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ICM Unit 3 HEENT > Otitis, Hearing, and Equilibrium > Flashcards

Otitis, Hearing, and Equilibrium Flashcards

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1
Q

Cerumen Impactation

A

usually self-induced (q-tip or digital trauma)

UNIlateral hearing loss and/or pain

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2
Q

Cerumen Impactation Tx

A

pt - detergent ear drops +irrigation (Hydrogen peroxide)

clinical - mechanical removal, suction, or irrigation (warm water NOT cold and ONLY if TM intact)

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3
Q

Foreign Bodies

A

MC kids

may or may not have FB sensation
+/- otorrhea

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4
Q

Foreign Bodies - to remove

A

loop or hook, alligator forceps (NOT blindly)

irrigation of inorg. objects

DO NOT IRRIGATE BEANS, SEEDS OR INSECTS (may swell)

insects subdued w/ lidocaine

send to ENT if unsuccessful or ED

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5
Q

Otitis externa

A

infxn of external ear canal

MC hx of water exposure or mechanical trauma

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6
Q

Otitis externa - causative agents

A

Bacteria = G- nods (Pseudo, Proteus)
Fungi = Aspergillus

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7
Q

Otitis externa - Clin Pres

A

ear pain
ear tenderness
otorrhea (foul-smelling)

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8
Q

Otitis externa - PE

A

Moving auricle (or pinna) PAIN
Erythema and edema of ear canal skin
Purulent exudate (wet or dry)
TM ? erythematous or not visualized

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9
Q

Otitis externa - TX

A

Protect ear from additional moisture, gently remove purulent debris

ABX drops + CS
(fluoroquinolone otic drops - ofloxacin 1st, ciprodex (cipro+dexamethasone) for mod-severe; IV severe

AG’s ototoxic

FUNGAL infxn
(acetic acid otic drops)
(clotrimazole otic drops)
Tolnaftate is TM integrity ?
Itraconazole if systemic

ANALGESICS

5+ drops 3-4 times a day

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10
Q

Otitis externa - Prevention

A

Drying agents for swimmers

50/50 solution vinegar and rubbing alcohol, frequ water exposure

avoid ear plugs, headphones

hair dryer, washcloth around edge of external ear and clean thoroughly daily

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11
Q

Necrotizing (malignant) Otitis Externa

advanced cases affects …

A

GRANULATIONS in ear canal
Persistent foul aural discharge
Advacned cases - CN palsies (CN 6,7,9,10,11,12)

Pain over mastoid

confirm w CT or MRI

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12
Q

Necrotizing (malignant) Otitis Externa - Tx

A

Hospitalization

prlonged ANTIPSEUDOMONAL IV abx (fluoroquinolone)

debridement of canal or drainage

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13
Q

Necrotizing (malignant) Otitis Externa - Complications

A

cranial neuropathy

sinus thrombosis

Intracranial infxns

High mortality (immunocomp)

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14
Q

External Ear Pruritis causes

A

Seb. derm
Eczema
Psoriasis
Self-induced

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15
Q

External Ear - Neoplasia Causes

A

External ear (SCC, BCC, Melanoma)

External ear canal (SCC, Bx/further eval

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16
Q

External Ear Pruritus tx

A

Low-mid topical steriods
Oral antihistamines

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17
Q

Eustachian Tube Dysfunc

A

air trapped w/i middle ear becomes absorbed and NEG pressure results

MC viral URI or allergy

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18
Q

Eustachian tube Dysfunction - Clin Pres

A

Fullness in ear
Popping or crackling sound when swallowing or yawning
Discomfort w/ barometric pressure changes
Recurrent or chronic otitis media

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19
Q

Eustachian tube Dysfunction - PE

A

Retracted TM
Decreased mobility on pneumatic otoscopy

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20
Q

Eustachian tube Dysfunction - Dx

A

clinical

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21
Q

Eustachian tube Dysfunction - Tx

A

For post-acute Viral = transient; DECONGESTANTS (oral or nasal)
autoinflation

Allergy-mediated = oral antihist; Intranasal STEROID prep; desensitize; 2-6 wks

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22
Q

Eustachian tube Dysfunction - AVOID

A

air travel
rapid alt change
underwater diving

during active phase

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23
Q

Serous Otitis Media

A

Otitis Media w/ Effusion (OME)

Middle ear infxn w/o inflammation
Prolonged ETD = neg middle ear press = fluid

MC kids

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24
Q

Serous Otitis Media - Clin Pres

A

Fullness in ear
Clear fluid behind TM
Dull, retracted TM
Conduc hearing loss

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25
Serous Otitis Media - TX
NO use abx ; watchful waiting audiology exam and ENT if persistent
26
Barotrauma
Diff. equalizing press. placed on middle ear Forceful nose blowing, air travel, underwater diving MC DESCENDING
27
Barotrauma - Preventative
autoinflation (before descending) Oral decongestants hrs in advance Nasal decongestant 1 hr before descent
28
Barotrauma - if persistent on the ground
More decongestants Myringotomy provides immed relief Tympanostomy tubes if freq flyer
29
Barotrauma : Diving
First 15 ft of descent can lead to TM rupture or hemotympanum (middle ear squeeze) Sensory hearing loss and vertigo can be assoc w/ decompression sickness
30
Acute Otitis Media
bacterial or viral infxn usually after URI presence of fluid in middle ear w/ acute onset of s/s of middle ear inflammation
31
Acute otitis media Bacterial pathogens
Streptococcus pneuomoniae Haemophilus influenza Moraxella catarrhalis
32
Acute otitis media - Risk factors
ETD (including obstruction of ET by mass - adenoids) Craniofacial abnormalities (cleft palate) Recurrent URI Bottle feeding or supine baby feeds (reflux into ear) Second hand smoke
33
Acute otitis media - Clin Pres
Otalgia, rapid onset Ear discharge Infants = irritability, disturbed sleep, feeding problems, ear pulling
34
Acute otitis media - PE
Erythematous, bulging, decreased TM Purulent effusion Otorrhea Tender auricular nodes Tender Mastoid
35
Acute otitis media - tx
Observation Abx Analgesics F/u plan (48-72 hrs) Absolutely need abx for = <6mo, severe s/s; mod/severe otalgia, otalgia >48 hrs, temp >102.2 Poor f/u potential Toxic appearance
36
Acute otitis media ABX
5-10 days 1st: Amoxicillin PCN allergy: cefdinir, cefuroxime, azithromycin 2nd line: Augmentin Analgesia: tylenol or ibuprofen for pain/F ENT -persis/recurrent AOM
37
Chronic otitis media
consequence of recurrent AOM present >6 wks perforation of TM common - otosclerosis, polyps
38
Chronic otitis media - Pathogens
P aeruginosa, Proteus species, Staph. aureus
39
Chronic otitis media - Clin Pres
PURULENT aural discharge unlikey painful except acute exacerbations conductive hearing loss or ossicular destruction?
40
Chronic otitis media- TX
Remove debris Wear ear plugs if water exposure Topical abx Surgery to repair TM
41
Cholesteatoma
growth of keratinizing epithelium thru TM perforation - cyst or pouches from neg pressure from chronic ETD
42
Cholesteatoma - other
can increase in size and erode ossicles, mastoid, or semicircular canal leads to hearing loss
43
Cholesteatoma - Tx
complete removal or marsupialization of sac if on important structure (facial n or semicirc. canals)
44
Acute Otitis Media extracranial complications
subperiosteal abscess petrous apicitis labyrinthine fistula Facial n paralysis
45
Acute Otitis Media intracranial complications
Meningitis Epi/subdural Abscess Brain abscess Lateral Sinus thrombophlebitis
46
Mastoiditis
after several wks inadequately treated AOM Postauricular pain and erythema w/ spiking fever
47
Mastoiditis - CT imaging shows
COALESCENCE of mastoid air cells from destruction of bony septa
48
Mastoiditis - Tx
Empiric IV abx Myringotomy for culture and drainage (hospital) Mastoidectomy (surgical drainage from fail med treatment)
49
Otosclerosis
abnormal bone resorption and deposition in middle ear that can lead to hearing loss genetic (autosomal dominant w/ incomplete penetrance)
50
Otosclerosis will have
CONDUCTIVE HEARING LOSS (lesions on oval window/stapes age 20-40
51
Otosclerosis - Tx
hearing aid, surgical prosthetic, replacement of stapes
52
Cochlear otosclerosis
lesions impinging the cochlea permanent SENSORY hearing loss
53
Middle Ear Neoplasia
primary middle ear tumors rare glomus tumors may arise in middle ear or jugular bulb do not spread
54
Middle Ear Neoplasia - Clin pres
PULSATILE TINNITUS AND HEARING LOSS may see vascular mass behind TM
55
Middle Ear Neoplasia -Tx
radiation, surgery, or both
56
Hyperacusis
excessive sensitivity to sound cochlear dysfunction - "recruitment" - abnormal sensitivity to loud sounds despite a reduced sensitivity to softer sounds
57
Hyperacusis - causes
Noise trauma (MC) Ear dz (TMJ, Meinere's Dz, Lyme Dz) Migraines Psychological reasons
58
Tinnitus SUBJECTIVE
- perception of sound in absence of sound source (subcortical auditory problem, not inner ear)
59
Tinnitus SUB - Causes
Hearing loss Medications: ASA, antiHTN, AG's Trauma: Barotrauma, loud noise Systemic dz Metabolic
60
Tinnitus SUB- Workup
audiometry MRI, MRA, venography?
61
Tinnitus SUB-Tx
Masking medical management Cochlear implant
62
Tinnitus OBJECTIVE
perception of sound caused by internal body sound (underlying vascular or mechanical disorder)
63
Tinnitus OBJECTIVE - Causes
VASCULAR Pulse synchronous AV malformation HTN Vascular tumor Benign intracranial HTN MECHANICAL patulous ET -abnormal opening palatal myoclonus - rapid clicking by contraction of ET
64
Vertigo
sensation of motion when there is no motion OR exaggerated sense of motion in response to mvmt
65
Vertigo - DX
duration and assocation w/ hearing loss key to DX diff b/w central and peripheral etiology
66
Vertigo - Peripheral
SUDDEN onset tinnitus/ hearing loss HORIZONTAL nystagmus common N/V
67
Vertigo - Central
GRADUAL onset more severe and debilitating NO associated auditory symp VERTICAL nystagmus may occur
68
Labyrinthitis
acute onset of continuous, SEVERE VERTIGO LASTING DAYS TO A WEEK unilateral assoc hearing loss and tinnitus Recovery several weeks unknown cause
69
Labyrinthitis - Tx
consider abx (pot infxn of inner ear) vestibular suppressants (meclizine)
70
Meniere's Disease
MOST CASES IDIOPATHIC EPISODIC VERTIGO LASTING 20 MINS - HRS, HEARING LOSS, TINNITUS, UNILATERAL AURAL PRESSURE
71
Meniere's Dz - TX
LOW SALT DIET AND DIURETICS (ACETAZOLAMIDE)
72
BPPV (benign paroxysmal positional vertigo)
vertigo spells w/ changes in head position last 10-15 sec (bending over or rolling over in bed) vertigo clusters may persist days otoliths out of position
73
BPPV - Dx
Dix Hallpike test
74
BPPV - Tx
Epley maneuver (constant repetition of positional changes causes " habituation"
75
Sensorineural Hearing Loss
damage to cochlea or neural pathways to inner ear to brain most bilateral symmetric hearing loss
76
Sensorineural Hearing Loss - causes
MC Presbyacusis (progressive, high frequ, bilateral) Ototoxicity (drugs: AG's, loop diuretics, neoplastics) Irreversible hearing loss Noise Trauma - 2nd MC cause Physical trauma Idiopathic (sudden sensory hearing loss) Hereditary Autoimmune
77
Sensorineural Hearing Loss - tx
mentions corticosteriods in some or other immunosuppressives
78
Conductive hearing loss
issues w/ sound transmission to hearing nerve
79
Conductive hearing loss - causes
impacted cerumen ETD (often from URI, allergic rhinitis)
80
Conductive hearing loss - Tx
treat underlying cause often corrected medically or surgically
81
Acoustic Neuroma
slow-growing tumor of vestibular or cochlear n. Benign but can damage surround structures uncommon, linked to NF2
82
Acoustic Neuroma - clin pres
UNILATERAL SENSORINEURAL HEARING LOSS dizziness, hearing loss, tinnitus (MC) may have decreased feeling on side of face, drooping of face, unsteady walk
83
Acoustic Neuroma - Dx
enhanced MRI of brain

ICM Unit 3 HEENT (6 decks)

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