Flashcards in Head & Ears Deck (180):
What are some common facial features of FAS (Fetal Alcohol Syndrome)
1. Short palpebral fissures
2. Thin vermilion border (upper lip)
3. Smooth filtrum
Common Trisomy 21 features?
1. Epicanthal folds
3. Small ears & mouth
4. Brushfield spots
What are Brushfield spots?
White spots on Iris
What connective tissue is Marfan's Syndrome a disorder of?
Common features of Marfan's Syndrome?
2. Loose joints
3. Crowded Teeth
4. Valvular & Aortic abnormalities
5. Pectus Caravatum
What defines the outer ear?
Visible ear & external auditory canal
What are the contents of the middle ear?
2. Malleus, Incus, Stapes
3. Eustachian Tube
What defines the inner ear?
Semicircular canals & Cochlea
In a Weber test, where is the tuning fork placed?
Top of head or general midline structure
In a Rinne test, where is the tuning for placed?
1st on the mastoid bone & then beside the ear
What is the Weber test supposed to detect?
Unilateral hearing loss
If you have Conductive hearing loss, which side will be louder in a Weber test?
If you have Sensorineural hearing loss, which side will be louder in a Rinne test?
If you start with a Rinne test and AC > BC but not 2:1, which type of hearing loss is it?
If you start with a Rinne test and AC < BC, which type of hearing loss is it?
Conductive (Negative rinne test)
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
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
Conductive hearing loss is found in which sections of the ear?
External & middle
What are the 4 mechanisms of Conductive hearing loss?
1. Obstruction in EAC
2. Mass-loading (effusion)
3. Stiffness effect
Is it easy or difficult to differentiate between sensory & neural hearing loss?
What does a 'deterioration of the cochlea' imply?
loss of hair cells from organ of Corti
Most common form of Sensory hearing loss?
What is presbyacusis?
progressive hearing loss due to advanced age?
What frequency is lost first in presbyacusis?
Contributing factors of presbyacusis
1. Excessive noise exposure
2. Head trauma
3. Systemic diseases
Lesions of the 8th cranial nerve involve what type of hearing loss?
Neural hearing loss involves lesions on...
1. CN VIII
2. Auditory nuclei
3. Ascending tracts
4. Auditory cortex
Causes of Neural hearing loss lesions
1. Acoustic Neuroma
3. Auditory Neuropathy
Treatments for sensorineural hearing loss?
1. Prevention (ear plugs)
2. Hearing aids
3. Cochlear implants
Common term for Traumatic auricular hematoma?
Why do you have to quickly treat Cauliflower ear?
prevent cosmetic deformity
Why do you have to quickly treat cellulitis of the auricle?
Function of Cerumen?
Protects ear by trapping dust, bacteria, etc
Where is Cerumen produced?
ear canal in outer 3rd cartilaginous portion
Cerumen is made of...
1. Viscous secretions from sebaceous glands
2. Less viscous secretions from modified apocrine sweat glands
What is the most common cause of hearing loss?
Symptoms of Cerumen Impaction
2. Fullness Sensation
4. Partial conductive hearing loss
Treatment for Cerumen Impaction
1. Baby oil/mineral oil
2. Drops - Debrox a.k.a glycerine
3. Sodium Bicarb + H20
4. H202 + H20
Complications of cerumen impaction removal?
1. Otitis Externa
3. Retained water in ear
4. TM perforation
What are overgrowths of bone in the ear canal called?
When do you NOT irrigate for a foreign body in an ear?
if the FB is organic (beans, insects)...they might swell
What is one of the biggest emergencies when it comes to foreign bodies in the ear?
What is Pruritis?
How do you get Pruritus
Excoriation or by overly zealous ear cleaning
Treatment for Pruritis
1. Stop using Q-Tips
2. Mineral oil
3. Topical corticosteroids
Characteristics of Otitis Externa?
1. Erythema & edema of ear canal skin
2. purulent exudate
3. Pain when touching auricle
What is a dangerous complication of OE?
osteomyelitis in the skull base (malignant external otitis)
Common causes of Otitis Media?
2. Dirty Water
3. High temp & humidity
4. Removing Cerumen
5. FB (foreign bodies)
7. Dermatologic diseases
Treatments for OE
Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals
Prevention for OE
What is another name for Necrotizing Otitis Externa?
Malignant Otitis Externa
Where does NOE/MOE spread to?
What is the most common pathogen in NOE/MOE?
How dangerous is NOE/MOE?
fatal if not treated
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)
How is NOE/MOE diagnosed?
CT scan w/bone
Treament of NOE/MOE
1. Daily Debridement of EAC
2. Glucose control
3. Antipseudomonal drugs (Quinolones)
Most common neoplasm of ear canal?
Squamous cell carcinoma
Mortality rate for Squamous Cell Carcinoma of the Ear Canal?
5-year (very high)
Treatment for Squamous Cell Carcinoma of the Ear Canal?
Surgical resection & radiation therapy
What does Eustachian Tube Dysfunction (ETD) cause?
unequal air pressure on either side of eardrum
Symptoms of ETD
1. Aural fullness
2. Fluctuating hearing
3. "Popping" in ears
4. Discomfort with pressure changes
What is someone with ETD at risk for?
Serous Otitis Media
Does ETD result in positive or negative pressure in the middle ear
Most common cause of ETD?
Viral URI & allergies
Treatment of ETD
Systemic & intranasal decongestants
What causes Serous Otitis Media?
Blocked Eustachian tube for a long time
What age group most commonly gets SOM?
How do adults get SOM?
1. Post URI
3. Chronic allergic rhinitis
What is the most important thing to exclude with persistent SOM?
Treatment for SOM
1. short course of oral corticosteroids (prednisone)
2. Oral antibiotics
What is Barotrauma?
Poor Eustachian tube function -- unable to equalize pressure in Eustachian tubes
Symptoms of Barotrauma
1. Ear discomfort/pain
2. Slight hearing loss (usually)
Treatment of Barotrauma
Chew gum, yawn, anything that opens the Eustachain tube.
Also antihistamines, decongestants, steroids, analgesics
What might you see in severe cases of barotrauma
Signs/Symptoms of Acute Otitis Media (AOM)
- Decreased eardrum mobility
- Cloudy/red/bulging TM
- Otorrhea (if perforated TM)
Risk Factors for AOM
- Bottle feeding
- sleeping w/bottle
- Pacifier use
- Passive smoking
- M > F
- Family History
If AOM in an adult is unilateral and recurrent, what must we worry about?
What 3 bacteria cause AOM?
- Steptococcus pneumoniae
- H. influenzae
- Moraxella catarrhalis
Treatment of AOM
- 80% resolve w/o clinical intervention
- ***Amoxicillin 80-90mg/kg/d
What is Auralgan?
pain killer drops
T/F...at 2 weeks, 50% will still have fluid
T/F...at 10 weeks, 10% will still have fluid
With AOM, how long should adults wait before ENT referral?
What is an issue with using antibiotic prophylaxis to treat Chronic OM?
increasing antibiotic resistance
What usually must happen first to place PE tubes in COM?
- 3 distinct episodes of AOM in 6 months
- 4 episodes in a year
What is the only type of water allowed around the ears in someone with PE tubes?
chlorinated water (such as in a pool)
What can you do for occluded PE tubes?
- Abx gtts (Antibiotic drops)
- ENT cleaning
How do PE tubes usually come out?
Some complications of OM?
- Hearing loss
- TM perforation
- Facial Paralysis
How do you treat a perforated TM?
- Abx gtts & Oral Abx
- H20 precautions
- Most heal in a month
What is a Cholesteatoma?
Skin cyst in the middle ear & skull bone
Symptoms of a Cholesteatoma?
- Hearing Loss
- Recurrent ear drainage
- Foul/unpleasant odor
Complications of Cholesteatoma?
- Erosion of bony structures
- Necrosis of Incus
- Facial nerve Palsy
- Brain Abscess
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
Treatment of Cholesteatoma
Surgery. May need to repair ossicles
What is Acute Suppurative Mastoiditis?
Infection of the mastoid bone of the skull
What is Acute Suppurative Mastoiditis caused by?
Middle ear infection spreading to mastoid bone
In Acute Suppurative Mastoiditis, what does the mastoid bone fill with?
Who is affected most by Acute Suppurative Mastoiditis?
Symptoms of Mastoiditis?
- Ear pain/discharge
- hearing loss
- Erythema of the ear/behind the ear
- post auricular edema
Diagnosis of Mastoiditis
- CT at level of middle ear
- Head CT
- skull x-ray
Treatment of Mastoiditis?
- Cefazolin & myringotomy
Complications of Mastoiditis
- Destruction of Mastoid bone
- Epidural abscess
- facial paralysis
- partial/complete hearing loss
- partial/complete spread of infection to brain/body
What is Petrous Apicitis?
Medial portion of petrous bone becomes site of persistent infection b/c of drainage of pneumatic cell tracts
What does Petrous Apicitis cause?
- foul discharge
- deep otalgia
- 6th nerve palsy (Gradenigo syndrome)
What is Facial Paralysis associated with?
Acute/Chonic Otitis Media
What anatomically causes Facial Paralysis?
inflammation of the 7th nerve
Prognosis for AOM paralysis?
excellent. complete recovery usually
Prognosis for Chronic OM paralysis?
slower; less favorable
What is the definition of Otosclerosis?
- Abnormal sponge-like bone growing in middle ear
How does Otosclerosis inhibit hearing?
Prevents the ear bones from vibrating
What is the most common cause of middle ear hearing loss in young adults?
Symptoms of Otosclerosis?
- Hearing loss
Is otosclerosis 1. Progressive/non-progressive & 2. familial/non-familial
Otosclerosis leads to lesions on which bone of the middle ear & what type of hearing loss is it?
Treatment of Otosclerosis
- Surgical - stapedectomy
- hearing aid
Who is affected more by Otoclerosis, M or F?
With persistent TM perforations, what is one thing we might worry about?
secondary infections from exposure to water
With diseases of the cochlea (loss of hairs), is hearing loss reversible or irreversible?
Are most cochlear diseases Bbilateral/unilateral hearing loss?
Bilateral & symmetric
What might unilateral/asymmetric hearing loss mean in a cochlear disease?
lesion proximal to cochlea
Primary management goal in cochlear diseases
- Prevention of further loss
- improvement w/amplification
What are the first & second most common causes of sensory hearing loss?
2. Noise Trauma
Name some irreversible ototoxic medications
- Loop diuretics (Furosemide, Bumetanide)
Name a reversible ototoxic medication
Salicylates such as aspirin
What is the most common cause of sudden sensory hearing loss?
idiopathic...perhaps viral infection or sudden vascular occlusion of internal auditory artery
Treatment for sudden sensory hearing loss?
cortical steroids (oral prednisone)
Hereditary hearing loss is often found in what type of disorders?
Hereditary hearing loss usually develops at what stage of life?
Autoimmune hearing loss is associated with...?
- Systemic Lupus erythematosus
- Wegener granulomatosis
- Cogan syndrome
Prognosis for autoimmune hearing loss?
Progressive. Gradual evolution to permanent loss
What types of things do we look for when we screen for autoimmune diseases?
- Antinuclear antibody (ANA)
- Rheumatoid factor (RF)
-Erythrocyte sedimentation rate (ESR)
What is tinnitus?
perception of abnormal ear or head noises
What does persistent tinnitis indicate?
sensory hearing loss
Treatment for tinnitis?
- avoid exposure to excessive noise & ototoxic agents
- transcranial magnetic stimulation of central auditory system
What is Hyperacusis?
Excessive sensitivity to sound
Does it occur with normal hearing or only with hearing loss?
What can cause hyperacusis?
- ear disease
- noise trauma
When talking about cochlear dysfunction, what does "recruitment" mean?
abnormal sensitivity to sounds despite reduced sensitivity to softer ones
What is Vertigo?
Sensation of motion w/o actual movement
Exaggerated sense of motion
Characteristics of Peripheral Vertigo
- Sudden onset
- associated w/tinnitis & hearing loss
- Horizontal nystagmus
Characteristics of Central Vertigo
- Gradual onset
- no auditory symptoms
- Vertical nystagmus (when present)
Triggers for Peripheral Vertigo
- Diet (high salt: Meniere's disease)
- bright lights
What are Endolympathic Hydrops also known as?
What is the classic triad associated with EH/Meniere's syndrome?
- transient hearing loss
Cause of EH/Meniere's syndrome
- Mostly unknown
- head trauma
How long does EH/Meniere's syndrome last
- several hours
What happens anatomically in EH/Meniere's syndrome?
Distention of endolymphatic compartment of inner ear
Fist line of treatment for EH/Meniere's Syndrome?
- Low salt diet (<1500mg per day)
- Oral diuretic therapy
Characteristics of Labrynthitis
- acute onset
- lasts several days to a week
- hearing loss and tinnitis
What is labrynthitis caused by?
- Mostly viral infection (usually follows an URI)
- bacterial infection, allergy
Prognosis for hearing with labrynthitis
- hearing may return to normal or remain permanently impaired
Treatment for labrynthitis
-antibiotics if febrile/have bacterial infection
Define Benign Paroxysmal Positioning Vertigo (BPPV)
- Recurrent episode of vertigo lasting under several minutes per episode
Name 1 way BPPV is different than other types of vertigo
- actual movement is what causes the problem
Name the anatomical cause of BPPV
Otoconia (a.k.a otoliths) - calcium carbonate crystals in semi-circular canals
What do the Calcium Carbonate Crystals in BPPV do?
move endolymph and stimulate sensation of movement
Define Vestibular Neuronitis
single attack of vertigo that lasts for several days to a week
A key distinguishing feature of Vestibular Neuronitis
No accompanying hearing loss
Name two other distinguishing features of Vestibular Neuronitis that occur in the Acute phase
-absent responses to caloric stimulation
Treatment of Vestibular Neuronitis
Supportive Care & diazepam/meclizine in acute phase only
What is the most common cause of vertigo following a head injury?
Treatment of Traumatic Vertigo
Supportive care & diazepam/meclizine
What is a Perilymphatic fistula?
- leakage of perilymphatic fluid from inner ear into tympanic cavity
Causes of Perilymphatic fistula
- physical injury
- extreme barotrauma
Treatment of Perilymphatic fistula
- middle ear exploration and window sealing
Causes of Cervical Vertigo
- after neck injury (esp. hyperextension)
- Degenerative cervical spine disease
Management of Cervical Vertigo
- Neck movement exercises (PT)
What is a Vestibular Schwannoma (a.k.a Acoustic Neuroma)?
Benign tumor on 8th CN
Characteristics of Acoustic Neuroma
- slow growing
- unilateral hearing loss
Which gender is more prone to acoustic neuromas?
How do you diagnose an acoustic neuroma?
Treatment of Acoustic Neuroma?
What is a common cause of vertigo in the elderly?
Vertebrobasilar insufficiency (VBI)
What is VBI triggered by?
changes in posture or extension of neck
Diagnosis of VBI?
- Rule out other causes
- Reduced flow demonstrated magnetic resonance angiography
What does Protean mean?
variable, not specific
In those with AIDS, what is the most common middle ear manifestation?
Serous Otitis Media due to ETD