HEENT QUIZ 3 - EAR Flashcards by pamela marte

incidence of AOM

-peak at 6-24 months
-70 % of infants will have at least one infection

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risk factors for AOM

-family of smokers
-fhx
-daycare
-lack of breastfeeding

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Pathogenesis of AOM

-ET dysfunction, usually follows URI
-in children, ET is shorter and more horizontal which causes issues with drainage, therefore bacteria will proliferate and cause ciliary dismotility.

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symptoms of AOM

-oltagia
-diarrhea and vomit
-high fever
-irritability
-decreased oral intake –can lead to hypoglycemia, dehydration and respiratory distress in infants

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AOM findings

-red TM
-decreased light reflex
-bulging of the tm with effusion - difficult to see the malleus
-drainage with TM rupture

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is AOM usually unilateral or bilateral

Acute otitis media is usually unilateral

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Bacterial causes of AOM

-strep pneumoniae (G+)
-Hemophilus influenzae (G-)
-m. cat moxarella catarrhalis (G+)

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TX for AOM

Amoxicillin for initial and uncomplicated AOM
-topical benzocaine ear drops for pain , unless TM is ruptured

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who should receive immediate antibiotics for AOM

-infants less that 6 months old
-toxic appearing
-immunocompromised
- craniofacial abnormalities

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without risk how long should you wait for tx of AOM

observe for 48-72 hours, treat if no improvement after 48 hours

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Chronic otitis media (COM) definition

recurrent or persistent infection

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what type of hearing loss is associated with chronic otitis media?

conductive hearing loss

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Common PE finding for COM

perforation of the tympanic membrane

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Will pt have pain with COM ?

pain may or may not be present with COM
-if rupture happens, may not have pain with this if fluid drains from the ear

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which other middle ear disorder is associated with COM?

cholestotoma

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Which middle ear disorder can lead to acute mastoiditis ?

acute otitis media

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Definition of otitis media with effusion (OME)

serous effusion of middle ear – not pus

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can otitis media be tx with antibiotics?

no, its not an infection

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causes of OME

-Allergic rhinitis
-smokers with allergies
-large adenoids
-ET blockage

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what will be seen in a PE of OME?

-TM will be retracted and immobile
-bubbles, fluid/air levels seen

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will there be hearing loss in OME ?

yes, OME is associated with conductive hearing loss

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symptoms in Bollous myringitis ?

-severe pain
-clear, watery discharge
-short lasting symptoms
-sudden onset

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ear findings in bollous myringitis ?

-vesicles (blisters) in the MT
- clear, watery discharges- pain usually goes away after it drains
-intact TM

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what is the usual etiology of bollous myringitis

viral etiology

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persistant, malodorous watery discharge is commonly seen in?

cholesteatoma

possible complications of cholesteatoma

-bone erosion -meningitis -facial muscle paralysis - conductive hearing loss

pathophysiology of cholesteatoma

1. COM causes chronic negative pressure in the middle ear 2. eardrum is pulled and retracted inward 3. pars flaccida pulled in forms a sac 4. sac is filled with debri and becomes granulation tissue

fluid in the middle ear eventually turns into a glue like consistency after...

chronic otitis media causes cholesteatoma

Acute mastoiditis cause

acute otitis media

symptoms seen in acute mastoiditis

-subperiosteal abscess -high fever - ear discharge - erythma, edema and tenderness of the mastoid area -ear my be budging outside of the head

is acute mastoiditis difficult to treat

yes, acute mastoiditis is difficult to treat with antibiotics

pt presents with edema, redness and tenderness of mastoid areas following an episode of AOM .What labs should be ordered?

- leukocytosis - ESR (look for increases) - blood c/s to R/O bacteremia -MRI to plan surgical tx if needed

onset and incidence of ostosclerosis

-15-35 y/o usually familial

pathophysiology of otosclerosis

-metabolic bone disease - periosteal bone replaces endochondral bone

sx of otosclerosis

ankylosis spondylitis: hardening of the stapes causes conductive hearing loss

can pts with otosclerosis present with tinnitus

75% of patients with otosclerosis present with tinnitus

pt is a swimmer and presents with severe pain cant right side, skin is macerated what are possible etiologies

Acute otitis externa - swimmers ear -strep, staph, pseudomonas

possible complications of acute otitis externa and what would be the symptoms

cellulitis can develop which extends from the epidermis to deeper ear tissue -if this occurs pt will present with LAO and fever

treatment for acute otitis externa

-keep water out of ear canal -antibiotic eardrops -oral pain meds

which external ear disorder is associated with skin conditions

chronic otitis externa

which skin disorders are associated with chronic otitis externa ?

1. atopic dermatitis 2. seborrheic dermatitis 3. psoriasis

pt has intense pruritus of the external ear and a hix of psoriasis, likely dx?

chronic otitis externa

possible complication of chronic otitis externa ?

secondary bacterial infection due to sticking things in the ear to scratch

pt presents with deformed pinna after getting a piercing , possible dx?

perichondritis

etiology of perichondritis

-trauma -bacterial(piercing) -insect bite

pathophysiology of perichondritis

avuscular necrosis

multi-system, episodic inflammation comoon in cartilaginous tissues

relapsing polychondritis

inital symptoms of relapsing polychondritis

ear pain and eythema -vioelacceous pina is the 1st sx

vioelacceous pina is the 1st symptom of what ear disorder

relapsing polychondritis

later symptoms of relapsing polychondritis

joint pain and weight loss

what can cause death in a pt with relapsing polychondritis

airway cartilage destruction

what age group is more commonly associated with relapsing polychondritis

middle aged adults

what part of the ear is spared in relapsing polychondritis

spares the earlobe except the pina

what systemic disorder is associated with relapsing polychondritis

arthritis

cause of herpers zoster oticus

sequelae of shingles

pt presents with ear rash, loss of taste, dry eyes and mouth. pt reports having severe pain prior to the rash appearing . possible dx?

herpes zoster oticus

herpes zoster oticus sx

-severe ear pain prior to rash -dry eyes and mouht -loss of taste

ramsay-hunt syndrome is associated with?

herpes zoster oticus

ramsay-hunt syndrome sx?

1. facial paresis 2. paroxysmal deep ear pain 3. vertigo 4. tinnitus 5. ipsilateral hearing loss

pt presents with ipsilteral ear pain, vertigo, tinnitus, facial weakness and sudden deep ear pain following a shingles episode, possible dx?

ramsay-hunt syndrome

Onset of meniere's disease/syndrome

usually 50s

difference between menieres syndrome and disease

syndrome: secondary cause dz: familial, idiopathic

possible causes menieres syndrome

thyroid problems autoimmune disease syphillis trauma

sx of menieres

-sudden onset of vertigo; severe isolated attacks -nausea and vomiting -attacks can last hours at a time -progressive hearing loss : low frequency sounds first -usually unilateral but 10-15% of cases are bilateral -tinnitus

what type of hearing loss is meniere's disease

sensorineural HL

Diagnostic criteria of meneire's

1. complete neuro exam 2. weber and rinne test 3. thyroid studies, electrolytes, glucose 4. CBC,ESR, ANA, fluorescent treponemal ab (syphillis) 5. MRI of the brain to R/O acoustic neuroma 6. dietary cahnges: decrease salt intake, avoid caffeine and decrease tobacco use

what causes meneire's disease

endolymphatic HTM

incidence of vestibular neuronitis

peak in 30s and 40s

etiology of vestibular neuronitis

viral infection. inflammation of the vestibular division of CNVIIi

sx of vestibular neuronitis

1. undirectonal horizontal nystagmus : made better by gaze fixation 2. abrupt onset of debilitating vertigo 3. nausea and vomiting no hearing loss or tinnitus , only vertigo

diagnostics for vestibular neuronitis

-(+) Romberg test -CBC, glucose -MRI if suspicious of CNS cause of vertigo

sx of vestibular migraines

- episodic vertigo -h/a: not always present -interictal symptoms: mild vertigo between attacks, susceptible to motion sickness

diagnostic criteria for vestibular migranes

1. at least 5 episodes of vestibular sx of moderate or severe intensity, lasting between 5 to 72 hours 2. one or more migranes feature with at least 50%of vestibular episodes 3. hx of migraine headaches 4. sx not better accounted fro by another dx

what type of vertigo and nystagmus is seen in a patient with acoustic neuroma

ocassional vertigo, rarely happens if it does it is central vertigo -vertical nystagmus worsened by gaze fixation and non-fatiguing

what is the most common cause of vertigo

benign positional vertigo (BPV)

HEENT QUIZ 3 - EAR Flashcards

(76 cards)