Ears

Question 1

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

Answer 1

Acute otitis media

Question 2

Viruses causing AOM

Answer 2

Strep pneumoniae
H. influenzae
Moraxella cattarhalis
Strep pyogenes

Question 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

Answer 3

Acute otitis media

Question 4

Treatment AOM

Answer 4

Amoxicillin (first line)

Cephalosporin, TMP-SMX, Azithromycin, Cefaclor, amox-clav

Question 5

Surgical treatment AOM

Answer 5

Tympanostomy, tympanocentesis, myringotomy

Question 6

What can occur with inadequate treatment of AOM?

Answer 6

Mastoiditis

Question 7

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

Answer 7

Chronic otitis media

Question 8

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

Answer 8

Chronic otitis media

Question 9

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

Surgery: Tympanic membrane repair/reconstruction

Answer 9

Treatment chronic otitis media

Question 10

Associated with water exposure, trauma, or exfoliative skin conditions like psoriasis or eczema; “Swimmer’s ear”

Pseudomonas, proteus, fungi

Answer 10

Otitis externa

Question 11

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

Answer 11

Otitis externa

Question 12

Abx drops and avoiding moisture

Aminoglycoside & fluoroquinolone +/- steroid

Answer 12

Otitis externa treatment

Question 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

Answer 13

Vertigo

Question 14

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

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

Answer 14

Vertigo

Question 15

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

Answer 15

Dix-Hallpike maneuver

Question 16

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

Answer 16

Central vertigo

Question 17

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

Answer 17

Treatments for vertigo

Question 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.

Answer 18

Labrythitis

Question 19

Abx with fever or associated bx infection

Vestibular suppressants are helpful during initial acute sxs

Answer 19

Treatment for labrynthitis

Question 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

Answer 20

Perforated TM

Question 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

Answer 21

Impacted cerumen

Question 22

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

Answer 22

Treatment for impacted cerumen

Question 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

Answer 23

Otitis media w/ effusion

Question 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.

Answer 24

Otitis media w/ effusion treatment

Question 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

Answer 25

Otosclerosis

Question 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

Answer 26

Treatment otosclerosis

Question 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.

Answer 27

Presbycusis

Question 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

Answer 28

Tinnitus

Question 29

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

Answer 29

AFFECTED GREATER

Question 30

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

Answer 30

UNAFFECTED Greater air conduction than bone conduction

Question 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

Answer 31

Cholesteatoma

Question 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)

Answer 32

Cholesteatoma treatment

Question 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

Answer 33

Mastoiditis

Question 34

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

Answer 34

Mastoiditis treatment

Question 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

Answer 35

Barotrauma

Question 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!

Answer 36

Barotrauma treatment

Question 37

Uncontrolled movement of the eyes Can cause dizziness, visual problems Tx: None really, case dependent

Answer 37

Nystagmus

Question 38

Epley maneuver puts crystals back into place

Answer 38

Tx for benign paroxysmal positional vertigo

Question 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

Answer 39

Meniere disease

Question 40

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

Answer 40

Meniere disease treatment

Question 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

Answer 41

Acoustic neuroma (Vestibular schwannoma)

Question 42

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

Answer 42

Acoustic neuroma (vestibular schwannoma)

Question 43

Sound is better in one ear than the other

Answer 43

Lateralization

Question 44

Disorders causing conductive hearing loss

Answer 44

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

Question 45

Most common cause of sensorineural hearing loss

Answer 45

Presbycusis

Question 46

Disorders that cause sensorineural hearing loss

Answer 46

Presbycusis Meniere disease Acoustic neuroma