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Flashcards in Ears Deck (46)
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1

Viral URI leads to Eustachian tube dysfunction or blockage creating bacterial infection with subsequent buildup of fluid and mucous. Common infants/children.

Acute otitis media

2

Viruses causing AOM

Strep pneumoniae
H. influenzae
Moraxella cattarhalis
Strep pyogenes

3

Sxs: Ear pain, ear pressure, hearing impairment
PE: TM erythema and limited motility with pneumotoscopy
Bulging and eventual rupture of TM can occur leading to otorrhea and abruptly decreased pain

Acute otitis media

4

Treatment AOM

Amoxicillin (first line)
Cephalosporin, TMP-SMX, Azithromycin, Cefaclor, amox-clav

5

Surgical treatment AOM

Tympanostomy, tympanocentesis, myringotomy

6

What can occur with inadequate treatment of AOM?

Mastoiditis

7

Repeated episodes of acute otitis media, trauma, cholesteatoma. Pseudomonas aeruginosa, S. aureus, proteus, anaerobes.

Chronic otitis media

8

PE: Perforated TM, chronic ear discharge w/o pain; conductive hearing loss

Chronic otitis media

9

Removal of infected debris, avoidance of water exposure, topical antibiotic drops

Surgery: Tympanic membrane repair/reconstruction

Treatment chronic otitis media

10

Associated with water exposure, trauma, or exfoliative skin conditions like psoriasis or eczema; "Swimmer's ear"

Pseudomonas, proteus, fungi

Otitis externa

11

Patient complains of ear pain esp. with movement of tragus/auricle. Sxs include redness, swelling of ear canal. Purulent exudate.

Otitis externa

12

Abx drops and avoiding moisture

(Aminoglycoside & fluoroquinolone +/- steroid)

Otitis externa treatment

13

Sensation of movement (spinning, tumbling, falling)
Causes of peripheral: labrinthytitis, meniere syndrom (endolymphatic hydrops), benign, paroxysmal positional vertigo, vestibular neuritis

Central: Head injury, tumors, MS, migraines

Vertigo

14

Dx: Presence and duration of hearing loss, nystagmus, N/V, tinnitis, (Peripheral)

Central usually motor, sensory, cerebellar defects, no auditory symptoms

Vertigo

15

Diagnosis for benign positional paroxysmal vertigo, patient lays in supine position while provider quickly turns head 90 degrees. Will produce fatiguable nystagmus.

Dix-Hallpike maneuver

16

If dix-hallpike maneuver is performed and nystagmus is not fatiguable, what could the cause be?

Central vertigo

17

Therapy based on underlying cause
Diazepam, meclizine for acute sxs
Physical therapy maneuvers
Intervention/surgical therapy

Treatments for vertigo

18

Acute severe vertigo with hearing loss and vertigo seven days to a week. The vertigo progressively improves over a few weeks, but hearing loss may or may not resolve.

Labrythitis

19

Abx with fever or associated bx infection
Vestibular suppressants are helpful during initial acute sxs

Treatment for labrynthitis

20

Rupture will occur from AOM or trauma
Most cases will resolve on their own; surgical repair may be necessary for Tm and ossicular chain w/ persistent hearing loss

Avoid water/moisture in ear to prevent secondary infection

Perforated TM

21

Causes conductive hearing loss. Caused by overproduction of wax, use of q-tips, creates plug that decreases hearing

PE: Copious cerumen, loss of visibility of TM

Impacted cerumen

22

Mechanically remove with ear curette/loop. Can use detergent drops, suction, irrigation.

Treatment for impacted cerumen

23

Most common in kids, can affect speech. Conductive hearing loss. Bottle feeding, smoking, eustachian tube issues. Viral.

Conductive hearing impairment/sleep issues. Nystagmus and vertigo (child will fall over). TM can appear blue and is neutral or retracted **Pneumatic otoscopy**

Otitis media w/ effusion

24

3 months or more = audiology referral. If pain or vertigo refer to ENT for tube placement (tympanostomy).

Can cause scarring, hearing loss, perforated TM.

Otitis media w/ effusion treatment

25

Conductive hearing loss. Abnormal bony growth of the middle ear. Affects both ears. Hearing loss may occur slow at first but continues to get worse. Hearing better in noisy environments than quiet ones.

Dx: Temporal bone CT may be done to rule out other causes of hearing loss

Otosclerosis

26

Fluoride calcium, vitamin D in early stages - surgery to remove bony overgrowth; hearing aids.

Complications = complete deafness, nerve damage, infection, dizziness, pain, blood clot in ear post surgery

Treatment otosclerosis

27

Most common etiology of sensorineural hearing loss. Genetic predisposition is strong. Increased risk is highly increased with noise exposure to various medications. Gradual impairment of higher sound frequencies that occurs with increasing age.

Tx: ENT referral for hearing aids, cochlear implant.

Presbycusis

28

Ringing in the ear

Tx: Instrumental; use other noise to distract ringing, electro-magnetic stimulation therapy, hypnotherapy, acupuncture, pharmacotherapy (lidocaine, antidepressants, sedatives, gabapentin); hearing aids may help

Tinnitus

29

With conductive loss, the Weber results in lateralization to the ________ ear. Rinne test also shows ______ bone conduction than air conduction on affected side.

AFFECTED

GREATER

30

With sensorineural hearing loss, the Weber test results in lateralization to the _______ side. The Rinne test will show?

UNAFFECTED

Greater air conduction than bone conduction

31

New onset of hearing loss in affected ear, ear drainage for 2 weeks, presents as painless (no irritation).

PE: Visualize TM, check for wax and foreign body, white mass behind TM (erosion within membrane) or granulation tissue on retracted TN. Diagnose by clinical suspicion

Cholesteatoma

32

Sent to ENT - Tube insertion or drain surgically and remove and reconstruct; audiologist for hearing issues; also CT scan to visualize location and size but try to avoid w/ children

Can cause brain infections (meningitis/abscess)

Cholesteatoma treatment

33

Uncomfortable red bump behind ear, fever, nausea, URI symptoms. School age children often in adults as well.

Risk = recurrent AOM, active AOM

PE: Inflammation of mastoid process, redness, **post-auricular lymph nodes** causing anterior displacement of pinna

Mastoiditis

34

Admission to hospital, IV abx (cephlotaxine), urgent ENT consult, drain abscess

Mastoiditis treatment

35

Inability to equalize barometric pressure in middle ear, associated with eustachian tube dysfunction (congenital narrowing or acquired mucosal edema). Can occur w/ flying, rapid altitude change, or diving underwater.

Presents with ear pain and hearing loss that persists past the inciting event

Barotrauma

36

Swallowing, yawning, auto inflation (with descent), as well as the use of systemic or topical nasal decongestants (prior to arrival), can be helpful.

Persistent sxs can be treated with decongestants repeated with auto inflation W/ severe pain/hearing loss, myringotomy may be considered!

Barotrauma treatment

37

Uncontrolled movement of the eyes
Can cause dizziness, visual problems

Tx: None really, case dependent

Nystagmus

38

Epley maneuver puts crystals back into place

Tx for benign paroxysmal positional vertigo

39

Endolymphatic hydrops. Sxs related to distention of the inner ear's endolymphatic compartment.

Sxs: Recurrent vertigo (lasting minutes to hours), w/ lower range hearing loss, tinnitus, one-sided aural pressure. W/ Caloric testing, nystagmus is lost on impaired side

Meniere disease

40

Low sodium diet and diuretics (acetazolamide). Unresponsive cases can be treated w/ more invasive procedures (intratympanic corticosteroid therapy, surgery).

Meniere disease treatment

41

Intracranial benign tumor affecting eighth cranial nerve. Unilateral and may present w/ progressive one-sided hearing loss w/ impaired speech discrimination. Hearing loss may also present more acutely.

Other sxs: Vertigo, continuous not episodic

Acoustic neuroma (Vestibular schwannoma)

42

Consider patient age, health status, tumor size; involve surgery or radiation

Acoustic neuroma (vestibular schwannoma)

43

Sound is better in one ear than the other

Lateralization

44

Disorders causing conductive hearing loss

Otitis media with or without pleural effusion
Cerumen impaction
Otosclerosis
Otitis externa

45

Most common cause of sensorineural hearing loss

Presbycusis

46

Disorders that cause sensorineural hearing loss

Presbycusis
Meniere disease
Acoustic neuroma