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Pance Re-Up > EENT Precision & Pearls #2 (Ears) > Flashcards

EENT Precision & Pearls #2 (Ears) Flashcards

1
Q

Otitis Externa, AKA ______, is MCC by what bacteria? What are some risk factors for this condition?

Symptoms of otitis externa?

A

Swimmer’s Ear

Pseudomonas Aeruginosa MCC

RF: Water immersion, mechanical trauma (Q tip), Age 7-12

Ear pain, pruritus, hearing loss, pain with traction of tragus, purulent discharge

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2
Q

Treatment for otitis externa

A

-Protect against moisture (isopropyl alcohol or acetic acid) and remove debris/cerumen
-Topical ABX: Ciprofloxacin-Dexamethasone, Ofloxacin
-Neomycin/Polymyxin B alternative (if no TM rupture)

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3
Q

What should you remember to NOT use if you suspect the TM to be ruptured?

A

Aminoglycosides (-mycin) as they are ototoxic drugs

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4
Q

Malignant otitis externa is a complication of otitis externa. It is MCC by what bacteria? Risk factors for this condition?

Symptoms of this include

A

Pseudomonas

Immunocompromised, DM, elderly, HIV, Chemotherapy

Severe preauricular pain, otorrhea, cranial nerve palsies, TMJ pain

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5
Q

Diagnostics for malignant otitis externa

A

-Otoscopy: edema of EAC, granulation tissue at bony cartilaginous junction of ear on canal floor

CT or MRI to confirm

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6
Q

Treatment for malignant otitis externa

A

-admission + IV ABX (Ciprofloxacin)

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7
Q

MCC of conductive hearing loss is _______

What is the treatment for this?

A

Cerumen impaction

Cerumen softening with hydrogen peroxide or carbamide peroxide –> removal with aural toilet or irrigation

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8
Q

What is an auricular hematoma and what are some common causes of this?

A

Blood collection from external ear trauma (contact sports, wrestling, etc.)

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9
Q

What can an auricular hematoma lead to if not treated and what is the treatment?

A

Permanent deformity such as a cauliflower ear

Drain and evacuate hematoma (if < 48 hours). Apply pressure dressing

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10
Q

With a foreign body in the ear, what should be removed IMMEDIATELY and what should be done for objects to get them out?

A

Button batteries can cause necrosis

Mineral oil or lidocaine to kill insects first before removing them. Avoid irrigation if there is a battery in there, as it can cause edema and be harder to get out.

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11
Q

What are risk factors for developing acute otitis media?

What are the common causes (including MC)?

Furthermore, if the patient has AOM with purulent conjunctivitis, what organism should be considered?

A

Age 6-18 months, not being breastfed, daycare, pacifier use, secondhand smoke in the house

Strep Pneumo (MC), H. Influenzae, Moraxella Catarrhalis, GABHS (Strep Pyogenes)

H. Flu with conjunctivitis

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12
Q

Symptoms of AOM

What if the TM ruptures?

A

-Otalgia, ear tugging, conductive hearing loss
-Bulging, erythematous TM with effusion
-Decreased TM mobility (most sensitive finding)

TM rupture = rapid relief of pain with bloody otorrhea

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13
Q

What diagnostic is definitive for AOM?

A

Tympanocentesis with culture

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14
Q

Treatment for AOM

A

Amoxicillin 80-90 mg/kg/day x 10-14 days
-2nd line: Augmentin or Cefaclor
-PCN Allergy: Azithromycin, Emycin, Bactrim

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15
Q

If AOM is associated with H. Flu, with the purulent conjunctivitis, what should the treatment be?

A

Augmentin

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16
Q

When should the patient be referred for Tympanostomy tubes for AOM?

A

If 3 in the last 6 months or 4 in the last 1 year

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17
Q

What is chronic otitis media?

What is the MCC?

Symptoms of this condition?

A

Recurrent infection of the middle ear with TM perforation > 6 weeks

Pseudomonas MCC

-Persistent purulent otorrhea, painless
-Conductive hearing loss
-Perforated TM on exam

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18
Q

Treatment for chronic otitis media (think Pseudomonas)

A

-Topical ofloxacin or Ciprofloxacin
-Surgery to remove infected debris and reconstruct the TM

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19
Q

What is serous otitis media with effusion?

What is the treatment?

A

Middle ear fluid with no signs of infection or inflammation

Observation for most. ENT referral if persistent or language delays, hearing loss, etc.

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20
Q

What is mastoiditis?

It is a complication of what condition?

MCC by what organism?

A

Infection of mastoid air cells of temporal bone

AOM

Strep Pneumo (same bugs as AOM)

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21
Q

Symptoms of mastoiditis

Diagnostics for this condition

A

Otalgia, fever, TM signs of AOM
Mastoid (postauricular) tenderness, edema
Protrusion of auricle, fluctuance

CT scan with contrast

22
Q

Treatment for mastoiditis

A

-IV ABX and drainage (myringotomy) with/without T tubes
-ENT referral, admission
-IV Vanco + Ceftazidime or Cefepime

-Refractory: mastoidectomy

23
Q

TM perforation should be considered in a patient with what type of history?

A

Noise trauma, penetrating trauma

24
Q

Symptoms of a TM rupture

Treatment?

A

-Acute ear pain, hearing loss, bloody otto rhea, tinnitus, vertigo

-Most heal spontaneously on their own. Observation for most.

25
Q

What is a cholesteatoma?

What is it MC from?

A

Abnormal keratinized collection of desquamated squamous epithelium that leads to mastoid bony erosion

MC from ET dysfunction –> conductive hearing loss

26
Q

Symptoms of a cholesteatoma?

A

Painless otorrhea (brown/yellow with strong odor)

Vertigo, dizziness, etc.

27
Q

Treatment for a cholesteatoma

A

-Surgical removal and reconstruction of ossicles

28
Q

What is the MCC of sensorineural hearing loss? Explain the problem here

A

Presbycusis (normal aging, decreased number of cilia)

Impaired transmission after cochlea

Other causes: noise exposure, Meniere, Labyrinthitis

29
Q

Explain what happens with the hearing tests in sensorineural hearing loss

A

Weber (fork on head): lateralizes to normal ear
Rinne (fork near ear): AC > BC (normal)

30
Q

If unilateral sensorineural hearing loss, what should you be considering as the diagnosis?

A

Acoustic neuroma

31
Q

What is the MCC of conductive hearing loss?
Explain the problem here

A

Cerumen impaction

Impaired transmission to the cochlea

Other causes: otitis media, externa, otosclerosis

32
Q

Explain what happens with the hearing tests in conductive hearing loss

A

Weber: lateralizes to the affected ear
Rinne: BC > AC (abnormal)

33
Q

Barotrauma occurs MC after events such as

Symptoms of this include

What is the best maintenance recommendations for this condition?

A

Flying, diving, hyperbaric oxygen treatment (due to damage of TM from inadequate pressure equalization)

Ear pain, fullness, hearing loss after event

Avoidance, don’t fly with a cold, autoinsufflation (yawning, chewing, etc.)

34
Q

When should you give ABX for Barotrauma?

A

Only if TM ruptured: Ciprofloxacin, Ofloxacin

-Analgesics for pain relief (NSAIDs, Acetominophen)

35
Q

What is eustachian tube dysfunction? Symptoms include….

Treatment?

A

Failure of the ET to maintain pressure equalization of middle ear –> negative pressure

Ear fullness, popping, underwater feeling, reduced hearing, auto phony, retracted TM

Treat underlying cause, autoinsufflation, decongestants if needed

36
Q

Explain peripheral vertigo (symptoms, where problem arises, and causes)

A

-Problem in labyrinth or CN8
-Symptoms: fatigable horizontal nystagmus, sudden onset, tinnitus
-Causes: BPPV, Meniere, Vestibular Neuritis, Labyrinthitis, Cholesteatoma

37
Q

Explain central vertigo (symptoms, where problem arises, and causes)

A

-Problem in brainstem or cerebellum
-Symptoms: nonfatigable vertical nystagmus, gradual onset, progressive
-Causes: Migraines, Tumors, MS

38
Q

What is BPPV and what is the cause?

A

Recurrent episodes of sudden peripheral vertigo (lasting 60 seconds or less) and provoked with specific head movements. No hearing loss or tinnitus.

Due to displaced otolith particles in the semicircular canals

39
Q

What diagnostic test can be done to diagnose a patient with BPPV and what the is the treatment?

A

Dix Hallpike test to diagnose

Epley Maneuver to reposition otolith particles

40
Q

What is the difference between vestibular neuritis and labyrinthitis?

A

VN: inflammation of vestibular portion of CN8
Labyrinthitis: inflammation of both parts of CN8

41
Q

What symptoms do VN and Labyrinthitis share? What symptoms are specific to labyrinthitis only?

A

Both: Continuous peripheral vertigo, horizontal nystagmus

Labyrinthitis only: unilateral hearing loss, tinnitus

42
Q

Treatment for VN and Labyrinthitis

A

-Glucocorticoids (Pred, Dexa, Cortisone)
-Meclizine for symptoms
-Both self limited

43
Q

Meniere’s Disease is idiopathic distention of the endolymphatic compartment of inner ear due to excess fluid. What are the symptoms of Meniere’s?

A

-Episodic peripheral vertigo (minutes to hours)
-Fluctuating sensorineural hearing loss
-Tinnitus, ear fullness
-Horizontal nystagmus

44
Q

Health maintenance recommendations for a patient with Meniere’s Disease?

A

Dietary: no salt, chocolate, caffeine, nicotine, alcohol
Meclizine, Benzol, Diuretics
Surgical decompression if needed

45
Q

An Acoustic Neuroma (also called Schwannoma) is a benign tumor of…..

It arises in the cerebellopontine angle and can compress wha three things?

A

Schwann cells that causes hearing loss

Compresses CN 5, 7, 8

46
Q

Symptoms of an acoustic neuroma

What diagnostics can be done, besides audiometry, to diagnose this?

A

Slowly progressive unilateral sensorineural hearing loss

MRI (DOC)

47
Q

True or False: Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise?

A

True! Do audiometry first, then MRI

48
Q

Name one common medication that can cause tinnitus?

A

Aspirin at a high dose!

49
Q

What is otosclerosis and what type of inheritance pattern does it follow?

A

Abnormal overgrowth of the stapes –> conductive hearing loss

Autosomal dominant

50
Q

Symptoms of otosclerosis

A

-Slowly progressive conductive hearing loss (especially at low frequencies)

51
Q

Treatment for otosclerosis

A

-Stapedectomy with prosthesis or hearing aid

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