EENT Ears

Question 1

On Weber testing, what will be present with cerumen impaction?

Answer 1

Lateralization to affected ear (bone conduction > air conduction

-Conductive hearing loss

Question 2

Name two solvents that work to soften the cerumen in an impaction.

Answer 2

Hydrogen peroxide

Carbamide peroxide

Question 3

What else can be done if softening the cerumen does not work to solve the problem?

Answer 3

Irrigation, curette, suction

Question 4

MCC of otitis externa

Answer 4

Pseudomonas aeruginosa

Question 5

Symptoms of otitis externa

Answer 5

• Pain
• Pruritus
• Pain with movement of tragus or auricle
• Purulent auricular discharge

Question 6

Topical ABX for otitis externa

Answer 6

-Ciprofloxacin-dexamethasone
-Ofloxacin
For about 7 days

Question 7

What is osteomyelitis of the temporal bone called and who does it normally occur in?

Answer 7

Malignant Otitis Externa

Immunocompromised states; elderly diabetes MC, high dose glucocorticoid therapy, chemo, HIV

Question 8

What cranial nerve palsies can malignant otitis externa lead to?

Answer 8

Cranial Nerves 6, 7, 10, 11, 12

Question 9

Treatment for malignant otitis externa

Answer 9

Admission + IV Ciprofloxacin

Question 10

Diagnostic for malignant otitis externa

Answer 10

CT or MRI

But, biopsy is most accurate

Question 11

Cauliflower ear is a result of _________

Answer 11

Blunt trauma that creates a hematoma. The hematoma creates avascular necrosis of the ear. Happens in wrestlers that do not wear helmets.

Question 12

MCC of acute otitis media

Answer 12

Staph Pneumoniae

Question 13

Symptoms and exam findings of a patient with acute otitis media

Answer 13

• Preceded by viral URI
• Otalgia
• Bulging and erythematous TM with effusion
• Decreased TM mobility (most sensitive)

Question 14

Risk factors for AOM

Answer 14

• Bottle feeding or pacifier
• Second hand smoke
• 6-18 months old

Question 15

Treatment for AOM

Answer 15

• Pain killers (Ibuprofen or Tylenol)
• Amoxicillin first line for 10 days
• Second line: Amoxicillin-Clavulanic acid, Cefdinir, Cefpodoxime

Question 16

If the patient has a penicillin allergy, what is the treatment for AOM?

Answer 16

-Azithromycin, Clarithromycin, Bactrim

Question 17

What is chronic otitis media?

Answer 17

-Recurrent infection of middle ear in presence of TM perforation > 6 weeks

Question 18

MCC of Chronic otitis media

Answer 18

Pseudomonas

-Staph A, Mycoplasma

Question 19

Symptoms of chronic otitis media

Answer 19

-Recurrent purulent otorrhea (painless)

Question 20

Treatment for chronic otitis media

Answer 20

-Removal of infected debris + Ofloxacin/Ciprofloxacin

Question 21

What is a cholesteatoma?

Answer 21

Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid

Question 22

Symptoms of a cholesteatoma

Answer 22

-Painless otorrhea (brown or yellow with a strong odor)

Question 23

Treatment for cholesteatoma

Answer 23

Surgical excision of debris and reconstruction of ossicles

Question 24

What two things should you avoid if you suspect a TM rupture?

Answer 24

Topical aminoglycosides (Gentamicin, Tobramycin, Amikacin)
Water

Question 25

What is an acoustic neuroma/vestibular schwannoma?

Answer 25

Benign tumor involving Schwann cells, which produce myelin sheath - Arises in the cerebellopontine angle and can compress cranial nerves 5, 7, 8 - MC intracranial tumors

Question 26

Symptoms of acoustic neuroma

Answer 26

- Sudden onset of unilateral sensorineural hearing loss (partial) that slowly worsens - Tinnitus, facial numbness (5), facial paresis (7)

Question 27

How do you confirm an acoustic neuroma with imaging? What do you perform for the laboratory of choice for this?

Answer 27

MRI Audiometry

Question 28

Treatment for barotrauma

Answer 28

- Prevention - Do not fly with a cold - Autoinsufflation: swallowing, yawning, chewing gum, decongestants

Question 29

Symptoms of narrowed Eustachian Tubes

Answer 29

- Fullness in the ears - Retraction of TM or decreased mobility - Popping or cracking with yawning or swallowing - Decreased hearing

Question 30

Treatment for narrowed Eustachian Tubes

Answer 30

Decongestants (Pseudoephedrine, Oxymetazoline) | Surgical insertion of T tube

Question 31

Symptoms of overly patent Eustachian Tubes

Answer 31

- Exaggerated ability to hear yourself breathe or speak | - Feel better during a URI