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Flashcards in ear/nose Deck (65):
1

conductive hearing loss

dysfunction of middle or external ear
-obstruction, effusion, stiffness or ossicle disruption
-most common: cerumen impaction or eustachian tube dysfunction (temp/reversible)
-if persistent: chronic inf., trauma, otosclerosis (stiffening of membrane)
-can be corrected w. hearing aids/surgery

2

sensory hearing loss

cochlear pathology: loss of hair cells from organ of Corti
(often combo w/ neural)
-may be due to excessive noise/trauma
-high freq. lost w/ age
-not surgically correctable but preventable

3

neural hearing loss

lesion of CN VIII, auditory nuclei, ascending tracts or cortex
-acoustic neuroma, MS, neuropathy

4

Weber test

-sound will be louder in affected ear if bone
conduction loss, opposite with sensory neural
(whisper test first)

5

Rinne test

air should exceed bone >2:1

6

who gets referred for testing

-everyone w/ hearing loss unless you have an obvious reversible cause
-i.e. mastoiditis

7

traumatic auricular hematoma (TAH) if untreated can lead to

cauliflower ear (boxers)
(cartilage necrosis)

8

chondritis/perichondritis vs cellulitis

earlobe spared in chondritis (not cartilage)

9

main cause of cerumen impaction
how to tx?

cause: Qtips in canal
-use curettes to clean out
-soften earwax w/ warm water
-Debrox: peroxide drops, softens earwax

10

if insect in ear

drown in lidocaine, flush out

11

what else in ears

toys, hairtip, Qtip tips
irrigate and/or use alligator forceps or refer to ENT

12

external otitis assoc. w/

excess moisture, tropics, swimmers, DM

13

pathogens in otitis externa

G- rods, fungi, pseudomonas
can get Cs if purulent

14

tx of otitis externa

acetic acid/etOH drops (dry out, kill fungus)
FQ drops +/- oral abx (if severe/malignant)

15

if swollen shut w/ otitis externa

use ear wick: into canal thru inflammation: put numbing meds + abx on strip-->expands-->relief (also use oral abx to avoid noncompliance)

16

complications with otitis externa

mastoiditis: fluid in/obstruction of air cells
meningitis, facial nerve palsy, encephalopathy, sinus cavernous thrombosis, tymp. mem. rupture
squamous cell carcinoma (SCC): most common neoplasm (typ. local, not usually metastasis)

17

eustachian tube disorders

present w/ fullness, hearing changes, popping/pain w. pressure changes, inc. risk for serous otitis

18

eustachian tubes with age

babies/kids: more horizontal
adults: vertical, stiffened (less dysfunction)

19

how to tx serous otitis

nasal spray (steroids): dec. congestion/inflamm of meatuses for drainage (clears eustachian tubes)
-oral steroids if that does not work

20

if on plane with congestion

valsalva, blowing out
-nasal sprays first, then sedated (dry out sinuses) and phenylephrine (nasal spray)-->can be addictive! rebound congestion when wears off

21

divers can get

barotrauma

22

acute otitis media tx

amoxicillin, augmentin

23

acute OM pathogens

strep. pneumo, strep, pyogenus (only in Current), H. influenza, 10% staph aureus

24

chronic OM pathogens

pseudomonas, proteus, staph

25

OM observ. on PE

*dec. mobility of TM, erythematous (insuflate) +/- fever

26

OM tx

nasal spray for symps. amoxicillin-->w/ clauvulinic acid (augmentin) if not improving or fever
if allergic: erythromycin + sulfonamide
or cephalosporins if no type 1 hypersens

27

chronic otitis media

sim. abx tx, usually longer

28

OM complications

cholesteatoma, mastoiditis, petrous apicitis, paralysis, sinus thrombosis, CNS spread, chronic perf., scarring of TM, meningitis (S. pneumo)

29

severe ear pain with normal presentation

look for signs of inf, treat pain, neurogenic
-shingles: tingling comes before rash, Ramsey-Hunt

30

referred ear pain

neurogenic pain (trigeminal, facial gloss pharyngeal, vagal and cervical innervation of ear structures), TMJ

31

otoxicity

ASA: typ. rev and dose related
aminoglycosides
loop diuretics (Furosamide) Ca meds

32

sudden hearing loss considered idiopathic may respond to..

corticosteroids, refer to audiology

33

sens. hearing loss beginning in adulthood often

hereditary, assoc. w/ connexin-26 mutation

34

how to tx tinnitis

avoid offending substance
-tricyclic antidepressants (nortriptaline)

35

peripheral vertigo

sudden +/- tinnitis, hearing loss
horizontal fatiguable nystagmus
dizziness may stop, prolonged imbalance

36

central vertigo

gradual +/- audio symptoms
vertical unfatiguable nystagumus
smtms rotary nystagmus (PCP/ketamine)
motion imbalance

37

causes of peripheral vertigo

vestibular neuritis/labyrinthitis
meniere disease
benign positional vertigo
etOH intox
inner ear barotrauma
semicircular canal dehiscence

38

causes of central nystagmus

seizure
MS
Wernicke encephalopathy
Chiari malformation
cerebellar ataxia syndromes

39

mixed central and peripheral causes of vertigo

migraine, stroke, vasc. insuff., PICA, AICA stroke, vert. art. insuff, vasculitides, cogan syndrom, susac syndrome
granulomatosis w. polyantiitis (wegener)
Behcet disease
cerebellopontine angle tumors
vestibular schwannoma
meningioma
infections: lyme disease, syphilis
vascular compression
hyperviscosity syndromes
Waldenstrom macroglobulinemia
endocrinopathies
hypothyroidism
pendred syndrome

40

ddx vertigo + audio symps

secs: perilymphatic fistula
hrs: endolymphatic hydrops (meniere, syphilis)
days: labyrinthitis, labyrinthine concussion, AI inner ear dis
mos: acoustic neuroma, ototoxicity

41

ddx vertigo - audio symps

secs: positioning vertigo (cupulolithiasis), vertebrobasilar insuff., migraine-assoc.
hrs: migraine-assoc.
days: vestibular neuronitis, migraine-assoc.
mos: MS, cerebellar degen.

42

viral rhinosinusitis

the common cold
(rhinovirus, coronovirus, adenovirus)
typ. self-limited

43

viral rhino sinusitis can lead to bacterial inf.

if >7-10 days

44

other complications from viral rhinosinusitis

otitis media (inflamm. of sinuses),
bronchitis (inflames epithelial cells) also causes laryngospasm-->asthma

45

viral rhinosinusitis presentation

runny nose +/- fever, cough (wet/dry)
clear vs. purulent mucus
"green boogers" day 10 OR chronic-->tx for bac inf
cobblestoning, hyponosmia, malsaise, sore throat, HA

46

how to tx the common cold

oral hydration, rest, tylenol (phenylephrine/dayquil), decongestants, sudafed
localized steroid, afrin, nasal saline spray, breaks up mucus and dilutes pathogens

47

bacterial rhinosinusitis

not as common as viral
imp. mucociliary clearance, obstruction of osteomeatal complexes (secondary inf.)

48

bac rhinosin pathogens

strep pneumo/cocci, staph, H. flu, moraxella

49

clinical criteria for BF

purulent discharge, mucus
length/severity to ddx from viral

50

types of BR

maxillary (dental pain), ethmoiditis, sphenoid sinusitis (behind eye pressure), frontal sinusitis, hospital-assoc. sinusitis (IC, tubes in body, nosocomial pathogen exposure, lying down, surgery, nasal packing)

51

?? if low grade fever consider

thromboembolism

52

how to see sinuses

CT, MRI

53

how to tx BR: first-line

amoxicilin, trimethoprim-sulfamethoxazole, doxycycline, amoxicillin-clavulanate

54

how to tx BR: first-line after recent abx use

levofloxacin
amoxicillin-clavulanate

55

how to tx BR: second-line

amoxicillin-clavulanate, moxifloxacin

56

potential complications of BR

orbital/periorbital cellulitis, empyenas on brain, meningitis, mastoiditis, osteomyelitis-->sprd to frontal bone-->Pott's puffy tumor (debridement/surgery)

57

who comes to the hospital w/ BR

frontal osteomyelitis
orbital cellulitis
immunecomps, chemo pts., already done 1st/2nd line tx, need IV
facial cellulitis

58

allergic rhinitis

-seasonality: pollens, spores, some year round: dust
-s/s sim to viral rhinitis
-ddx from vasomotor rhinitis: allergy tx, vasomotor improves w/ apotropium spray

59

allergic rhinitis tx

-intranasal corticosteroid: can take 2-4 wks, probe: not supposed to sniff up, may cause anosmia, nosebleeds
-antihistamines: non-sed. vs sedating (Claritin, Zertec, Allegra, Alvert), work faster than nasal spray, complications: over dry, sedation, dev. resistance, need to switch class

60

adjunct tx for allergic rhinitis

-antileukotriene meds (montelukast)
-mast cell stabilizers (cromolyn sodium, sodium nedocroil)
-anticholinergic nasal sprays (ipratropium bromide) -for vasomotor rhinitis

61

olfactory dysfunction

send to neurologist?
caused by obstruction of nasal cavity by polyps, tumors, septal deformity
-dec. taste, may cause anorexia
transient w/ cold s/s nasal allergies
idiopathic, trauma, worry about safety concern: CO/gas/fire detectors

62

epistaxis

typ. anterior and unilateral
*Kiesselbach's plexus

63

causes of epistaxis

nasal trauma, rhinitis, dry mucosa, deviated septum, HTN, atherosclerosis, hereditary hemorrhagic telangiectasia (osler-weber-rendu syndrome)
cocaine/etOH use

64

epistaxis: det. causes and area

trauma
lean back? no will swallow blood, use direct pressure
blow out to det. where, oozing or bleeding?-phenylephrine spray to constrict/cauterize vessels, packing, cocaine (vasoconstr)

65

tx options for epistaxsis

direct pressure, topical nasal decong.
topical cocaine (4%)
patch (surgicel)
packing
thrombin: aerosol in nos, forms clot
embolization