External ear Flashcards
(117 cards)
1
Q
Otalgia
A
pain in ear
2
Q
Otorrhea
A
D/c in ear
3
Q
Right, left, both ears
A
AD
AS
AU
4
Q
External auricular canal
A
Auricle/ Pinna
External canal
5
Q
External Auricular Canal notes
A
2.5cm long - adult
S-shaped
Cerumen (wax)
6
Q
Cereum is secreted where?
A
Sebaceous glands in lateral third of EAC
7
Q
Middle ear anatomy
A
Air filled Ossicles -Malleus (hammer) -Incus (anvil) -Stapes (stirrup) Windows -Oval -Round
8
Q
Inner ear anatomy
A
Cochlea - organs of corti Semicircular canals - loops (sup/post/lat) - vestibular control CN VIII -Vestibular n. -Cochlear n.
9
Q
What structure is responsible for vestibular control?
A
Semicircular canals
10
Q
Mastoid process anatomy
A
Portion of temporal bone
Numerous air cells
Communicates w/ middle ear (infection potential)
11
Q
Basal cell carcinoma of auricle due to
A
UVB radiation (chronic sun exposure)
12
Q
Basal cell carcinoma of auricle Appearance
A
Nodular lesion - May ulcerate/bleed
13
Q
Basal cell carcinoma of auricle Grows how fast?
A
Slow
14
Q
Basal cell carcinoma of auricle TXT
A
Consult ENT/Derm
- local excise
- Mohs surgery
15
Q
Squamous cell carcinoma of auricle MC pop
A
Elderly males
16
Q
Squamous cell carcinoma of auricle RFs
A
>age Immunosuppression Non-healing ulcer Chemical exposure UV radiation
17
Q
Squamous cell carcinoma of auricle Appearance
A
Plaque, nodule, ulcer
Prone to bleed
18
Q
Which is more aggressive- BCC vs SCC?
A
SCC
19
Q
Precursor to SCC
A
Actinic keratosis
20
Q
SCC txt
A
Req larger excision than BCC
21
Q
SCC eval for mets?
A
Eval neck for nodules w/ careful F/Us
22
Q
Malignant melanoma of auricle is
A
Unpredictable tumor affecting all ages w/ high M/M
23
Q
Malignant melanoma of auricle Appearance
A
Pigmented lesions changes w/ growth, color, margin, ulcer, bleed, deep pigmentations
24
Q
Malignant melanoma of auricle Pathophys
A
Stars in epidermis >
Invades Dermis >
Predictor of severity
25
Malignant melanoma of auricle Lifesaving txt?
Early ID
| excision
26
Epidermal inclusion cyst presents as?
Slow growing
Central puncture
Well defined, non-TTP
Soft, mobile, cystic mass
27
Epidermal inclusion cyst Can spontaneously what?
Drain - foul smell
28
EIC Dx
Clinical
29
EIC Txt
Self limiting - pt can request txt
--inj triamcinolone into dermis May speed resolution.
OR
—excise - when not inflamed - wait 4-6w PRN
30
Auriclar hematoma is
Blood build-up between cartilage/Perichondrium, usually due to blunt trauma
31
Auriclar hematoma Pathophys
Cartilage lacks blood supply >
Hematoma develops >
Necrosis of cartilage
32
To PVT deformities due to Auriclar hematoma?
Prompt drainage and pressure dressings
33
Fluctuate def?
Fluid underneath skin
34
Auriclar hematoma Presents as
Edema
Fluctuate
Eccymotic
Loss of NL landmarks
35
Auriclar hematoma TXT
Evacuate hematoma
Pressure dressing
Splinting
Prph (PO) Abx
36
Purpose of Abx for Auriclar hematoma?
Lacks blood supply so susceptible to infection
37
When to refer Auriclar hematoma?
ENT - >7d hematoma
38
Abx used for Auriclar hematoma?
Staph/pseudomonas
- Dicloxicillin or cephalexin
- cipro > pseudomonas
39
Auriclar hematoma Complications?
Necrosis
Infection
Cauliflower deformity
40
When does Cauliflower deformity set in?
48-72h
41
Evacuation of a ear hematoma process?
```
Cleanse > anesthesia
FNA - <24h sml
Or
Incision - >24h lrg/<7d old
Dressing x1w - check 24h
(PO) Abx
```
42
How to incise a hematoma?
Along posterior following skin curvature
-curved hemastats
Irrigate
43
Auricle nerve supply
Auriculotemporal n. = superiorly/anteriorly
Greater auricular/lesser occipital n = posterior/inferior
Vagus n. = concha and external auditory meatus
44
Serious underlying trauma (and SOC)
Middle ear trauma
Basilar skull fx
Facial n. or parotid gland involved
-CT w/out contrast
45
Middle ear trauma - S/S
```
Hemotympanum
Middle ear effusion
Otorrhea
Hearing deficit (Weber/Rinne)
Battle sign
Facial n. Dysfx
```
46
Basilar skull fx
CSF in ears, nose - CN VIII deficits +-
47
Lacerations of ear preferred txt?
Primary closure - limits exposure time to inf
Or
Delayed if >24h old or red, warm, edema.
+ quinolone Abx
48
Laceration of ear txt procedure
10mL syringe 1% lidocaine
NO EPI
1- local block (INJ posteriorly/anteriorly)
2- Regional blk- maj lacerations (avoid skin disrupt)
---Do not exceed 4mg/kg 1% lidocaine
49
Other consideration to TXT for lacerations of ear?
Tetanus shot
Prph Abx
Aftercare - daily cleanse w/ (Top) Abx
50
Cellulitis def
an infection of the skin
51
Perichondritis
an infection of the tissue surrounding the cartilage
52
Chondritis
infection of the cartilage (does not involve lobule)
53
Cellulitis / Perichondritis / Chondritis - present as?
Edema, warm, TTP, erythematous auricle
| Pain on deflection of auricle (pinch of auricle = pain)
54
Cellulitis / Perichondritis / Chondritis TXT
```
Poor blood circulation -difficult
Remove jewelry
Mils - (PO FQ and F/U 24h max)
Mod-Sev - (IV Abx - FQ, Aminoglycoside, PCN) or debridement
ENT refer
```
55
Cellulitis / Perichondritis / Chondritis is due to
Due to P. Aeruginosa - 95%
56
Dz of EAC
```
Cerumen impaction
FOB
Traumatic External Otitis
AOE/MOE
Pruritis
Exostosis
Osteomas
Neoplasm
```
57
Cerumen Fx
Secreted by outer portion of EAC so it may protect the skin of canal by acidifing it > PVTs bacteria/fungus
Lipid rich > PVTs penetration/maceration (hydrophobic)
58
Lateral 1/3 EAC has
cartilaginous EAC with hair and glandular-bearing skin
59
Medial 2/3 EAC has
bony EAC w/ thin skin attached to periosteum of temporal bone
60
Isthmus is?
Where canal narrows
61
Reasons for Cerumen impaction
1. Obstruction from EAC dz
2. Narrowing EAC
3. Failure of epithelial migration
4. Overproduction
62
Obstruction of EAC leading to impactions is due to?
Exostoses
Inf/derm (otitis externa, eczema, psoriasis, seb derm)
Cutaneous S/S of systemic dz (SLE, Crohn’s)
63
Narrowing of EAC leading to impactions is due to?
NL anatomy, tumors, excess hair, lareal 1/3 collapse of cartilage (trauma).
64
Failure of epthelial migration leading to impactions is due to?
Aging
Atrophic glands > produce harder/thicker cerumen
Ear plugs/hearing aids
Q-tips - sticking crap in the ear
65
Overproduction of cerumen in EAC leading to impactions is due to?
Local trauma, retained water, idiopathic
66
Cerumen Impaction - presents
Usually asymp - incidental finding w/ otoscopic exam
| Symp > hearling loss, otalgia, itch, fullness
67
Cerumen Impaction - home hygeine
Clean external opening w/ washcloth/index finger once/wk
68
Removal indications of cerumen impaction
Symptomatic > removal= avg 10dB hearing improve
Asymptomatic > Observe
69
Removal includes what 3 therapeutic options?
1st-L > cerumenolytic agents
then > irrigation
then > Manual removal by clinician
70
Cerumenolytic CI
TM damage suspected
- Otorrhea
- Otalgia
- Hx freq ear infections
71
Cerumenolytic are safe to use in what pts?
No hx of infection, perf, otologic surgery
72
Cerumenolytic max dosing regiment time?
Do not exceed 3-5d
73
Cerumenolytic Rx's
OTC - mineral oil or hydrogen peroxide 3%
| Rx - Carbamide peroxide (5-10drops in canal)
74
Complications of Cerumenolytic?
```
Allergic rxn
Otitis externa
Earache
Transient hearing loss
Dizzy
```
75
Irrigation is more effeective for?
Hard impactions
76
Irrigation solution?
warm water w/ hydrogen peroxide 1:10
| F/U w/ acidification (water+2% acetic acid or boric acid)
77
Following irrigation perform a?
Otoscopy
78
What environment encourages bacterial growth?
Wet desquam skin + high pH environment
79
Irrigation complications?
Retention of water behind residual cerumen = maceration > infection
80
Too aggressive irrigation can cause
TM perf
HL or tinnitus +- vertigo
Pain
81
Manual removal/cleaning under microscope guidance reqs?
ENT consult
82
Complications of manual removal?
Otalgia
TM perf
Inf
bleed/laceration
83
Cerumen Impaction - Prevention if recurrent
Mineral oil cotton ball placed in EAC 10-20m once/w > helps liquefy cerumen and aid NL elimination
Remove hearing aids during sleep
Routine clean by HCP q6-12mo
84
FOB S/S
Present w/ pain, pruritis, conductive HL, and/or bld
Persistent object > inf/formation of granulation tissue
85
TXT of FOB
Remove w/ care (NOT blindly remove)
Prepare w/ correct instuments
Irrigate may dislodge (CI if organic object (beans/bugs)
Insect > 2% viscous lidocaine > kill/anesthatizes
86
Otitis Externa S/S?
Painful itchy erythema (esp auricle/tragus manipulation)
Edema of EAC
Purulent exudate
TM mobile
Can evolve to OM of skull base (x-imm or DM)
87
Otitis Externa AKA?
Swimmers ear - inflammatory/infectious process
88
Otitis Externa is due to?
Pseudomonas aeruginosa and Staphylococcus aureus
89
Predispoing factors of Otitis Externa?
```
Freq/aggresive cleaning
Q-tips
Water exposure
scratching
All = lack of cerumen (too clean)
```
90
Advanced Otitis Externa may see what S/S?
LAD of periauricular and anterior cervical lymph nodes
91
AOE TXT?
1- cleaning - gently remove loose debris
| 2- TXT inflam/infection (top)
92
Mild - AOE w/out infection - TXT?
Drying agent - 50/50 isopropyl etoh/white vinegar
2% acetic acid (5gtts into canal tid/bid) change pH
--P. aeruginosa/S. aureus grow in 6.5-7.3 pH
93
Mod - AOE w/ infection or high risk - TXT?
Polymyxin B/hydrocortisone- inexpensive , but contains neomycin - potent sensitizer (itch, erythema, edema)
Aminoglycosides (gentamicin sulfate 0.3%): more expensive and potentially ototoxic (? TM)
Quinolones (ciprofloxacin or ofloxacin): highly effective but expensive (qd – bid dosing)
Rx: Ofloxacin Otic; 10 gtts into affected ear(s) 1/d x7 d
94
AOE systemic TXT indications? or +- refer
```
Cellulitis
DM
X-imm
Hx radiation to ear
Severe otitis externa
Sigedema inhibiting topical meds
```
95
AOE systemic TXT Rx?
Ciprofloxacin (P. aeruginosa and S. aureus) 500mg/w
| Control pain - NSAIDs opioid analgeiscs
96
AOE PVT?
Protect water from ears
Cotton ball w/ p. jelly during her bath
Educate/PVT
97
Necrotizing Otitis Externa is?
Malignant - otitis externa
| Severe bacterial infection of EAC/skull base
98
Necrotizing Otitis Externa MC pop?
Elderly DM
| X-imm
99
Necrotizing Otitis Externa typical offending agent?
Pseudomonas
100
Necrotizing Otitis Externa pathophys?
1st- external otitis spreads to temporal bone > the skull base, leading to fatal complications
101
Necrotizing Otitis Externa S/S?
deep otalgia, EAC granulation, persistent foul otorrhea
Cranial nerve palsies are a poor prognostic sign (VI, VII, IX, X, XI, or XII)
102
Necrotizing Otitis Externa Dx?
CT, with bone windows, can dx infection in the bone (which is the sequelae of this disease)
103
Necrotizing Otitis Externa is AKA?
Malignant otitis externa (however nothing to do w/ malig) - its an infection
104
Necrotizing Otitis Externa TXT
ENT consult
Daily debride
Antipseudomonas Abx/ear drops
-Ciprofloxacin (po/IV) 3mo
Refrac > surgical debridement
105
Pruritis - notes
Common
Self-induced (excoriations/ear cleaning)
Ass/w external otitis, psoriasis, seb derm.
106
Pruritis TXT
```
Allow cereum build up
Avoid cleaning EAC
Mineral oil - repel moisture
Inflam > (top) triamcinolone
(po) Benadryl
```
107
Exostoses is
multiple EAC lesions, firm, bony, broad-based lesions composed of lamellar bone, reactive bone formation
108
Osteoma is
pedunculated bony EAC lesion, benign osseous neoplasms, attached to the tympanosquamous or tympanomastoid suture line
109
Exostoses Ass/w
Chronic cold water exposure
110
Exostoses AKA
Surfers ear
111
Structural ear canal D/Os?
Exostoses
| Osteomoa
112
Structural D/O - Txt single lesion
Unless very Lrg - no txt
113
Structural D/O - Txt multiple lesions
Often progress req surgery
114
MC neoplasm of EAC?
SCC
115
If obvious otitis externa does not resolve w/ therapy think?
Malignancy
116
EAC malignancy - notes
```
High mortality (w/in 5yr)
Ivades lymphatics of cranial base
```
117
Tumors of the ceruminous glnads are called?
Adenomatous tumors (less severe)
