ENT Flashcards
(31 cards)
How do you determine AOM v. OM w/ Effusion?
- 1- Is there an effusion?
- Blue, white, yellow, amber color
- Opacity
- Dec mobility of TM
- 2 - Is there inflammation? (if so, AOM)
- Red (mainly injection) - poor specificity
- Bulging (look at relationship to short process of malleus and the annulus)
- Sx - ear pain
What physical exam components should be performed for vertigo?
- Orthostatics - look for systolic dec > 25 mmHg
- Dix - Hallpike
- Watch pt walk without their awareness
- Ear exam - signs infection or growths
- Neuro exam - esp CN, Romberg, cerebellar testing
- Meas vestibular-ocular reflex by asking them to read Snellen chart while shaking head no - should be able to read if reflex intact
Meniere’s Disease
- 1- vertigo
- 2- change in vision w/ tinnitus
- 3- fullness in ear
Tx = low Na diet, K sparing diuretics to decrease endolymph; may need surgical drainage of endolymph sac or ablation / chemical ablation of labyrinth w. gentamicin
BPPV (sx and tx)
Benign Paroxysmal Positional Vertigo (#1 cause vertigo)
Sx = Nystagmus & positive Dix-Hallpike
- Particles most often in posterior canal b/c inferior when upright
- Positional change –> particles move –> brain thinks you are moving –> eyes move (nystagmus)
- Tx = Epley Maneuver
- Start w/ Dix-Hallpike on symptomatic side - WAIT 30 sec - rotate 270 degrees until nose down - sit patient up
Dix-Hallpike
- Head turned 45% to affected side w/ chin up in seated position; then lay back
- If positive will see period of latency followed by up-beat nystagmus
Vestibular Neuronitis
- Acute presentation is spinning and vomiting for days; often associated w/ URI sx
- Tx = IVF and vestibular suppressants temporarily; may have long term sequelae
What are 3 features of pre-syncope?
1- tunnel vision
2- lightheadedness
3- flushing / warmth
Disequilibrium (+ common causes)
Feeling off balance
CAUSES
- Presbystasis - w/ age - Post-labyrinthitis vestibulopathy - long term sequelae - Multi-Sensory
How do you generally treat dizziness?
- Adjust medications - STOP vestibular suppressants
**Meclizine, dimenhydrinate (dramamine), Benzo, scopalamine, TCAs, perchlorperazine, droperidol, diphenhydramine (Benadryl), hydroxzine, etc
- Rehabilitation and exercise
3 Indications for Tracheotomy
- Bypass upper airway obstruction (ex - cancer)
- In order to extubate (can take off sedation and stop throat/larynx irritation)
- Remove aspirated secretions
Anatomical Considerations in Tracheotomy
- Lower than cricothyroidectomy (between thyroid and cricoid cartilages)
- Extend neck during surgery to move trachea more anteriorly
- Skin - fat- strap muscles - anterior jugulars and thyroid gland nearby (may have to move it up or down or cut it)
If a tracheotomy is not suctioning what must you consider?
- Trach may have moved to anterior mediastinum when adjusted –> then when vent you cause pneumomediastinum –> requires needle decompression in 2nd intercostal space
What is the number one thing to remember in someone with a laryngotomy?
DO NOT PLUG STOMA
Steps in Tracheotomy Decannulation
- trade in for smaller tube and do trial with it plugged first; one-way inspiration only valve (Passy-Muir valve)
- CANNOT HAVE CUFF INFLATED WITH VALVE
Weber Test
- place fork on midline nose or forehead - LATERALIZE
- If lateralizes to good ear = sensorineural problem
- If lateralizes to bad ear = conductive problem
Rinne Test
- compare bone of mastoid to air in front of ear)
- If air > bone = normal
- If bone > air = conductive (could also mean that patient is completely deaf in that ear and is really just hearing thru other ear when using bone)
Sensorineural Hearing Loss (common presentation, causes, tx)
- problem with inner ear (internal basilar membrane and cochlear nerve)
- Usually occurs over 3 days or less, decrease in hearing by 30 decibels, loss across 3 consecutive frequencies
- Causes - 90% idiopathic, drugs (cisplatin, gentamicin), trauma, noise, CVD (stroke), MS
- Tx - oral prednisone + intra-tympanic steroid injections (best if given within 2 wks)
How do you treat a sub-perochondrial hematoma?
Do I&D to drain –> dressing and abx; suture dental roll or gauze in place over ear
Otitis Externa
- Risk = Q tip use, hearing aids, eczema, DM, immune-comp, water and heat exposure
- Prevention = 1:1 rubbing alcohol and white vinegar
- Tx
- 1- clean ear
- 2- keep ear dry
- 3- TOPICAL abx - ciprodex, floxin
- 4- culture if not getting better
- If chronic it may be fungal –> topical anti-fungal like Lotrimin or clotrimazole)
Osteoma v Exostoses
- Osteoma - bony and pedunculated; leave it unless obstructing ear canal
- Exostoses - associated w/ cold water in ear (esp surfers); often bilateral and multiple per ear; also leave unless obstructing
TM Perforation
- Often secondary to infection or trauma
- Sx = pain, dec hearing, aural fullness, tinnitus
- No mobility on pneumo otoscopy because air goes right thru hole
- Tx
- If small, observe and spontaneous healing
- If large, tympanoplasty
- Keep dry to avoid infections
Serous OM
- fluid behind TM w/o infection
- Risk = air travel, URI, nasopharyngeal mass, E tube dysfunction
- Tx = nasal steroids or limited use of nasal decongestants, pop ears
- If > 3 mo then myringotomy +/- tubes to relieve the negative pressure (equalize it) so that inner ear fluid can resorb
How do you treat chronic suppurative otitis media?
give topical steroid (ciprodex) + topical abx
Cholesteatoma
- Keratin debris in middle ear (created by epithelial layer of TM)
- Nidus of infection or causes erosion of ossicles (hearing loss), facial nerve (palsy), semicircular canals (vertigo)
- Tx - surgical
