Ears Flashcards
(40 cards)
What would you suspect from these issues?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
Auricular Hematoma
How would dress this?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
A dental roll or a firm sterile pledget can then be placed over the restored site with through-and-through sutures connected to a similar bolster on the
opposite side.
How would you treat this?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
- Local anesthesia
- Semicircular incision (using sterile technique) should be made through the skin with caution not to violate the underlying perichondrium
- Irrigations
True/False
A auricular hematoma pt needs prophylactic oral antibiotics
False
Patient DOES NOT need prophylactic oral antibiotics
What antibiotics would you give for this after draining the hematoma?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
Neomycin-bacitracin-polymyxin B (Neosporin)
Apply one application twice daily
What is the goal of treatment for this after removing the fluid collection?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
maintain pressure in the area for several days to prevent reaccumulation of fluid.
What are the instruments of choice for removal of a foreign body in the ear
Cerumen loops/scoops,
right angle hook,
alligator forceps
IF there is a live object in the ear canal what do you do?
Live objects should be drowned with a 2% lidocaine solution or viscous lidocaine
Why are live objects drowned in 2% lidocaine or viscous lidocaine?
this immediately paralyzes the offending insects and provides modest topical anesthesia.
Although some patients with cerumen impaction may present with a c/c totally unrelated to the ears, the majority of patients will report decrease in what and/or what?
hearing, and/or a
sensation of pressure or fullness
If irrigation fails for a cerumen impaction, then the next step would be to use WHAT?
Carbamide Peroxide (Debrox) – cerumenolytic Instill 2-5 drops in affected ear BID for a max of 4 days.
True/False Carbamide Peroxide (Debrox) is indicated for perforated TM
FALSE
Contraindicated
What would you suspect?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
Otitis Media
What antibiotic therapy would you give for this?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
(a) Amoxicillin 1000mg TID x 5-7 days
OR
(b) Amoxicillin/Clavulanate (Augementin) 2000mg/125mg PO BID x 5-7 days
What antibiotic therapy would you give for this IF your patient has a PCN allergy?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
1) Ceftriaxone 1-gram IM one dose
OR
2) Doxycycline 100mg PO BID x10 days
F/u and initial care for Otitis media
(1) Follow up in 1 week to be reevaluated
(2) Consult to ENT as needed
(3) Refer for sudden worsening with fever or marked swelling.
What the complications for otitis media?
(1) Cholesteatoma
(2) Mastoiditis
(3) Central Nervous system infection
PT has these issues what would you suspect?
(1) Severe Ear Pain
(2) Fullness or “under water sensation”.
(3) Hearing loss or “muffled hearing”
(4) Tinnitus
(5) “Popping or snapping noises”
Eustachian Tube Dysfunction
Differential Diagnosis for ETD
(1) Tympanic membrane perforation
(2) Barotrauma
(3) Meniere disease
What are some med options for ETD
(a) Pseudoephedrine 60mg q4-6h PRN
(b) Oxymetazoline 1-2 sprays each nostril q12h PRN (limit use to 3 days)
(c) Fluticasone propionate (Flonase) 1-2 sprays each nostril daily PRN
(d) Cetirizine (Zyrtec) 5-10mg PO daily PRN
(e) Fexofenadine (Allegra) 60mg PO BID PRN
When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the ______, usually anteriorly or inferiorly
Pars tensa
pt has these issues what would you suspect?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
TM Perf
pt has these issues how would you TREAT this?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
Foreign material is suspected to remain in the canal or in the middle ear so place on systemic antibiotics.
(a) Augmentin 875 mg PO BID x 7 days OR
(b) Doxycycline 100mg PO BID x 7 days
DDX for TM perf
(1) Barotraumas
(2) Otitis Media
(3) Foreign bodies
