Ears Flashcards
(19 cards)
Tophi
uric acid crystals, hard & painless
Hematoma
trauma or blood dyscrasia. can become cauliflower ear if not drained - tender blue mass
Keloid
piercing scars
Infection
cellulitis. treated with Cephalexin or diclox 500mg 2-4 x daily for 7-10 days
Dry skin
eczema, seborrhea, esp. in ear fold
Cerumen impaction
Caused by excessive production, narrow canal, obstruction
C/O discomfort, decreased hearing, dizziness
OTC wax softener; remove with curette or H2O pik
Otitis externa
(swimmers ear)
Pruritis and discomfort, drainage, decreased hearing
Pseudomonas, Staph, Candida
Canal filled with white exudate, inflammed and erythematous
Remove debris, acidify canal (50:50 white vinegar & H2O)
Antimicrobial: Cipro HC,Cortisporin otic, Floxin otic, Zoto-HC, Lotrimin gtt
Culture if recurrent. Refer malignant OE
Hearing loss
Hx to reveal occupational risks, FH, ototoxic meds
Sudden or gradual; unilateral or bilateral; associated sxs & dx
Conductive vs. sensorineural—Weber & Rinne tests
Examine to id external blockage, normal TM
Refer for audiometry and to ENT (labs and CT?)
Conductive loss
Mechanical - obstruction from cerumen, infection, cholesteatoma, tumor
BC>AC
Sensorineural
Problem with cochlea and auditory nerve (acoustic neuroma, autoimmune dx, infection, meniere’s, trauma)
AC>BC
Otitis Media
Bacterial, fungal, viral infection of middle ear
Acute OM or chronic OM with effusion (OME)
Eustachian tube dysfunction accumulation of secretions microbial overgrowth
Most common cause: Strep pneum & H. flu
Causes pain, sensation of ear fullness, related URI sxs
TM is bright red, bulging, decreased landmarks. Bullae with mycoplasma
Management of AOM
Do not give antibiotics for effusion AOM antibiotic regimes: Amoxicillin 250mg TID for 7-10 days Augmentin 500mg BID Cephalosporin 2nd or 3rd generation Zpak Bactrim DS Decongestants, analgesics (Auralgan gtts) Perforations: Refer to ENT, avoid water in ear canal
Effusion and scarring appear as ______ on TM?
White /dull TM
Benign Positional Vertigo
Episodes of vertigo without hearing loss
Associated with specific head movements
Usually self-limiting over several months
Cupulolithiasis—Baranay (Dix-Hallpike) test to diagnose, Epley maneuvers to treat
Meclizine; slow position changes
Labyrinthitis
Sudden onset of vertigo, N & V
A/W recent URI
Self-limiting, resolves within 2-3 weeks
Acoustic Neuroma
Benign tumor of 8th cranial nerve (schwannoma)
Present with unilateral hearing loss, tinnitus, mild positional vertigo
Can have ataxia, decreased corneal reflex
Confirm with MRI
Surgery
Tinnitus
Chronic ringing, buzzing, roaring in ears; benign or sign of serious disease (pulsatile, unilateral)
Risk factors: advancing age, male, history of military service or noise exposure, smoking, HTN
Etiology:
Otologic: hearing loss, presbycusis, Menieres dx, otosclerosis
Neurologic: MS, acoustic neuroma
Ototoxic drugs: ASA, gentamycin , furosemide ,valproate, antineoplastic
Metabolic: thyroid dx, DM, zinc deficiency, anemia
Mechanical: head/neck injury, TMJ disorder, infection, cerumen
Vascular: aortic/carotid stenosis, AV fistula malformation, tumor, ,
Tinnitus: Assessment
Subjective: meds, hx of noise exposure, onset and character, associated symptoms
PE: inspect for obstruction, infection, bruit, TMJ problem, thyroid, cranial nerves
Plan: imaging to R/O vascular lesion if indicated, audiogram, labs to R/O thyroid dx, anemia, DM, zinc deficiency
Treatment of Tinnitus
Most causes are irreversible and 25% will worsen over time.
Avoid noise above 80 decibels over the course of an eight-hour day
Wear ear plugs or muffs to prevent stimulus and worsening tinnitus
ENT and/or audiology referral recommended
Amplification (Hearing Aids), masking,
Tinnitus Retraining Therapy (TRT); Cognitive Behavior Therapy (CBT)
White noise machine at night time
No evidence that benzodiazepenes, antidepressants, gababetin, herbals, or acupuncture are helpful.
