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Clinical Medicine I > Outer & Middle Ear > Flashcards

Outer & Middle Ear Flashcards

(54 cards)

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1
Q

Cerumen impaction clinical presentation

A

A lot of cerumen and secretion in ear canal

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2
Q

Cerumen impaction causation

A

Self-induced trauma in ear drum

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3
Q

Cerumen impaction management

A

Mineral or olive oil for natural cleaning process
OR
irrigation by medical provider

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4
Q

HOW TO: irrigation

A
  • use warm water
  • directed stream at posterior canal
  • only if TM is visualized **
  • dry afterwards

potential suction by ENT

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5
Q

Foreign body

A

Risk factor: children
Insects can be immobilized with lidocaine or mineral oil
Removal with hook

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6
Q

Otitis externa clinical presentation

A

otalgia, ptitoris, swelling & inflammation, purulence, hyphae (fungus)

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7
Q

Otitis externa causation

A

Water immersion, local mechanical trauma (hearing aids, cotton tips), psuedomonas aeruginosa, gram - bacteria
or aspergillus or candida for fungal infections (overuse of abx)

RISK FACTORS: younger age, narrowed ear canals, psoriasis, eczema

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8
Q

Otitis externa management

A

Abx ear drops 7-10 days, 5+ drops 3-4 times a day
a) neomycin/polymyxcin B/ hydrocortisone (NOT USED IF PERFORATION EXPECTED)
b) Ciprodex (ciprofloxacin and dexamethasone) $$

need oral abx with cellulitis of pre-auricular tissue

MUST utilize wick if swollen shut as well as consider cleaning, suction, etc. to get where they need to go (CANNOT WITH PERFORATION)

avoid water for 7-10 days

FUNGAL: clotrimazole (lotrimin) or acetic acid
recurrent–> ENT

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9
Q

Malignant otitis externa clinical presentation

A
  • copious foul discharge
  • granulation tissue
  • severe OE
  • otalgia, headache, otorrhea
    –fever>101
    –peripheral lymphadenopathy
    –resistance to topical treatment
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10
Q

Malignant otitis externa causation

A

pseudomonas aeruginosa 95%

RISK FACTORS:
-elderly, diabetes mellitus, immunocompromised

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11
Q

Malignant otitis externa management

A

Need CT scan to confirm, MRI to rule out abscess, need IV abx, admit to hospital, biopsy???

IV Fluoroquinolones (ciprofloxacin)
subsequent abx for several months

KIDS=IV cephalosporins

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12
Q

Pruritus

A

Itching; caused by too much cleaning, allergies
treated by oil drops, with inflammation topical steroid can help (refer to ENT)

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13
Q

Auricular hematoma clinical presentation

A

Cauliflower ear, caused by blunt trauma (wrestlers & boxers), blood developed between perichondrium and cartilage leads to fibrosis

Need surgery to sew layers back together (w/o treatment, deformity)

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14
Q

auricular hematoma treatment

A

I&D, bolster w/ antibiotic to keep shape, ciprofloxacin. Without this, hardens and loses shape

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15
Q

temporomandibular joint dysfunction causes

A

malocclusion (misaligned teeth)
displacement of condylar head
bruxism (grinding teeth)
trauma
acute synovitis (joint swelling)
arthiritis
dental caries or abcess
herpes zoster (shingles)

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16
Q

TMJ symptoms

A

Pain on opening and closing mouth
Radiating pain
Restricted jaw function (tight - catching mechanism)
Noise, popping, clicking, crepitus (popcorn popping)

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17
Q

TMJ exam

A

index finger on either side of face, pt open and closes mouth
- clicking or popping noises or sensation
- limited ROM
- subluxation (locking)
- deviation of jaw during movement
pain

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18
Q

TMJ management

A

avoid chewing, grinding
Analgesics (NSAIDS x 10-15 days)
massage, heating pad
evaluate after 2-4 weeks

muscle relaxers + NSAIDS
Tricyclic antidepressants at bedtime, gabapentin
short course of corticosteroids (5-7 days)
mood disorder –> CBT

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19
Q

cholesteatoma

A

OM complication – prolonged eustachian tube dysfunction
forms epithelial inclusion cyst –> destruction of middle ear ossicles, hearing loss

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20
Q

cholesteatoma types

A

congenital (embryonal) and acquired (from chronic or recurrent otitis media, TM rupture)

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21
Q

cholesteatoma clinical presentation

A

otalgia
headache
hearing loss
painless otorrhea
strong odor
middle ear deafness PEARLY GRAY-WHITE MIDDLE EAR MASS BEHIND TM

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22
Q

Cholesteatoma treatment

Study These Flashcards
A

non-contrast CT
ENT referral
mastoidectomy surgery
abx 7-10 days to reduce inflammation/granulation

23
Q

acute otitis media

Study These Flashcards
A

precipitated by viral URI that causes eustachian tube obstruction

1) strep. pnuemoniae
2) h. influenzae
3) strep. pyogenes
4) moraxella catarrhalis

24
Q

acute otitis media symptoms

Study These Flashcards
A

otalgia
aural pressure
decreased hearing
Fever
erythema, retraction/bulging “DONUT” decreased mobility of TM, occasional bullae

25
acute otitis media 2nd conditions
acute mastoiditis - cefazolin and myringotomy for culture & drainage myringitis - blistering and bullae on TM labyrinthitis - inner ear inflammation
26
AOM management (adults)
amoxicillin amoxicillin-clavulanate (resistant cases) cefuroxime cefpodoxime recurrent --> long term sulfamethoxazole or lower dosing amoxicillin
27
AOM in children risk factors
family history atopy (allergies, asthma, ezcema) uri low SE status exposure to smoke daycare short term breastfeeding prematurity adenoid hypertrophy craniofacial anomaly pacifier use
28
AOM children symptoms
ear tugging, irritability, difficulty sleeping, decreased eating, change in behavior
29
recurrent definition
>3 separate episodes in 6 months, >4 episodes in past 12 months with last in 6 monts
30
tympanometry
flat or nearly flat indicates impaired TM
31
AOM treatment (children)
tylenol and ibuprofen (no I <6 months) antibiotics indicated for <6 months, bilateral AOM, or with strong atalgia, >48 hours, >39/102.2 amoxicillin amoxicillin-clavulanate (if recieved a in last 30 days, unresponsive) cephalosporin, cefdinir -- PCN allergy
32
AOM treatment duration
10 days <2 7 days 2-5 5-7 days >6 yrs recurrent = tympanostomy tubes and adenoidectomy NO prophylatic antibiotics, follow up
33
AOM prevention
PCV vaccination flu vaccine breastfeeding avoid smoke tympanostomy tubes if recurrent
34
chronic otitis media
>2 weeks of otorrhea, persisting 6 wks to 3 months chronic middle ear inflammation with TM perforation and persistent or intermittent otorrhea - P aeruginosa - Proteus species -staph aureus
35
chronic otitis media clinical
otorrhea - intermittent or continuous pain UNCOMMON - TM perforated conductive hearing loss, need CT of temporal bones, refer to ENT
36
chronic otitis media treatment
maintain dry ear aural toilet (procedure to clean out debris) 1) ofloxacin, ciprofloxacin (often w dexamethasone, topical otic abx) 2) systemic antibiotics, oral ciprofloxacin definitive = tympanoplasty/mastoidectomy
37
otitis media with effusion (OME)
most common cause of hearing impairment -- poor ET function, URI, allergies
38
OME risk factors
genetics, allergies, smoke, GERD, obesity
39
OME clinical
air-fluid level or bubbles, dull TM
40
OME treatment
watchful waiting x3 months if no risk, autoinflation, OR tympanostomy consider nasal steroid, oral antibiotics?
41
eustachian tube dysfunction
negative pressure results from viral URI, allergies sense of fullness impairment of hearing popping or crackling sound retraction of TM
42
ETD treatment
viral illness -- systemic & intranasal decongestants w autoinsufflation -pseudoephedirne -oxymetazoline allergic patients, intranasal corticosteroids, beclomethasone dipropionate air pressure change should be avoided. if doesn't resolve, tympanostomy tubes or balloon dilation of ET
43
barotrauma causation
result of sudden pressure change, sudden dysfunction can clear w popping or time, or causes bleeding or fluid leakage, worst = fistula
44
barotrauma risks
colds, allergies, infections
45
barotrauma symptoms
otalgia, ears are stuffed, "need to pop", extreme pain, vertigo, bleeding/fluid in ear, hearing loss
46
barotrauma treatment
swallow, yawn, pop ears, OTC decongestants (pseudoephedrine) topic decongestants - phenylephrine or oxymetazoline keep kids upright, bottle/pacifier, special ear plugs
47
tympanic membrane perforation
hole in ear drum, caused by infection, trauma, unintentional/doctors
48
TMP symptoms
ear pain, otorrhea, hearing loss, whistling sound
49
hemotympanum
bloody otorrhea present only if TM ruptures, otherwise behind TM. consider ENT removal, vascular tumor?
50
inner ear fistula
due to trauma, stables -->vestibule
51
inner ear fistula causes
barotruama, rapid descent, explosion, straining
52
inner ear fistula clinical
hearing loss, disequilibrium, vertigo, mixed hearing loss, unilateral, definitive w surgical diagnosis
53
inner ear fistula management
oral corticosteroids, stool softeners to reduce straining, tympanotomy to enhance healing
54
otosclerosis
bony overgrowth of stapes which blocks conductions CONDUCTIVE slow hearing loss, tinnitus (vertigo NOT common), confirm w CT scan familial tendency conservative hearing aids stapedectomy w prothesis

Clinical Medicine I (33 decks)

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