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Flashcards in Head & Ears Deck (180):
1

What are some common facial features of FAS (Fetal Alcohol Syndrome)

1. Short palpebral fissures
2. Thin vermilion border (upper lip)
3. Smooth filtrum

2

Common Trisomy 21 features?

1. Epicanthal folds
2. Macroglossia
3. Small ears & mouth
4. Brushfield spots

3

What are Brushfield spots?

White spots on Iris

4

What connective tissue is Marfan's Syndrome a disorder of?

Fibrillin

5

Common features of Marfan's Syndrome?

1.Tall
2. Loose joints
3. Crowded Teeth
4. Valvular & Aortic abnormalities
5. Pectus Caravatum

6

What defines the outer ear?

Visible ear & external auditory canal

7

What are the contents of the middle ear?

1.Tympanic Membrane
2. Malleus, Incus, Stapes
3. Eustachian Tube

8

What defines the inner ear?

Semicircular canals & Cochlea

9

In a Weber test, where is the tuning fork placed?

Top of head or general midline structure

10

In a Rinne test, where is the tuning for placed?

1st on the mastoid bone & then beside the ear

11

What is the Weber test supposed to detect?

Unilateral hearing loss

12

If you have Conductive hearing loss, which side will be louder in a Weber test?

Impaired ear

13

If you have Sensorineural hearing loss, which side will be louder in a Rinne test?

Unaffected ear

14

If you start with a Rinne test and AC > BC but not 2:1, which type of hearing loss is it?

Sensory

15

If you start with a Rinne test and AC < BC, which type of hearing loss is it?

Conductive (Negative rinne test)

16

If the Rinne test shows AC < BC & Weber test is louder in the left ear, what is the diagnosis?

Conductive hearing loss in left ear

17

If the Rinne test shows AC > BC & Weber test is louder in the left ear, what is the diagnosis?

Sensorineural hearing loss in the right ear

18

Conductive hearing loss is found in which sections of the ear?

External & middle

19

What are the 4 mechanisms of Conductive hearing loss?

1. Obstruction in EAC
2. Mass-loading (effusion)
3. Stiffness effect
4. Discontinuity

20

Is it easy or difficult to differentiate between sensory & neural hearing loss?

difficult

21

What does a 'deterioration of the cochlea' imply?

loss of hair cells from organ of Corti

22

Most common form of Sensory hearing loss?

Presbyacusis

23

What is presbyacusis?

progressive hearing loss due to advanced age?

24

What frequency is lost first in presbyacusis?

high frequency

25

Contributing factors of presbyacusis

1. Excessive noise exposure
2. Head trauma
3. Systemic diseases
4. Smoking
5. Ototoxicity

26

Lesions of the 8th cranial nerve involve what type of hearing loss?

Neural

27

Neural hearing loss involves lesions on...

1. CN VIII
2. Auditory nuclei
3. Ascending tracts
4. Auditory cortex

28

Causes of Neural hearing loss lesions

1. Acoustic Neuroma
2. MS
3. Auditory Neuropathy

29

Treatments for sensorineural hearing loss?

1. Prevention (ear plugs)
2. Hearing aids
3. Cochlear implants

30

Common term for Traumatic auricular hematoma?

Cauliflower ear

31

Why do you have to quickly treat Cauliflower ear?

prevent cosmetic deformity

32

Why do you have to quickly treat cellulitis of the auricle?

prevent perichondritis

33

Function of Cerumen?

Protects ear by trapping dust, bacteria, etc

34

Where is Cerumen produced?

ear canal in outer 3rd cartilaginous portion

35

Cerumen is made of...

Mixture of...
1. Viscous secretions from sebaceous glands
2. Less viscous secretions from modified apocrine sweat glands

36

What is the most common cause of hearing loss?

Cerumen impaction

37

Symptoms of Cerumen Impaction

1. Earache
2. Fullness Sensation
3. Tinnitus
4. Partial conductive hearing loss

38

Treatment for Cerumen Impaction

1. Baby oil/mineral oil
2. Drops - Debrox a.k.a glycerine
3. Sodium Bicarb + H20
4. H202 + H20

39

Complications of cerumen impaction removal?

1. Otitis Externa
2. Bleeding
3. Retained water in ear
4. TM perforation

40

What are overgrowths of bone in the ear canal called?

Exostoses/Osteomas

41

When do you NOT irrigate for a foreign body in an ear?

if the FB is organic (beans, insects)...they might swell

42

What is one of the biggest emergencies when it comes to foreign bodies in the ear?

batteries

43

What is Pruritis?

Itchy ear

44

How do you get Pruritus

Excoriation or by overly zealous ear cleaning

45

Treatment for Pruritis

1. Stop using Q-Tips
2. Mineral oil
3. Topical corticosteroids
4. Antihistamines

46

Characteristics of Otitis Externa?

1. Erythema & edema of ear canal skin
2. purulent exudate
3. Pain when touching auricle

47

What is a dangerous complication of OE?

osteomyelitis in the skull base (malignant external otitis)

48

Common causes of Otitis Media?

1. Moisture
2. Dirty Water
3. High temp & humidity
4. Removing Cerumen
5. FB (foreign bodies)
6. trauma
7. Dermatologic diseases

49

Treatments for OE

Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals

50

Prevention for OE

Alcohol drops

51

What is another name for Necrotizing Otitis Externa?

Malignant Otitis Externa

52

Where does NOE/MOE spread to?

temporal bone

53

What is the most common pathogen in NOE/MOE?

Pseudomonas

54

How dangerous is NOE/MOE?

fatal if not treated

55

How does NOE/MOE present?

1. Persistent foul aural discharge
2. Granulations in ear canal
3. Deep otalgia
4. Progressive CN palsies (6,7,9,10,11,12)

56

How is NOE/MOE diagnosed?

CT scan w/bone

57

Treament of NOE/MOE

1. Daily Debridement of EAC
2. Glucose control
3. Antipseudomonal drugs (Quinolones)
4. Surgery

58

Most common neoplasm of ear canal?

Squamous cell carcinoma

59

Mortality rate for Squamous Cell Carcinoma of the Ear Canal?

5-year (very high)

60

Treatment for Squamous Cell Carcinoma of the Ear Canal?

Surgical resection & radiation therapy

61

What does Eustachian Tube Dysfunction (ETD) cause?

unequal air pressure on either side of eardrum

62

Symptoms of ETD

1. Aural fullness
2. Fluctuating hearing
3. "Popping" in ears
4. Discomfort with pressure changes

63

What is someone with ETD at risk for?

Serous Otitis Media

64

Does ETD result in positive or negative pressure in the middle ear

negative

65

Most common cause of ETD?

Viral URI & allergies

66

Treatment of ETD

Systemic & intranasal decongestants

67

What causes Serous Otitis Media?

Blocked Eustachian tube for a long time

68

What age group most commonly gets SOM?

children

69

How do adults get SOM?

1. Post URI
2. Barotrauma
3. Chronic allergic rhinitis

70

What is the most important thing to exclude with persistent SOM?

nasopharyngeal carcinoma

71

Treatment for SOM

Controversial
1. short course of oral corticosteroids (prednisone)
2. Oral antibiotics
(amoxicillin)

72

What is Barotrauma?

Poor Eustachian tube function -- unable to equalize pressure in Eustachian tubes

73

Symptoms of Barotrauma

1. Ear discomfort/pain
2. Slight hearing loss (usually)
3. dizziness

74

Treatment of Barotrauma

Chew gum, yawn, anything that opens the Eustachain tube.
Also antihistamines, decongestants, steroids, analgesics

75

What might you see in severe cases of barotrauma

hemotympanum

76

Signs/Symptoms of Acute Otitis Media (AOM)

- Fever
- Decreased eardrum mobility
- Cloudy/red/bulging TM
- Otorrhea (if perforated TM)

77

Risk Factors for AOM

- Bottle feeding
- sleeping w/bottle
- Pacifier use
- Passive smoking
- M > F
- Family History

78

If AOM in an adult is unilateral and recurrent, what must we worry about?

nasopharyngeal carcinoma

79

What 3 bacteria cause AOM?

- Steptococcus pneumoniae
- H. influenzae
- Moraxella catarrhalis

80

Treatment of AOM

- 80% resolve w/o clinical intervention
- ***Amoxicillin 80-90mg/kg/d
- Auralgan

81

What is Auralgan?

pain killer drops

82

T/F...at 2 weeks, 50% will still have fluid

True

83

T/F...at 10 weeks, 10% will still have fluid

True

84

With AOM, how long should adults wait before ENT referral?

~8 weeks

85

What is an issue with using antibiotic prophylaxis to treat Chronic OM?

increasing antibiotic resistance

86

What usually must happen first to place PE tubes in COM?

- 3 distinct episodes of AOM in 6 months
OR
- 4 episodes in a year

87

What is the only type of water allowed around the ears in someone with PE tubes?

chlorinated water (such as in a pool)

88

What can you do for occluded PE tubes?

- Abx gtts (Antibiotic drops)
- H202
- ENT cleaning

89

How do PE tubes usually come out?

90% spontaneously

90

Some complications of OM?

- Hearing loss
- TM perforation
- Facial Paralysis
- Tympanosclerosis
- Cholesteatoma

91

How do you treat a perforated TM?

- Abx gtts & Oral Abx
- H20 precautions
- Most heal in a month

92

What is a Cholesteatoma?

Skin cyst in the middle ear & skull bone

93

Symptoms of a Cholesteatoma?

- Hearing Loss
- Recurrent ear drainage
- Foul/unpleasant odor
- Vertigo

94

Complications of Cholesteatoma?

- Erosion of bony structures
- Necrosis of Incus
- Facial nerve Palsy
- Meningitis
- Brain Abscess

95

Diagnosis of Cholesteatoma?

- history & clinical findings
- Ear discharge
- crust/keratin in the attic, pars flaccida or pars tensa
-with or w/out perforation of TM

96

Treatment of Cholesteatoma

Surgery. May need to repair ossicles

97

What is Acute Suppurative Mastoiditis?

Infection of the mastoid bone of the skull

98

What is Acute Suppurative Mastoiditis caused by?

Middle ear infection spreading to mastoid bone

99

In Acute Suppurative Mastoiditis, what does the mastoid bone fill with?

pus

100

Who is affected most by Acute Suppurative Mastoiditis?

Children

101

Symptoms of Mastoiditis?

- Ear pain/discharge
- Fever
- headache
- hearing loss
- Erythema of the ear/behind the ear
- post auricular edema

102

Diagnosis of Mastoiditis

- CT at level of middle ear
- Head CT
- skull x-ray

103

Treatment of Mastoiditis?

- Cefazolin & myringotomy
- Mastoidectomy

104

Complications of Mastoiditis

- Destruction of Mastoid bone
- Vertigo
- Epidural abscess
- facial paralysis
- meningitis
- partial/complete hearing loss
- partial/complete spread of infection to brain/body

105

What is Petrous Apicitis?

Medial portion of petrous bone becomes site of persistent infection b/c of drainage of pneumatic cell tracts

106

What does Petrous Apicitis cause?

- foul discharge
- deep otalgia
- 6th nerve palsy (Gradenigo syndrome)

107

What is Facial Paralysis associated with?

Acute/Chonic Otitis Media

108

What anatomically causes Facial Paralysis?

inflammation of the 7th nerve

109

Prognosis for AOM paralysis?

excellent. complete recovery usually

110

Prognosis for Chronic OM paralysis?

slower; less favorable

111

What is the definition of Otosclerosis?

- Abnormal sponge-like bone growing in middle ear

112

How does Otosclerosis inhibit hearing?

Prevents the ear bones from vibrating

113

What is the most common cause of middle ear hearing loss in young adults?

Otosclerosis

114

Symptoms of Otosclerosis?

- Hearing loss
- Tinnitus
- Vertigo

115

Is otosclerosis 1. Progressive/non-progressive & 2. familial/non-familial

1. Progressive
2. Familial

116

Otosclerosis leads to lesions on which bone of the middle ear & what type of hearing loss is it?

- Stapes
- Conductive

117

Treatment of Otosclerosis

- Surgical - stapedectomy
- hearing aid

118

Who is affected more by Otoclerosis, M or F?

Females

119

With persistent TM perforations, what is one thing we might worry about?

secondary infections from exposure to water

120

With diseases of the cochlea (loss of hairs), is hearing loss reversible or irreversible?

usually irreversible

121

Are most cochlear diseases Bbilateral/unilateral hearing loss?

Bilateral & symmetric

122

What might unilateral/asymmetric hearing loss mean in a cochlear disease?

lesion proximal to cochlea

123

Primary management goal in cochlear diseases

- Prevention of further loss
- improvement w/amplification

124

What are the first & second most common causes of sensory hearing loss?

1. Presbyacusis
2. Noise Trauma

125

Name some irreversible ototoxic medications

- Aminoglycosides
- Erythromycin
- Vancomycin
- Loop diuretics (Furosemide, Bumetanide)

126

Name a reversible ototoxic medication

Salicylates such as aspirin

127

What is the most common cause of sudden sensory hearing loss?

idiopathic...perhaps viral infection or sudden vascular occlusion of internal auditory artery

128

Treatment for sudden sensory hearing loss?

cortical steroids (oral prednisone)

129

Hereditary hearing loss is often found in what type of disorders?

mitochondrial

130

Hereditary hearing loss usually develops at what stage of life?

adulthood

131

Autoimmune hearing loss is associated with...?

- Systemic Lupus erythematosus
- Wegener granulomatosis
- Cogan syndrome

132

Prognosis for autoimmune hearing loss?

Progressive. Gradual evolution to permanent loss

133

What types of things do we look for when we screen for autoimmune diseases?

- Antinuclear antibody (ANA)
- Rheumatoid factor (RF)
-Erythrocyte sedimentation rate (ESR)

134

What is tinnitus?

perception of abnormal ear or head noises

135

What does persistent tinnitis indicate?

sensory hearing loss

136

Treatment for tinnitis?

- avoid exposure to excessive noise & ototoxic agents
- transcranial magnetic stimulation of central auditory system

137

What is Hyperacusis?

Excessive sensitivity to sound

138

Does it occur with normal hearing or only with hearing loss?

normal hearing

139

What can cause hyperacusis?

- ear disease
- noise trauma
- psychological

140

When talking about cochlear dysfunction, what does "recruitment" mean?

abnormal sensitivity to sounds despite reduced sensitivity to softer ones

141

What is Vertigo?

Sensation of motion w/o actual movement
OR
Exaggerated sense of motion

142

Characteristics of Peripheral Vertigo

- Sudden onset
- associated w/tinnitis & hearing loss
- Horizontal nystagmus

143

Characteristics of Central Vertigo

- Gradual onset
- progressive
- no auditory symptoms
- Vertical nystagmus (when present)

144

Triggers for Peripheral Vertigo

- Diet (high salt: Meniere's disease)
- stress/fatigue
- bright lights

145

What are Endolympathic Hydrops also known as?

Méniére's Syndrome

146

What is the classic triad associated with EH/Meniere's syndrome?

- tinnitis
- transient hearing loss
- vertigo

147

Cause of EH/Meniere's syndrome

- Mostly unknown
- syphilis
- head trauma

148

How long does EH/Meniere's syndrome last

- several hours

149

What happens anatomically in EH/Meniere's syndrome?

Distention of endolymphatic compartment of inner ear

150

Fist line of treatment for EH/Meniere's Syndrome?

- Low salt diet (<1500mg per day)
- Oral diuretic therapy

151

Characteristics of Labrynthitis

- acute onset
- lasts several days to a week
- hearing loss and tinnitis

152

What is labrynthitis caused by?

- Mostly viral infection (usually follows an URI)
- bacterial infection, allergy

153

Prognosis for hearing with labrynthitis

- hearing may return to normal or remain permanently impaired

154

Treatment for labrynthitis

-antibiotics if febrile/have bacterial infection

155

Define Benign Paroxysmal Positioning Vertigo (BPPV)

- Recurrent episode of vertigo lasting under several minutes per episode

156

Name 1 way BPPV is different than other types of vertigo

- actual movement is what causes the problem

157

Name the anatomical cause of BPPV

Otoconia (a.k.a otoliths) - calcium carbonate crystals in semi-circular canals

158

What do the Calcium Carbonate Crystals in BPPV do?

move endolymph and stimulate sensation of movement

159

Define Vestibular Neuronitis

single attack of vertigo that lasts for several days to a week

160

A key distinguishing feature of Vestibular Neuronitis

No accompanying hearing loss

161

Name two other distinguishing features of Vestibular Neuronitis that occur in the Acute phase

-Nystagmus
-absent responses to caloric stimulation

162

Treatment of Vestibular Neuronitis

Supportive Care & diazepam/meclizine in acute phase only

163

What is the most common cause of vertigo following a head injury?

Traumatic vertigo

164

Treatment of Traumatic Vertigo

Supportive care & diazepam/meclizine

165

What is a Perilymphatic fistula?

- leakage of perilymphatic fluid from inner ear into tympanic cavity

166

Causes of Perilymphatic fistula

- physical injury
- extreme barotrauma

167

Treatment of Perilymphatic fistula

- middle ear exploration and window sealing

168

Causes of Cervical Vertigo

- after neck injury (esp. hyperextension)
- Degenerative cervical spine disease

169

Management of Cervical Vertigo

- Neck movement exercises (PT)

170

What is a Vestibular Schwannoma (a.k.a Acoustic Neuroma)?

Benign tumor on 8th CN

171

Characteristics of Acoustic Neuroma

- slow growing
- unilateral hearing loss
- tinnitus

172

Which gender is more prone to acoustic neuromas?

females

173

How do you diagnose an acoustic neuroma?

MRI

174

Treatment of Acoustic Neuroma?

-surgical
-radiation

175

What is a common cause of vertigo in the elderly?

Vertebrobasilar insufficiency (VBI)

176

What is VBI triggered by?

changes in posture or extension of neck

177

Diagnosis of VBI?

- Rule out other causes
- Reduced flow demonstrated magnetic resonance angiography

178

What does Protean mean?

variable, not specific

179

In those with AIDS, what is the most common middle ear manifestation?

Serous Otitis Media due to ETD

180

What are some complications of SOM in those with AIDS?

Progressive hearing loss (caused by cryptococcal meningitis & syphilis)

Acute facial paralysis (caused by herpes zoster infection-Ramsay Hunt Syndrome)