Ears Flashcards
cerumen impaction etiology, presentation, diag, Tx
Cerumen protects ear.
Etiology: self induced
PE: Hearing loss, earache, fullness, itchiness, reflex cough (vagus) Dizziness, tinnitus
Tx: detergent ear drops, mechanical removal, irrigation with body temp water, dry canal.
HnP: Q-tip
Pt education: no Q-tips, refer if unruly pt or cerumen wont break up.
Foreign body etiology, presentation, diag, Tx, complications
Children> adults
PE: Asymptomatic, decreased hearing, otaglia, drainage, chronic cough/ hiccups
Tx: Urgent if button battery, live insect, penetrating FB. Firm = irrigate and loop, organic, immobilize and loop.
Complications: TM or canal lacerations. Check other ear and nostrils
Otitis Externa etiology, presentation, Epidemiology, diag, Ddx, Tx, Prevention
Swimmer’s ear: Allergies, dermatologic conditions, infection (Pseudomonas, S. epidermidis, S. aureus, Fungi
PE: Swelling, erythema, discharge, otaglia, puritis, hearing loss, Hx of water exposure, tender tragas, TM moves with pneumatic otoscope
Epidemiology: Warm humid climate, psoriasis, trauma, occlusive devices.
Ddx: Otitis media, contact dermititis, psoriasis, herpes zoster, squamous cell carcinoma, Chronic suppurative otitis media, radiation.
Diag: Clinical diag on HnP
Tx: Aminoglycoside, fluoroquinolones if TM ruptured + corticosteroids, PLace wick, remove debris, refer to ENT.
Prevent: No Q-tips or swimming
Hematoma of External ear etiology, presentation, Tx
Trauma to auricular (hemoragge). Tx: prompt drainage
Complication: cauliflower ear.
AOM etiology, risk factors, presentation, Epi, diag, Tx
Risk factors: Age, inflammation, congenital malformation, Fx, day care, lack of breastfeeding, pacifier use, tobacco/air pollution
Etiology: Bacterial (HMSSS) URI predictor EDT obstructed, accumulates fluid allows 2nd infection, Allergies, 2nd hand smoke
Epi: children in the winter (4-24 months).
PE: otaglia, pressure, hearing loss, fever, URI symptoms, TM immobile with erythema and bulge (mycoplasma). TM may rupture
Ddx: OM with effusion, ETD, Herpes zoster, head/neck infection
Tx: 1st line: Amoxi 80-90 divided, PCN resistant = cephalo, doxy, macrolides. 2nd line = amoxi-clavulanate and 2nd-3rd gen cephalosporin. Ofloxin for TM rupture
improve within 48-72 hrs
Chronic Otitis media etiology, presentation, diag, Tx
Etiology: recurrent AOM
PE: chronic otorreah, Perforated TM, Conductive hearing loss (BC>AC)
Tx: remove debris, earplugs, topical or oral antibiotics, Surgery to repair TM.
Serious Otitis Media etiology, Epi, presentation, diag, Tx
Etiology: eustachian tube prolonged blocked, negative pressure.
Epi: Kids = narrow and horizontal EDT. Adults after URI, barotrauma, chronic allergies
PE: No inflammation, conductive hearing loss, fullness, TM is dull hypomobile, bubbles visible,
Cholesteatoma etiology, presentation, diag, Tx, complications
Specific type of chronic otitis media.
Etiology: prolonged ETD (most common cause), Chronic negative pressure pulls TM, creates lined sac - squamous epithelium, keratin: pseudomonas Proteus (always behind TM).
PE: Asympt or hearing loss, Chronic infection, otorreah, TM pocket, perforating exudating debris.
Tx: antibiotics drops, surgical.
Complications: Erosion into inner ear, facial nerve, brain abscess.
Eustachian Tube dysfunc. etiology, presentation, diag, Tx, management, & complications
Middle ear to Nasopharyx. Ventilate and drain middle ear. Usually closed unless swallowing & yawn.
Etiology: Tube lining edema, trapped air in middle ear = negative pressure. VURI, allergies
PE: fullness, fluctuating hear, otaglia, pressure change, popping or crackling sensation. retracted TM with decreased mobility.
Management: Avoid air travel and scuba diving.
Tx: decongestants (topical/oral), Autoinflation, desensitize to allergies, Intranasal contricosteroids, surgery, Complication: serous otitis media, cholesteatoma
Otic Barotrauma etiology, presentation, diag, Tx, Pt ed
Cant equilize pressure in middle ear during: air travel, rapid altitude change, underwater diving.
Etiology: Mucosal edema, congenital narrowing.
PE: otaglia during descent
Tx: enhance Eustachian tube with decongestant (systemic before fly, nasal before descent)
Pt ed: swallow, yawn, autoinflate in planes - inhibit negative pressure. Hemotympanum, perilymphatic fistula = ruptured oval window, sensory heaing loss, acute vertigo, vomit.
TM perforation etiology, presentation, diag, Tx
Small rupture (25% autorepair), larger require tympanoplasty, No water in canal until TM closed. Avoid ototoxic ear drops (aminoglycoside) use quinolones
AOM Complications and Tx
Labyrinthitis, Hearing loss, Mastoiditis
Tx: with antibiotics or mastoidectomy.
Resistance = IV antibotics , check resistances.
Tympanostomy (PE tubes)
Otic barotrauma complications
TM ruptured, middle ear infection. Persistant pressure after landing. Decongestant, autoinflate, mydringotomy for immediate relief, Ventilating PE tubes
Ramsey Hunt Syndrome
HSV, facial palsy. Outer ear canal
weber test results
BC> AC, crummy ear
cough reflex
vagus nerve, hiccups too
place wick why?
in OE due to inflammation
malignant otitis externa
Dx, Tx
AKA necrotizing otitis externa: osteomyolitis of temporal bone. Foul smalling, granualtions, deep otaglia, cranial nerve palsies.
Dx: CT
Tx: IV quinolones, surgery
3 signs of Chronic otitis media
Chronic ottorhea, conductive hearing loss, perforated TM
types of Hearing loss
Acute vs Gradual, Conductive vs sensorineural. Mostly in older patients
Tinnitus, Hx, Dx, Tx
ringing, buzzing.
Sensory-neural hearing loss association. Affects 50 million people, more in men.
Hx: HTN, ASCVD, depression, insomnia
Dx: MRI, idiopathic
Tx: Pt edu, stop ototoxic Rx, avoid loud sounds, music can mask it.
Labyrinthitis Etiology, PE, Tx, Pt edu
Inflamed CN 8, post-viral infection.
PE: acute onset continuous, sever vertigo, hearing loss, tinnitus, N/V gait impairment.
Tx: Antibiotics, antihistamine, benzos, Anti-emetics, corticosteroid.
Pt edu: self limiting, gradual recovery, vestibular rehab.
Meniere disease, PE, Dx, Tx
Endolymphatic Hydrops
Vertigo syndrome due to peripheral lesion. Endolymph pressure changes.
PE: episodic vertigo 20 mins, sensorineural hearing loss, tinnitus (low tone)
Vertigo + hearing loss + tinnitis
Dx: Referral to ENT
Tx: diuretics low salt diet
vestibular schwannoma
Dx, PE, Tx
acoustic neuroma, common intracranial tumors, benign tumor, CN 8 compressed (pons and hydrocephalus) Unilateral
Dx: Audiometry, MRI
PE: unilateral hearing loss, Continuous dysequilibrium, Tinnitus
Tx: Observation, surgical, radiotherapy.
