

How do you treat Meniere’s Disease?

Answer 16

Antiemetics, antihistamines (meclizine), benzos

If refractory/severe –> decompression

Preventative –> diuretics, avoid salt/caffeine/chocolate/etoh

Question 17

What are the 2 types of vertigo?

Answer 17

Peripheral & central

Question 18

What causes peripheral vertigo?

Answer 18

1. Benign positional vertigo (MC): episodic
2. Meniere: episodic + hearing loss
3. Vestibular neuritis: continuous
4. Labyrinthitis: continuous + hearing loss
5. Cholesteatoma

Question 19

What does peripheral vertigo look like on PE?

Answer 19

Horizontal nystagmus, fatigable

Sudden tinnitus & hearing loss

Question 20

What causes central vertigo?

Answer 20

Cerebellopontine tumors
Migraines
Cerebral vascular disease 
MS 
Vestibular neuroma

Question 21

What does central vertigo look like on PE?

Answer 21

Vertical nystagmus, nonfatigable

Gait problems, + CNS signs

Gradual onset

Question 22

How do you treat vertigo?

Answer 22

1. Antihistamines 1st line
2. Dopamine blockers: metoclopramide, prochlorperazine, IV promethazine (often given w/ Benedryl to prevent dystonic rxns)
3. Anticholinergics: scopolamine
4. Benzos

Question 23

What are s/s of labyrinthitis?

Answer 23

vestibular neuritis + hearing loss/ tinnitus

Question 24

How do you treat labyrinthitis?

Answer 24

Corticosteroids 1st line

If sx –> antihistamines (meclizine)