middle ear Flashcards
(119 cards)
1
Q
eustacian tube links?
A
pharynx to the middle ear
2
Q
Eustacian tube fx?
A
Equalize pressure
Mucus drainage
3
Q
Children are at higher risk of eustacian tube issues due to?
A
1- Shorter ET
2- Horizontal ET
3- Immature floppy elastic cartilage
4- Larger adenoids
4
Q
Eustacian tube reaches adult length by what age?
A
Age 6
5
Q
ETD (eustacian tube dysfx) S/S to dx?
A
Aural Fullness
Fluctuating hearing
Discomfort with barometric pressure changes
6
Q
ETD is at risk of developing?
A
Otitis media with effusion (OME) AKA - Serous Otitis Media (SOM)
7
Q
How to assess TM integrity and eustachian tube patency
A
Valsalva maneuver
8
Q
Difference between - DILATORY DYSFUNCTION (common) vs PATULOUS DYSFUNCTION (uncommon)?
A
Dilatory dysfx = stuck closed - cannot dilate
Patulous dyfx = stuck open
9
Q
Dilatory dysfx can be due to?
A
Any cause of inflam -Infection – usually viral MC OR -Allergies MC Pressure dysreg (altitudes) Anatomic/congenital ABNL -Downs, Turners
10
Q
MC cause of ETD?
A
Allergies
11
Q
Patulous dyfx can be due to?
A
Overly patent - hear my body fx - rare/benign
wgt loss as little as 6lbs
Scarring
Atrophy from neuromuscular d/o
12
Q
Dilatory dysfx S/S
A
HL, TM retraction/effusion
13
Q
Patulous dyfx S/S
A
– autophony, (TM appears normal without HL), movement of TM with inspiration and expiration
14
Q
Dilatory dysfx TXT
A
Decongestants for URI AH and/or nasal steroids for allergic rhinitis Smoking cessation Behavioral mod/PPI – acid reflux Frequent valsalva
15
Q
Patulous dyfx TXT
A
Mild - ressure and educate, hydrate, NS spray
Sev - Surgery maybe (cartilage graft)
16
Q
Serous Otitis Media AKA
A
Otitis Media with Effusion (OME)
17
Q
SOM patho
A
ETD dilatory - blocked prolonged time >
Negative pressure middle ear pressure > transudation
18
Q
SOM S/S
A
Middle ear fluid w/ut inflam/infection
Viscous bubbles
Conductive HL
Reduced TM mobility
19
Q
PEDs get SOM due to?
A
narrow/horizontal ET
20
Q
Adults may have h/o w/ SOM?
A
URI
CHronic seasonal allergies
barotrauma
21
Q
Best way to Dx SOM?
A
Tympanometry
22
Q
Adults w/ persistent (>3mo) unilateral SOM req?
A
R/O nasopharyngeal carcinoma w/ NP endoscopy
23
Q
SOM TXT?
A
HL mild > Observe 3mo
Freq valsalva
Rx - if URI/allergic rhinitis (po) CCS, AH, Abx +-
Failure of TXT >
Pressure equalization tube placement
Adenoidectomy (relives nasal obstruct)
Endoscopic orifice widening
24
Q
TM PE Tubes complications
A
PE tubes allow water to enter middle ear = recurrent infections.
25
TM PE tube surgery expectations?
In place 6-18mo > naturally fall out.
| TM heals on its own.
26
AOM essentials of Dx
#1 S/S - Otalgia often w/ URI
Erythema,
hypomobile TM
27
PE Tubes indications
Severe/recurrent AOM
SOM >3mo or >30dB HL
Chronic retraction of TM (ETD)
Surgery/rad/cranial involvement of middle ear
28
AOM is a sequeala of?
ETD
29
MC illnesses affecting children?
URI and OM
30
RFs of getting AOM?
Pacifer/bottle feed
Daycare
2nd hand smoke
31
What will protect infants from getting AOM?
Breastfeeding
32
AOM presents PEDs/Adults
Peds- Fever, irritable, crys, ear drainage, altered sleep
Adults - Fever, sudden otalgia onset in affected ear, Mastoid TTP, aural pressure, HL
33
Dx PE findings *
Decreased TM mobility, bulging TM w/out TM, erythema
Pneumatic otoscopy
34
MC bacteria of AOM
S. pneumoniae
H. influenza
S. pyogenes = (GABHS)
35
AOM TXT
Abx, antipyretics/analgesics (Ibuprofen, APAP)
36
AOM observe for TXT when?
>2yo
Healthy and mild illness (<102.2 fever)
Able to F/U if worsens
37
AOM Abx indications for PEDs?
<2yo
no improvement in 48-72h of observation
more severe S/S
38
AOM 1st line Abx? Resistant?
Amoxicillin
| -Amox-clav
39
AOM #1 S/S? needs what?
Otalgia - (po) analgesic
40
SNAP is an AOM concept for?
Safety-net approach to Abx prescription
| - Prescribe Abx however educate pt/parent to only use Abx if no improvement after 2d
41
PEDs SE of taking amoxicillin?
Itchy maculopapular rash >72h of initiation (adults too)
- not an allergy/CI to future amoxicillin
Ensure not MONO
42
X-imm - persistent - recurrent AOM infection req?
Tympanocentesis for Cx
43
Severe otalgia/complications (mastoiditis/meningitis) req?
Myringotomy
44
Recurrent AOM def?
≥ 3 distinct episodes of AOM within 6 months, OR
| ≥ 4 episodes within 12 months
45
Recurrent AOM TXT in young children?
PE Tubes
46
COM essentials of Dx *
Chronic otorrhea +- otalgia
| TM perf w/ conductive HL (ossicular chain destroyed)
47
COM is a sequela of?
Recurrent AOM
48
COM time frame to call it as such?
2w to 3mo
49
COM is defined as?
Chronic infection of middle ear/astoid that results in Chronic otorrhea thru perforated TM
50
COM bacteria?
Different from AOM
- P aeruginosa
- Proteus species
- S aureus
- anaerobic bacteria
51
Hallmark COM S/S?
Purulent D/C thats continuous or intermittent that increases w/ URI or water exposure
52
Is pain common w/ COM?
No - uncommon (+- exacerbations)
53
TXT of COM?
```
Remove debris
Earplugs for water
(top) Abx drops (ofloxacin, cipro, dexamethasone)
(po) cipro
Surgical TM repair
Mastoidectomy
```
54
Complications of otitis media?
```
Perf TM
Cholesteatoma
Masoiditis
Facial paralysis
CNS inf (otogenic meningitis)
```
55
TM perf occurs w/ otitis media due to?
Purulence draing down path of least resistance
56
TM perf TXT
Combo (po)/(top) Abx
- Otic - cirpo or ofloxacin for contaminated ear canals
(po) Abx if infection is present
PVT water into ear
57
TM perf CI rx
Aminoglycosides
Alcohol
Polymyxin/neomycin
58
TM perf heals spontaneously if
<25% involvement
59
Refer TM perf when?
Persists >6w
60
Chronic perf occurs when/patho?
All 3 layers perf >
If Squamous layer and cuboidal layer meet >
Fibrous layer stop growing
61
Chronic perf TXT?
Tympanoplasty
62
Cholesteatoma is?
Epidermal inclusion cyst behind tympanic membrane
63
Cholesteatoma is due to?
Prolong ETD dysfx/Chronic NEG middle ear pressure
Draws upper flaccid portion of TM in (pars flaccida) >
Creastes squam epi lined sac fill with keratin >
Chroniclly infected
64
Cholesteatoma presents as?
TM retraction
| Perf w/ keratin debris/granulation
65
SOC for Cholesteatoma?
CT
66
Cholesteatoma TXT?
Surgical excise - (recurrence common due to inability to remove entire lesion)
ETD dysfx still remains > PE tubes PVT NEG pressure
67
Mastoiditis evolves from?
Inadq TXT of AOM/COM
68
Mastoiditis presents as?
Fever, posterior ortalgia and/or erythema over mastoid
Edema of the pinna or displacement of auricle
Protruding auricle & loss of postauricular crease
69
Mastoiditis mgmt?
CT > Positive > Refer
70
Mastoiditis CT findings?
coalescence of the mastoid air cells due to destruction of their bony septa
71
Mastoiditis TXT
IV ABX (cefazolin)
72
Mastoiditis offending organisms
S pneumoniae,
H influenzae,
S pyogenes
73
Mastoiditis Abx TXT fails reflex?
Myringotomy for culture and drainage
| Mastoidectomy
74
What is definitive TXT of mastoiditis?
Mastoidectomy - surgical drainage is definitive treatment
75
Petrous apicitis AKA?
Petrositis
76
Petrous apicitis is?
Rare AOM complication - infection spreads w/in temporal bone of the petrous apex
77
Petrous apicitis classic triad presentation?
(Gradenigo syndrome):
- Retro-orbital pain
- AOM (foul smelling discharge)
- CN VI palsy (abducens) lateral rectus/eye abduction)
78
Petrous apicitis Dx?
Gradenigo syndrome triad +
| Rad - bony destructivion of petrous apex
79
Petrous apicitis TXT?
prolonged Abx based on Cx and surgical drainage
80
Facial palsy ass/w AOM - notes? Patho/TXT/prognosis
Inflam of CN VII in middle ear
TXT: myringotomy for drainage and Cx, + IV Abx
Good prognosis
81
Facial palsy ass/w COM - notes?
Evolves slowly - due chronic CN VII pressure by cholesteatoma
TXT: surgical correction of cholesteatoma
Less favorable prognosis than AOM
82
MC intracranial complication of ear infections? TXT?
Otogenic meningitis - myringotomy
83
Tympanosclerosis is
Formation of hyaline deposits and calcification in the TM
84
What causes Tympanosclerosis plaques?
Injuries to the eardrum, PET and chronic disease in the middle ear
85
Tympanosclerosis evolve to what S/S?
Deposits cause CHL due to decrease mobility of TM and immobilization of ossicular chain.
86
Tympanosclerosis Dx
Pneumatic otoscopy - decreased/absent mobility
87
Otosclerosis is
ABNL bony growth on footplate of stapes that results in HL (max 60dB) > impedence of sound through ossicular chain
88
Otosclerosis max HL?
60dB
89
Otosclerosis presents as?
Slow progressive unilateral or bilateral CHL
| Onset in early life (3rd-4th decade)
90
Dx of Otosclerosis req to R/O other causes of CHL w/?
CT/MRI
Weber/Rinne
Tympanometry
91
Otosclerosis TXT? Mild/sev
Unilateral and mild CHL - Observation
NL cochlear Fx + speech discrimination - Amplification
Sev- Surgery: stapes prosthesis (stapedectomy)
92
Barotrauma is? due to?
```
If equalization does not occur >
TM will retract from negative pressure >
-Air travel
-Diving
-Blast injuries
```
93
Barotrauma PE findings?
TM retraction, hemotympanum, +/- perforation
94
Barotrauma Dx?
Clinical
95
Barotrauma PVT?
Avoidance - Swallow, Yawn, Valsalva, chew gum
Rx - Pseudoephedrine/Oxymetazoline - prior to descent
Ventilating tubes if freq flier
96
Barotrauma TXT?
Most resolve spon
TXT if ETD
- analgesics
-Abx PRN
97
When to refer Barotrauma to ENT?
```
Severe otalgia,
HL,
Vertigo,
>4-5d persistence,
Blast injury
```
98
When/how to TXT Barotrauma?
Ossicular disruption or perilymphatic fistula
| - Myringotomy (Also PVT)
99
Impact injury or explosive acoustic trauma can cause?
TM perforation
Hemotympanum
Disruption of ossicular chain
100
TM perf - notes
Heal spon usually
| LRG perf may req tympanoplasty
101
Hemotympanum can occur due to?
Blunt trauma
| Extreme barotrauma
102
Hemotympanum TXT?
None - heals spon over several weeks
103
>30dB CHL >3mo may indicate?
Disruption of ossicular chain
104
Disruption of ossicular chain TXT?
Middle ear exploration w/ reconstruction of ossicular chain and TM repair
105
Mgmt for TM?
Signs of inf > Abx
HL
Refer ENT/Audiology PRN
106
Mgmt for TM w/out comorbids/HL?
Observe
Avoid water in ears (No swimming)
F/U 2-3mo
107
Primary middle ear tumors type?
Glomus tumor
108
Glomus tumors patho
arise i middle ear or in jugular bulb with upward erosion into hypotympanum
109
Glomus tumors present as?
Pulsatile tinnitus and CHL
| LRG tumors > CN neuropathies
110
Glomus tumors PE
Vascular mass may be visible behind intact TM
111
Glomus tumors TXT?
requires surgery, radiotherapy, or both
112
Pulsatile tinnitus finding always reqs?
magnetic resonance angiography and venography to rule out a vascular mass
113
Earache w/ pain out of proportion?
Herpes zoster oticus, esp. when vesicles in EAC or auricle
114
Earache w/ Persistent pain and discharge?
Osteomyelitis of the skull base or cancer
115
Non-otologic causes of earche
TMJ dysfx (chewing - bruxism or malocclusion)
CN V, VII, IX, X and upper cervical nerve issues
Glossopharyngeal neuralgia
Inf/neoplasma of oropharynx, hypopharynx, and larynx
116
Repeated episodes of severe lancinating otalgia (pain in the back of the throat and in the ear) indicate?
Glossopharyngeal neuralgia
117
Glossopharyngeal neuralgia mgmt after TXT failures?
Microvascular decompression of CN IX is required
118
TMJ dysfx mgmt?
Soft diet, heat to masticatory muscles, massage, NSAIDs, and dental referral
119
Persistent earache reqs?
refer to R/O cancer of upper aerodigestive tract
