Lecture 10 (HEENT)-Exam 4 Flashcards

Question

Foreign Bodies of the Ear Canal * Common in who? * What is the MC ages? and groups of people? * Often what? * How do you diagnosis?

Answer 1

* Fairly common in a Pediatrics (toys, beads, insects, etc) * Most common ages 1-6 * Adults in sports and outdoor activities * Often asymptomatic * Diagnosis: Visualization with otoscope (check the nose too!)

Answer 2

If there is an abnormal lesion that doesn’t improve, refer! * Basal cell carcinoma * Squamous cell carcinoma * Melanoma

Answer 3

* Otitis Media * Tympanic Membrane Perforation * Cholesteatoma * Mastoiditis

Answer 4

Acute, suppurative infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the middle ear space

Answer 5

* Eustachian tube dysfunction with subsequent tube obstruction * Increased negative pressure * Accumulation of fluid * Microbial grown * Suppuration

Answer 6

* Most common pathogens – **Streptococcus Pneumoniae**, Haemophilus Influenzae, Moraxella catarrhalis, Staph aureus * Can also be viral (~ 16%)

Answer 7

Pneumatic otoscope * TM does not move: OM * TM moves: normal

Answer 8

Antibiotic therapy –> #1 Amoxicillin * Consider severity, age, risk factors, caregiver * <6 months, severe sx, toxic appearing- Abx therapy * Uncomplicated children Abx therapy * Adults: amoxicillin or amoxicillin/clavulanate (Augmentin) * Observation before abx if parental preference and low risk (explain risks/benefits/f/u)

Answer 9

Amoxicillin 90 mg/kg per day ( high dose) -divided in two doses, max 3g/day Duration * 10 days (<2 years, perf TM, or hx of recurrence) * 5-7 days (> 2 years with intact TM and no recurrent hx) Pain control- ibuprofen/acetaminophen

Answer 10

* Recurrent AOM (4 or more episodes per year) * May cause TM sclerosis * Tubes permit drainage of the middle ear fluid, aeration, and return of mucosa to normal * Refer to ENT for placement

Answer 11

* Vaccine – Pneumococcal Vaccine (PCV) offers modest prevention (~7% risk reduction) * Influenza vaccine under age 6 offers modest prevention (~4%) * Exclusive breastfeeding until 6 months reduces risk (~43%) * Without antibiotics, AOM often resolves within 24 hours in ~ 60% ## Footnote Pneumococcal 15-valent conjugate vaccine, also PCV 20 now available

Answer 12

Otitis Media with Effusion * Otoscopic findings of OME include visible fluid (often yellowish, but sometimes clear) behind an intact tympanic membrane.

Answer 13

* Watchful waiting (often spontaneous resolution <6 weeks) * Consider early surgical referral in children at risk for speech/learning problems * Tympanostomy tube placement if >3 months * Antibiotics, antihistamines, and steroids have not been shown to be useful in the treatment of OME

Answer 14

* Cholesteatoma * Tympanic Membrane Perforation * Mastoiditis * Facial Nerve Palsy

Answer 15

* Abnormal accumulations of epithelium in middle ear and mastoid * Skin cells become trapped in middle ear, proliferate, and erode bone and surrounding structures * Rare complication of AOM or OME, ET dysfunction (9/100,000)

Answer 16

* Suspect in any patient with a chronically draining ear * Sx: Ear drainage and hearing loss * Exam: Focal retractions and white mass behind intact TM * Dx: Temporal Bone CT

Answer 17

* Txt: ENT referral for surgery * Prognosis: Frequent recurrence * Complications: labyrinthitis, facial palsies and paralysis, meningitis and hearing loss

Answer 18

Cholesteatoma

Answer 19

* Usually after weeks of inadequately treated AOM * Presentation: Postauricular pain/erythema, fevers * Exam: Tenderness and erythema posterior over mastoid bone

Answer 20

* Dx: CT -reveals coalescence of the mastoid air cells due to bony septa destruction. * TX – IV antibiotics (first line) * No improvement->surgical drainage or mastoidectomy

Answer 21

* Acoustic neuroma * Barotrauma * Dysfunction of eustachian tube * Labyrinthitis * Vertigo (BPPV) * Meniere’s disease

Answer 22

Presentation: * Unilateral hearing loss (95%-sensorineural), +/- disequilibrium (continuous), tinnitus Diagnosis: Enhanced MRI or CT * Can confirm hearing loss with audiogram

Answer 23

Treatment – Refer to ENT Surgery * May do observation with repeat imaging

Answer 24

with unilateral, asymptomatic hearing loss * Any individual with a unilateral or asymmetric sensorineural hearing loss should be evaluated for an intracranial mass lesion

Answer 25

acoustic neuroma

Answer 26

* Increased barometric stress exerted on the middle ear can cause trauma * Common causes: **air travel (#1)**, scuba diving, blast injuries ## Footnote The problem is generally most acute during airplane descent, since the negative middle ear pressure tends to collapse and block the eustachian tube, causing pain.

Answer 27

* Presentation: ear pressure, hearing loss (conductive), pain, +/- tinnitus * Diagnosis: Clinical (suspect based on symptoms and history) * May visualize trauma (**hemotympanum**) on otoscope exam

Answer 28

Treatment: **Conservative**-Usually resolves spontaneously * Recommend bedrest, head elevation, avoid anything that increases pressure * NSAIDS No improvement in a few days->requires urgent referral to ENT * **SNL hearing loss& vertigo->concern for perilymph fistula**

Answer 29

Patient Education: * Avoid diving with TM perforation or URI Prevention: Oral decongestants, antihistamines, and nasal decongestant sprays used prior to flying or diving * Counsel to swallow, yawn, and autoinsufflatation ## Footnote autoinsufflate (pinching nostrils closed while gently exhaling through the nose)

Answer 30

Tympanic membrane barotrauma (bleeding)

Answer 31

* ET connects middle ear to the nasopharynx * Provides ventilation and drainage for the middle ear * May dysfunction with URI, sinusitis, diving * Increased in kids, improves by age 6 * Can hypo or hyper function

Answer 32

Presentation: * Fullness in ear, decreased hearing, popping of ears Clinical diagnosis * TM may be retracted or normal * Can confirm with nasal endoscopy or tympanogram

Answer 33

Txt: Treat the underlying cause (rhinosinusitis, allergic, mass?) * Rhinosinusitis -pseudoephedrine, antihistamines, nasal steroids, pain control * autoinsufflation (if no active nasal infection)- Modified Valsalva Education: Avoid travel, diving, rapid altitude change

Answer 34

* Inflammation of the inner ear (labyrinth) or the nerves that connect the inner ear to the brain * Not dangerous, but incapacitating

Answer 35

* Broad differential (consider vascular events in >60, HA, neuro deficits, risk factors) * Diagnosis is clinical (consider MRI to r/o other diagnoses)

Answer 36

Txt: * Viral (secondary to URI)- supportive treatment (antihistamines, antiemetics, vestibular suppressants <24hrs) * Consider oral steroids (Grade 2C) if no contraindications (short-term relief, long term outcome uncertain) * Vestibular rehab in ongoing * Bacterial- (with otitis media or meningitis)- Abx treatment Differentiate from vestibular neuritis (auditory function preserved, no cochlear involvement)

Answer 37

* Sensation of self motion when no motion occurs * Occurs in conditions affecting the vestibular sensory organs of inner ear, cerebellum and brainstem and the connections between them. * Difficult to diagnose and determine etiology

Answer 38

Must differentiate peripheral from central causes * Peripheral: Sudden onset, +/- tinnitus and hearing loss; horizontal nystagmus * Central: Onset is gradual, no associated auditory symptoms, neuro symptoms Most common:Benign paroxysmal positional vertigo (BPPV)

Answer 39

* Walk test before discharging from an ED! * Peripheral- hearing loss/tinnitus * Central- usually no ear complaints * Good neuro exam required either way document your neuro exam

Answer 40

* Most common form of peripheral vertigo (about 1⁄2 of vertigo cases) * Pathogenesis: Occurs when calcium debris are displaced spontaneously into the semicircular canals

Answer 41

Presentation: **Recurrent, short episodes of vertigo** (seconds to 1 min) * **Usually provoked by head movements** * +/- N/V (intermittent) * +/-imbalance * Dizziness lasting minutes to hours is not BPPV

Answer 42

* Dx: Dix-Hallpike maneuver (move to supine position at head 45 angle) and normal neuro exam * DHM: delayed nystagmus (2-40secs) which lasts less than a minute + moderate vertigo * Treatment: Epley maneuver (can refer to physical therapy)

Answer 43

* Idiopathic condition (exact cause unknown) * Believed to be associated with excess endolymph fluid in the inner ear (endolymphatic hydrops)

Answer 44

* Presentation (classic triad): Episodic vertigo, tinnitus, hearing loss (sensorineural, low frequency) * Though hearing loss comes and goes, there is an expected progressive loss of hearing in the low frequencies

Answer 45

Refractory Symptoms: Refer to ENT * Steroids orally or intratympanic * Middle ear injection of Gentamycin * Surgical options: decompression Persistent disequilibrium: Vestibular rehabilitation ## Footnote * For patients with MD and persistent disequilibrium symptoms between attacks, we suggest referral for vestibular rehabilitation therapy (Grade 2C). Helps compensate * Hearing loss may accompany Meniere disease or posterior circulation ischemia (due to infarction of the labyrinth) and is not pathognomonic of Meniere disease)

Answer 46

* Nearly 20% of the global population live with hearing loss * ~15% of American adults aged 18 and over report some trouble hearing * 2 to 3 out of every 1000 neonates are born with a detectable hearing loss * 30 million people in US are exposed to dangerous noise levels on a regular basis * Increased prevalence of hearing loss with age (43% ages 65-84)

Answer 47

* Should be a part of every yearly H & P (physical diagnosis/Bates) * Screening for hearing is done during well child visits for peds * Any detected hearing loss in primary care should be referred for audiologist testing * Screen the elderly regularly * Audiologist-professional licensed medical professional who works in various settings treating patients with hearing loss and balance disorders

Answer 48

Common complaints: * inability to hear or understand speech in a noisy environment * difficulty understanding consonants * inability to hear high-pitched voices or noises * tinnitus Diagnostics: Screening questions, Weber/Rinne, otoscope exam, refer to audiology

Answer 49

Treatments: * Adaptative techniques and environmental modifications * Hearing aids beneficial but underutilized * Cochlear implantation an option those who have not benefited from hearing aids

Answer 50

Impairment of the passage of sound vibrations to the inner ear: * Obstruction (eg, cerumen) * Mass loading (eg, middle ear effusion) * Stiffness (eg, otosclerosis) * Discontinuity (eg, ossicular disruption)

Answer 51

Etiologies: * Cerumen impaction * Transient eustachian tube dysfunction due to upper respiratory tract infection * Chronic ear infection (OM, cholesteatoma) * Trauma (perforation) * Otosclerosis * Perforations of the tympanic membrane Often correctable with medical or surgical therapy, or both

Answer 52

Weber –Normal test- sound heard equally in both ears * Tuning fork placed on midline of head –tone is heard loudest in ear with hearing loss * Unilateral conductive hearing loss- tone is heard loudest in ear with hearing loss * Unilateral sensorineural hearing loss – the tone is heard louder in the normal ear

Answer 53

* Tuning fork held against mastoid bone, then, comparing its sound when held lateral to the patient’s ear (air conduction) * Normal is when tone can still be heard (AC>BC) * Conductive hearing loss- Bone conduction sounds louder than air conduction (BC>AC)

Answer 54

B Left-sided conductive hearing loss

Answer 55

C Right-sided sensorineural hearing loss

Lecture 10 (HEENT)-Exam 4 Flashcards

(114 cards)