Ears

Question 1

What are the indications to remove cerumen clinically?

Answer 1

• EVERYTHING!

Question 2

What is ceruminosis?

Answer 2

• excessive buildup of cerumen

Question 3

What treatments soften the cereumen?

Answer 3

• H2O2/glycerin

- docusate sodium (laxative)

Question 4

What are the mechanincal type treatments for cerumen?

Answer 4

• curreting
• irrigation
• suctioning

Question 5

_________ complicated by _________ can lead to pericondritis.

Answer 5

• auricular hematoma (cauliflower ear)

- infection

Question 6

What should be in the ddx list for pericondritis and how do you r/o?

Answer 6

• auricular cellulitis

- lobe is less involved with pericondritis

Question 7

What are the treatments for pericondritis?

Answer 7

• systemic abx

- I&D

Question 8

What is otitis externa?

Answer 8

• inflammation of the skin of the external ear canal & surrounding soft tissues

Question 9

What are some enviornmental causes of otitis externa?

Answer 9

• maceration from loss of cerumen & increased moisture
• increased pH
• trauma
• ear plugs
• contact dermatitis (neomycin)
• infection s/p OM with perforation

Question 10

What are the most common bug causes of otitis externa?

Answer 10

• S. aureus
• P. aerunginosa
• yeast is rare

Question 11

What can occur with otitis externa?

Answer 11

• facial cellulitis

Question 12

What is the treatment for otitis externa?

Answer 12

• otic drops
• ear wicks
• moist heat
• avoid water in the ear

Question 13

How can otitis externa be prevented?

Answer 13

• one footed dance
• 1:1 sol’n vinegar/70% ethyl ETOH before and after water exposure
• 2% acetic acid drops

Question 14

What are the classifications of otitis media?

Answer 14

• acute (AOM)
• with effusion (OME)
• chronic suppurative

Question 15

What is AOM?

Answer 15

• acute otitis media

- acute onset of middle ear inflammation AND middle ear effusion (MEE)

Question 16

How is a MEE determined?

Answer 16

• bulging TM
• limited or absent mobility of the TM
• air-fluid level behind the TM
• otorrhea

Question 17

Define otorrhea

Answer 17

• fluid leaking from a hole in the TM

Question 18

What are signs and symptoms of middle ear infection?

Answer 18

• TM erythema
• otalgia
• bluging TM 2ndary to crying

Question 19

How does OM present?

Answer 19

• fever with otalgia

- disrupted sleep/activity

Question 20

What is the exam for OM?

Answer 20

• pneumatic otoscopy (insuflation)
• cerumen removal
• tympanometry

Question 21

What are complications from OM?

Answer 21

• typanosclerosis
• cholesteatoma
• TM perforation
• chronic suppurative OM
• mastoiditis
• facial n. paralysis

Question 22

What is the treatment for OM?

Answer 22

• pain management/analgesia
• watchful waiting
• abx (1st: amoxicillian 2nd: augmentin)
• typanocentesis

Question 23

What is the toynbee test?

Answer 23

• closed nose swallowing to generated (-) middle ear pressure
• pressure changes if TM is intact

Question 24

What is serous otitis media?

Answer 24

• prolonged eustachian tube dysfunction causing (-) pressure builds up transudate in middle ear

Question 25

What is the treatment for serous otitis media?

Answer 25

- PE tubes if MEE lasts longer than 4mo or (B) hearing impairment of 20dB+

Question 26

What are the two types of cholesteatomas?

Answer 26

- central TM perf | - peripheral TM perf

Question 27

What is a central TM perf?

Answer 27

- drainage of purulent fluid from middle ear

Question 28

What is a peripheral TM perf?

Answer 28

- squamous epithelium from auditory canal invade middle ear through perf - keratinaceous debris (tumor) forms at site - bony errosion

Question 29

What is congenital cholesteotoma and when is it found?

Answer 29

- squamous epithelium trapped in the temporal bone during embryogenesis - discovered 6mo-5y/o

Question 30

What is primary acquired cholesteotoma?

Answer 30

- pars flaccida of TM retracts medially over ossicles with their desctuction - may erode into the mastoid or lateral semicircular canal

Question 31

What can 2nd type of primary acquired cholesteatomas lead to?

Answer 31

- facial n. exposure

Question 32

What is secondary acquired cholesteotoma?

Answer 32

- occurs 2ndary to TM injury | - squamous epithelium implants in middle ear

Question 33

What are complications from cholesteotomas?

Answer 33

- menigitis - brain abscess - facial n. paralysis

Question 34

What is the treatment for cholesteotoma?

Answer 34

- refer to ENT for mastoidectomy, myringoplasty, tympanoplasty

Question 35

What is mastoiditis?

Answer 35

- spectrum ranging from mastoid periostium inflammation to bony destruction - *complication of OM*

Question 36

How does mastoiditis present?

Answer 36

- postauricular pain - down or outwardly displaced pinna - sore

Question 37

What is the treatment for mastoiditis?

Answer 37

- IMMEDIATE ENT REFERRAL - myringotomy w/ or w/o PT tubes - IV abx - cortical mastoidectomy

Question 38

What are common foreign bodies found in adults v. children?

Answer 38

- adults: insects (i.e. cockroaches) | - children: food and small inorganic objects

Question 39

When do children start putting foreign bodies in their ear and why?

Answer 39

- after 9 mo | - pincer grip

Question 40

What are techniques to remove foreign bodies in the ear?

Answer 40

- mechanical extraction/curetting - irrigation - suction

Question 41

When is irrigation contraindicated for removal of a foreign body in the ear?

Answer 41

- when the item might swell (organic matter)