Ear Disorders

Question 1

Auricular Hematoma

Answer 1

• Collection of blood around the external ear
• Blunt trauma
• Sporting events or altercations

Question 2

Auricular Hematoma management inlcudes?

Answer 2

• Prompt drainage to prevent the re-accumulation of blood

Question 3

T or F

Cauliflower ear is the permanent deformity

Answer 3

• True

Question 4

Auricular Hematoma management for < 2cm and present within 48 hours ?

Answer 4

• Needle aspiration

Question 5

Auricular Hematoma management for > 2cm and present from 48 to 7 days ?

Answer 5

• I & D

Aftercare
- Prevent re-accumulation of blood 
- Compression bandage or bolster 
- Recheck 
Every 24 hours 
For 3-5 days

Question 6

Cerumen impaction

Answer 6

• Very common but most won’t build up

- Cerumen is a protective secretion

Question 7

Cerumen impaction causes?

Answer 7

Repeated stimulation of the ear canal

• Ear plugs
• Loud music
• Ear buds
• Q-tips

Question 8

Cerumen impaction symptoms?

Answer 8

• Feeling of fullness in the ear
• Pain in the ear
• Difficulty hearing, which may continue to worsen
• Tinnitus
• A feeling of itchiness in the ear
• Discharge from the ear
• Odor coming from the ear
• Dizziness

Question 9

Cerumen impaction management ?

Answer 9

• Warm shower water
• Home wax removal kits
• Avoid Q tips
• Use something to soften the wax
  1) Debrox
  2) Colace
• Irrigation
  1) Commercial kits
  2) Bulb suction
  3) IV catheter
• Warm water +
• Hydrogen peroxide

Question 10

Cerumen impaction management preferred treatment ?

Answer 10

• The least invasive method

Question 11

A cooperative patient helps facilitate the removal of a foreign body ?

T or F

Answer 11

• True

Question 12

Removal of a foreign body ?

Answer 12

Attempted with

• Loop
• Irrigation
• Commercial devices
• Alligator forceps
• Lights for insects

Question 13

Should you consider Abx for a pt with a foreign body?

T or F

Answer 13

• True

- For trauma to the canal

Question 14

Otitis externa

Answer 14

• Infection of the external auditory canal

Question 15

Otitis externa causes include?

Answer 15

• Warm summer months
• Frequent swimming
• Warm humid environment
• Mechanical trauma
• Scratching

Question 16

Most common pathogen causing Otitis Extrerna ?

Answer 16

1 Pseudomonas MC

#3 Anerobes
Bacteroides
Clostridil
Strep
Fungi

Question 17

Otitis externa presenting symptoms?

Answer 17

• Ear pain - Very Painful
• Pruritus
• Discharge
• Hearing loss

Question 18

Otitis externa PE findings?

Answer 18

• Pain with manipulation of the tragus or auricle
• Insertion of the otoscope may be very painful
• Ear canal: edema and erythema
• Debris and cerumen
• TM
  Partially visible
  Fully visible

Depending on degree of swelling

Question 19

Otitis Externa management includes ?

Answer 19

• Clean out the ear canal
• Gentle irrigation
• Goal is to reduce inflammation and infection

Question 20

Otitis Externa topical Abx Tx includes?

Answer 20

• Cetraxal otic (Cipro)
• Ofloxacin (generic)

Combination
Abx + Steroids

• Ciprodex (Cipro + dexamethasone)
• Cipro HC (Cipro + hydrocortisone)
• TobraDex (tobramycin + dexamethasone)

Insert a wick for severely edematous canals

Question 21

When to use Oral Abx for Otitis Externa treatment?

Answer 21

• Deep tissue infections that extend beyond the EAC
• Infections not responding to topical drops
• First line choice: Quinolones
  (pseudomonas coverage)

Question 22

Otitis externa pain medication is helpful wen treating ?

T or F

Answer 22

• True
• NSAIDS
• Narcotics might be required

Question 23

Otitis Externa follow up should be ?

Answer 23

• 24 hours if wick is in place
• 48 to 72 hrs if not improving
• Because infection can spread

Question 24

Another name for Otitis Externa ?

Answer 24

• Swimmers Ear

Question 25

Oral or Systemic antibiotics are specifically not recommended for Otitis externa unless the patient is ?

Answer 25

- Immunocompromised or - Infection is spreading to the pinna cartilage of the external ear - Outside of the external auditory canal

Question 26

Eustachian Tube Dysfunction

Answer 26

- Common in adults | - Difficulty equalizing the pressure associated with changes in altitude

Question 27

Eustachian Tube Dysfunction associated with?

Answer 27

- Upper respiratory infection | - Allergic Rhinitis

Question 28

Eustachian Tube Dysfunction

Answer 28

- Swelling around the opening of the Eustachian tube in the nasopharynx - Cannot ventilate or open the tube

Question 29

Adult Eustachian Tube Dysfunction adult pt's complain of ?

Answer 29

- Fullness in their ear - Often mistake the fullness for an “Ear infection” - Pain along the jaw line on affected side - Very painful as pressure is allowed to build up in the middle ear

Question 30

What exacerbates the pain of eustachian tube dysfunction ?

Answer 30

- Sniffling from nasal congestion | - Changes in altitude (flying, diving)

Question 31

Eustachian tube dysfunction PE findings?

Answer 31

- Dull retracted TM that does not move - No cone of light present - Due to pressure difference

Question 32

Eustachian tube dysfunction treatment includes?

Answer 32

- Self-care (Yawn, swallow, chew gum or sip on a straw to auto-inflate the Eustachian tube) - A Valsalva will also help to maintain the patency of the Eustachian tube

Question 33

Eustachian tube dysfunction medication treatments include?

Answer 33

- Afrin (Immediate relief) MAX of 3 days - Nasal steroids for ongoing care

Question 34

What happens if you use Afrin for more than 3 days?

Answer 34

- Rebound congestion due to over use

Question 35

Barotrauma

Answer 35

- Failure of the Eustachian tube to allow pressure equalization - Bruising - Bleeding - Or Rupture of the ear drum - Even perilymph fistula

Question 36

Barotrauma symptoms include?

Answer 36

- Pain - Hearing loss - Vertigo

Question 37

Avoidance of barotrauma ?

Answer 37

- Nose/throat congestion, avoid flying / diving until better - May use phenylephrine nose drops as prophylaxis 30 min-1 hour before ascent or descent - Outside pressure increasing : yawn, chew gum, swallow - Outside pressure decreasing: pinch nose shut, mouth closed, blow gently through nose

Question 38

Otitis Media with Effusion

Answer 38

- Middle ear fluids - Without signs of inflammation or illness - Usually follows AOM but can be due to 1) Allergies or 2) Barotrauma - Eustachian tube dysfunction Predisposing factor

Question 39

Effusion in the ear is always due to infections? T or F

Answer 39

- False

Question 40

Acute otitis media (AOM)

Answer 40

- Extremely common in children - Middle ear fluid 1) Inflammation 2) Infection - Related to obstruction of the Eustachian tube

Question 41

In children an URI can lead to ?

Answer 41

- AOM | - Acute Otitis Media

Question 42

Most common pathogens of AOM?

Answer 42

#1 Strep. Pneumoniae (44%) (CAP) #2 H. Influenzae (36%) #3 M. Catarrhalis (8%)

Question 43

Acute otitis media symptoms include?

Answer 43

- Fever - Ear pain - Diminished hearing

Question 44

Acute otitis media PE findings?

Answer 44

- Typically unilateral but not always - Erythematous - Bulging tympanic membrane - Opacification - Lack of or poor mobility

Question 45

The detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of otitis media with effusion (OME) T or F

Answer 45

- True

Question 46

Treatment for AOM ?

Answer 46

- Pain control - Avoid inappropriate Abx use - Prevent complications (mastoiditis) - Sometimes oral abx required

Question 47

Use Abx with AOM in patients ?

Answer 47

- Children < 2 YO - Any child with ear drainage - Moderate or severe ear pain - Pain > 48 hours - Fever > 102 F - Immunodeficient or craniofacial abnormalities - Uncertain access to follow up

Question 48

T or F May choose to observe AOM instead of ABx?

Answer 48

- True | - 70% self limited