PANCE PEARLS-Hearing, Vestibular, Middle Ear COPY Flashcards
(83 cards)
1
Q
Sensorineural Hearing Loss: Weber and Rinne Test
A
sensori_N_EURAL lateralizes to _N_ORMAL ear and _N_ORMAL Rinne
- Weber: Lateralizes to NORMAL ear. Thus, if lateralizes right, SNHL on left.
- Rinne: AC> BC (though patient will still have difficulty hearing own voice and deciphering words)
__________
Etiologies
- INNER EAR
- Most common: Presbyacusis
- Chronic loud noise exposure
- CNS lesions (ex. acoustic neuroma)
- Labyrinthitis
- Meniere syndrome
2
Q
Sensorineural Hearing Loss: Etiologies
A
__________
Etiologies
- INNER EAR
- Most common: Presbyacusis
- Chronic loud noise exposure
- CNS lesions (ex. acoustic neuroma)
- Labyrinthitis
- Meniere syndrome
_______
sensori_N_EURAL lateralizes to _N_ORMAL ear and _N_ORMAL Rinne
- Weber: Lateralizes to NORMAL ear. Thus, if lateralizes right, SNHL on left.
- Rinne: AC> BC (though patient will still have difficulty hearing own voice and deciphering words)
3
Q
Meniere’s Disease (Idiopathic Endolymphatic Hydrops):
Pathophysiology
A
Pathophysiology
- Idiopathic distention of endolymphatic compartment of inner ear by excess fluid
- This results in increased pressure within the inner ear
Clinical Manifestations
- Episodic peripheral vertigo lasting minutes to hours
- Horizontal nystagmus (sign of peripheral vertigo)
- Tinnitus
- Ear fullness
- fluctuating hearing loss (primarily low tone hearing loss)
- Nausea
- Vomiting
Diagnosis
- Transtympanic electrocochleography most accurate (during active episode)
- Loss of nystagmus with caloric testing
- Audiometry (loss of low tones)
Management
Symptomatic
- antiemetics
- antihistamines (Meclizine, Prochlorperazine)
- Benzodiazepines (diazepam)
- Anticholinergics (Scopolamine)
- Decompression if refractory to meds or severe (ex. Typanostomy tube or Labyrinthectomy)
Preventative
- Diuretics (hydrochlorothiazide): reduce endolymphatic pressure
- Avoid: salt, caffeine, chocolate, ETOH (these increase endolymphatic pressure)
4
Q
Meniere’s Disease (Idiopathic Endolymphatic Hydrops):
Clinical Manifestations (7)
A
Clinical Manifestations
- Episodic peripheral vertigo lasting minutes to hours
- Horizontal nystagmus (sign of peripheral vertigo)
- Tinnitus
- Ear fullness
- fluctuating hearing loss (primarily low tone hearing loss)
- Nausea
- Vomiting
Diagnosis
- Transtympanic electrocochleography most accurate (during active episode)
- Loss of nystagmus with caloric testing
- Audiometry (loss of low tones)
Management
Symptomatic
- antiemetics
- antihistamines (Meclizine, Prochlorperazine)
- Benzodiazepines (diazepam)
- Anticholinergics (Scopolamine)
- Decompression if refractory to meds or severe (ex. Typanostomy tube or Labyrinthectomy)
Preventative
- Diuretics (hydrochlorothiazide): reduce endolymphatic pressure
- Avoid: salt, caffeine, chocolate, ETOH (these increase endolymphatic pressure)
Pathophysiology
- Idiopathic distention of endolymphatic compartment of inner ear by excess fluid
- This results in increased pressure within the inner ear
5
Q
Meniere’s Disease (Idiopathic Endolymphatic Hydrops):
Diagnosis
A
Diagnosis
- Transtympanic electrocochleography most accurate (during active episode)
- Loss of nystagmus with caloric testing
- Audiometry (loss of low tones)
Management
Symptomatic
- antiemetics
- antihistamines (Meclizine, Prochlorperazine)
- Benzodiazepines (diazepam)
- Anticholinergics (Scopolamine)
- Decompression if refractory to meds or severe (ex. Typanostomy tube or Labyrinthectomy)
Preventative
- Diuretics (hydrochlorothiazide): reduce endolymphatic pressure
- Avoid: salt, caffeine, chocolate, ETOH (these increase endolymphatic pressure)
Pathophysiology
- Idiopathic distention of endolymphatic compartment of inner ear by excess fluid
- This results in increased pressure within the inner ear
Clinical Manifestations
- Episodic peripheral vertigo lasting minutes to hours
- Horizontal nystagmus (sign of peripheral vertigo)
- Tinnitus
- Ear fullness
- fluctuating hearing loss (primarily low tone hearing loss)
- Nausea
- Vomiting
6
Q
Meniere’s Disease (Idiopathic Endolymphatic Hydrops):
Management (Symptomatic and Preventative)
A
Management
Symptomatic
- antiemetics
- antihistamines (Meclizine, Prochlorperazine)
- Benzodiazepines (diazepam)
- Anticholinergics (Scopolamine)
- Decompression if refractory to meds or severe (ex. Typanostomy tube or Labyrinthectomy)
Preventative
- Diuretics (hydrochlorothiazide): reduce endolymphatic pressure
- Avoid: salt, caffeine, chocolate, ETOH (these increase endolymphatic pressure)
Pathophysiology
- Idiopathic distention of endolymphatic compartment of inner ear by excess fluid
- This results in increased pressure within the inner ear
Clinical Manifestations
- Episodic peripheral vertigo lasting minutes to hours
- Horizontal nystagmus (sign of peripheral vertigo)
- Tinnitus
- Ear fullness
- fluctuating hearing loss (primarily low tone hearing loss)
- Nausea
- Vomiting
Diagnosis
- Transtympanic electrocochleography most accurate (during active episode)
- Loss of nystagmus with caloric testing
- Audiometry (loss of low tones)
7
Q
Acoustic (Vestibular) CN VIII Neuroma/Vestibular Schwannoma:
Pathophysiology
A
Pathophysiology
Cranial nerve VIII/8 Schwannoma-benign tumor of Schwann cells, which produce myelin sheath
Clinical Manifestation
**Unilateral SNHL is an acoustic neuroma until proven otherwise**
- Unilateral SNHL
- Tinnitus
- Headache
- Facial Numbness
- Continuous disequilibrium/vertigo (unsteadiness while walking)
Diagnosis
- CT scan. Usually unilateral.
- If bilateraly, suspect neurofribromatosis type II
Management
- Surgery
- Focused radiation therapy
8
Q
Acoustic (Vestibular) CN VIII Neuroma/Vestibular Schwannoma:
Clinical manifestation
A
Clinical Manifestation
**Unilateral SNHL is an acoustic neuroma until proven otherwise**
- Unilateral SNHL
- Tinnitus
- Headache
- Facial Numbness
- Continuous disequilibrium/vertigo (unsteadiness while walking)
Diagnosis
- CT scan. Usually unilateral.
- If bilateraly, suspect neurofribromatosis type II
Management
- Surgery
- Focused radiation therapy
Pathophysiology
Cranial nerve VIII/8 Schwannoma-benign tumor of Schwann cells, which produce myelin sheath
9
Q
Acoustic (Vestibular) CN VIII Neuroma/Vestibular Schwannoma:
Diagnosis
A
Diagnosis
- CT scan. Usually unilateral.
- If bilateraly, suspect neurofribromatosis type II
Management
- Surgery
- Focused radiation therapy
Pathophysiology
Cranial nerve VIII/8 Schwannoma-benign tumor of Schwann cells, which produce myelin sheath
Clinical Manifestation
**Unilateral SNHL is an acoustic neuroma until proven otherwise**
- Unilateral SNHL
- Tinnitus
- Headache
- Facial Numbness
- Continuous disequilibrium/vertigo (unsteadiness while walking)
10
Q
Acoustic (Vestibular) CN VIII Neuroma/Vestibular Schwannoma:
Management
A
Management
- Surgery
- Focused radiation therapy
Pathophysiology
Cranial nerve VIII/8 Schwannoma-benign tumor of Schwann cells, which produce myelin sheath
Clinical Manifestation
**Unilateral SNHL is an acoustic neuroma until proven otherwise**
- Unilateral SNHL
- Tinnitus
- Headache
- Facial Numbness
- Continuous disequilibrium/vertigo (unsteadiness while walking)
Diagnosis
- CT scan. Usually unilateral.
- If bilateraly, suspect neurofribromatosis type II
11
Q
**Unilateral SNHL is an __________ until proven otherwise**
A
Acoustic (Vestibular) CN VIII Neuroma/Vestibular Schwannoma
Pathophysiology
Cranial nerve VIII/8 Schwannoma-benign tumor of Schwann cells, which produce myelin sheath
Clinical Manifestation
**Unilateral SNHL is an acoustic neuroma until proven otherwise**
- Unilateral SNHL
- Tinnitus
- Headache
- Facial Numbness
- Continuous disequilibrium/vertigo (unsteadiness while walking)
Diagnosis
- CT scan. Usually unilateral.
- If bilateraly, suspect neurofribromatosis type II
Management
- Surgery
- Focused radiation therapy
12
Q
Barotrauma:
Pathophysiology
A
Pathophysiology
- Rapid pressure change leads to the inability of the Eustachian Tube to equalize pressure
- Symptoms similar to Eustachian Tube Dysfunction
- Ex: taking a flight on an airplane, scuba diver, or patients on mechanical ventilation
Clinical Manifestations
- Auricular pain and fullness
- Hearing loss that persists after the etiologic event
- May have bloody discharge if traumatic
- Tympanic Membrane: +/- rupture or petechiae
Management
- Autoinsufflation (swallowing, yawning)
- Decongestants or antihistamines (reduce eustachian tube edema)
13
Q
Barotrauma:
Clinical Manifestations (4)
A
Clinical Manifestations
- Auricular pain and fullness
- Hearing loss that persists after the etiologic event
- May have bloody discharge if traumatic
- Tympanic Membrane: +/- rupture or petechiae
Management
- Autoinsufflation (swallowing, yawning)
- Decongestants or antihistamines (reduce eustachian tube edema)
Pathophysiology
- Rapid pressure change leads to the inability of the Eustachian Tube to equalize pressure
- Symptoms similar to Eustachian Tube Dysfunction
- Ex: taking a flight on an airplane, scuba diver, or patients on mechanical ventilation
14
Q
Barotrauma:
Management
A
Management
- Autoinsufflation (swallowing, yawning)
- Decongestants or antihistamines (reduce eustachian tube edema)
Pathophysiology
- Rapid pressure change leads to the inability of the Eustachian Tube to equalize pressure
- Symptoms similar to Eustachian Tube Dysfunction
- Ex: taking a flight on an airplane, scuba diver, or patients on mechanical ventilation
Clinical Manifestations
- Auricular pain and fullness
- Hearing loss that persists after the etiologic event
- May have bloody discharge if traumatic
- Tympanic Membrane: +/- rupture or petechiae
15
Q
Patient is experiencing a “false sense of motion” or “exaggerated sense of motion”. What is the terminology for this?
A
Vertigo
16
Q
Vertigo
Location of problem: Peripheral vertigo
A
Peripheral Vertigo
Location of problem
- Labyrinth or vestibular nerve (which is part of CNVIII/8)
Etiologies
- Benign Positional Vertigo (BPV) (most common)
- Meniere
- Vestibular Neuritis
- Labyrinthitis
- Cholesteatoma
Clinical
- HORIZONTAL nystagmus (usually beats away from affected side)
- Fatigable
- Sudden onset of tinnitus and hearing loss usually associated with peripheral compared to central causes
17
Q
Vertigo
Etiologies: Peripheral vertigo
A
Peripheral Vertigo
Etiologies
- Benign Positional Vertigo (BPV) (most common)
- Meniere
- Vestibular Neuritis
- Labyrinthitis
- Cholesteatoma
Clinical
- HORIZONTAL nystagmus (usually beats away from affected side)
- Fatigable
- Sudden onset of tinnitus and hearing loss usually associated with peripheral compared to central causes
Location of problem
- Labyrinth or vestibular nerve (which is part of CNVIII/8)
18
Q
Vertigo
Clinical Presentation: Peripheral vertigo
A
Peripheral Vertigo
Clinical
- HORIZONTAL nystagmus (usually beats away from affected side)
- Fatigable
- Sudden onset of tinnitus and hearing loss usually associated with peripheral compared to central causes
Location of problem
- Labyrinth or vestibular nerve (which is part of CNVIII/8)
Etiologies
- Benign Positional Vertigo (BPV) (most common)
- Meniere
- Vestibular Neuritis
- Labyrinthitis
- Cholesteatoma
19
Q
Vertigo
- Episodic vertigo
- No hearing loss
A
Peripheral Vertigo
- Benign Positional Vertigo (BPV) (most common)
20
Q
Vertigo
- Episodic vertigo
- Positive for hearing loss
A
Peripheral Vertigo
- Meniere
21
Q
Vertigo
- Continuous vertigo
- Positive for hearing loss
A
Peripheral Vertigo
- Labyrinthitis
22
Q
Vertigo
- Continuous vertigo
- No hearing loss
A
Peripheral Vertigo
- Vestibular Neuritis
23
Q
Vertigo
Pathophysiology of nausea and vomiting
A
Nausea and vomiting are caused by sensory conflict mediated by the neurotransmitters GABA, acetylcholine, histamine, dopamine, and serotonin. Antiemetics work primarily by these transmitters
24
Q
Vertigo
Identify which type of vertigo:
- HORIZONTAL nystagmus
- Fatigable
A
Peripheral Vertigo
25
**_Vertigo_**
Identify which type of vertigo:
* VERTICAL nystagmus
* **NON**Fatigable (continuous)
**_Central Vertigo_**
26
**_Vertigo_**
Central Vertigo: Location of problem
**_Central Vertigo_**
**_Location of problem_**
Brainstem or cerebellar
**_Etiologies_**
1. Cerebellopontine tumors
2. Migraine
3. Cerebral vascular disease
4. Multiple sclerosis
5. Vestibular neuroma
**_Clinical_**
1. VERTICAL nystagmus
2. NONfatigable (continuous)
3. Gait problems more severe
4. Gradual onset
5. Positive CNS signs
27
**_Vertigo_**
Central Vertigo: possible etiologies (5)
**_Central Vertigo_**
**_Etiologies_**
1. Cerebellopontine tumors
2. Migraine
3. Cerebral vascular disease
4. Multiple sclerosis
5. Vestibular neuroma
**_Clinical_**
1. VERTICAL nystagmus
2. NONfatigable (continuous)
3. Gait problems more severe
4. Gradual onset
5. Positive CNS signs
**_Location of problem_**
Brainstem or cerebellar
28
**_Vertigo_**
Central Vertigo: clinical manifestations (5)
**_Central Vertigo_**
**_Clinical_**
1. VERTICAL nystagmus
2. NONfatigable (continuous)
3. Gait problems more severe
4. Gradual onset
5. Positive CNS signs
**_Location of problem_**
Brainstem or cerebellar
**_Etiologies_**
1. Cerebellopontine tumors
2. Migraine
3. Cerebral vascular disease
4. Multiple sclerosis
5. Vestibular neuroma
29
Vertigo: What is your first line for managing Nausea/Vomiting in patients with vertigo? Other treatments?
30
What is the most common cause of vertigo?
Benign Positional Vertigo (BPV)
31
**_Benign Paroxysmal Positional Vertigo (BPV or BPPV)_**
Pathophysiology
**_Pathophysiology_**
* Caused by displaced otoliths (calcium carbonate particles)
* Normally, otoliths are attached to the hair cells inside the saccule and utricule (attached to the 3 semicircular canals)
* Head movements cause displaced otolith movement, which leads to vertigo
**_Clinical manifestations_**
1. Sudden, episodic peripheral vertigo (provoked with changes of head positioning)
* Vertigo usually lasts 10-60 seconds
2. Positive Dix-Hallpike Test/Nylan Barany
* Patient placed in supine position with head 30 degrees lower than body
* Head quickly turned 90 degrees to one side
* Result: Delayed fatigable horizontal nystagmus
* IF NYSTAGMUS IS PERSISTANT OR NON-FATIGABLE, ASSESS FOR CENTRAL CAUSE OF VERTIGO INSTEAD.
**_Management_**
1. Epley maneuver
* Canalith repositioning mainstay of treatment
* Usually resolves with time as the otoliths naturally dissolve and the vertigo episodic brief
2. Medications usually not needed. But, if medicate:
* antihistamines,
* anticholinergics,
* benzodiazepines
32
**_Benign Paroxysmal Positional Vertigo (BPV or BPPV)_**
Clinical Manifestations
**_Clinical manifestations_**
1. Sudden, episodic peripheral vertigo (provoked with changes of head positioning)
* Vertigo usually lasts 10-60 seconds
2. Positive Dix-Hallpike Test/Nylan Barany
* Patient placed in supine position with head 30 degrees lower than body
* Head quickly turned 90 degrees to one side
* Result: Delayed fatigable horizontal nystagmus
* IF NYSTAGMUS IS PERSISTANT OR NON-FATIGABLE, ASSESS FOR CENTRAL CAUSE OF VERTIGO INSTEAD.
**_Management_**
1. Epley maneuver
* Canalith repositioning mainstay of treatment
* Usually resolves with time as the otoliths naturally dissolve and the vertigo episodic brief
2. Medications usually not needed. But, if medicate:
* antihistamines,
* anticholinergics,
* benzodiazepines
**_Pathophysiology_**
* Caused by displaced otoliths (calcium carbonate particles)
* Normally, otoliths are attached to the hair cells inside the saccule and utricule (attached to the 3 semicircular canals)
* Head movements cause displaced otolith movement, which leads to vertigo
33
**_Benign Paroxysmal Positional Vertigo (BPV or BPPV)_**
Management
**_Management_**
1. Epley maneuver
* Canalith repositioning mainstay of treatment
* Usually resolves with time as the otoliths naturally dissolve and the vertigo episodic brief
2. Medications usually not needed. But, if medicate:
* antihistamines,
* anticholinergics,
* benzodiazepines
**_Pathophysiology_**
* Caused by displaced otoliths (calcium carbonate particles)
* Normally, otoliths are attached to the hair cells inside the saccule and utricule (attached to the 3 semicircular canals)
* Head movements cause displaced otolith movement, which leads to vertigo
**_Clinical manifestations_**
1. Sudden, episodic peripheral vertigo (provoked with changes of head positioning)
* Vertigo usually lasts 10-60 seconds
2. Positive Dix-Hallpike Test/Nylan Barany
* Patient placed in supine position with head 30 degrees lower than body
* Head quickly turned 90 degrees to one side
* Result: Delayed fatigable horizontal nystagmus
* IF NYSTAGMUS IS PERSISTANT OR NON-FATIGABLE, ASSESS FOR CENTRAL CAUSE OF VERTIGO INSTEAD.
34
Anatomy and functions of the Labyrinth
**_Labyrinth:_** The bony and membranous part of the inner ear. Consists of 2 components:
1. Cochlea: responsible for hearing (converts wave impulses from middle ear into auditory nerve impulses)
2. vestibular system: 3 semicircular canals originating in the vestibule responsible for balance.
35
**_Vestibular Neuritis+ Labyrinthitis_**
Pathophysiology
**_Pathophysiology_**
* **Vestibular Neuritis:** Inflammation fo the vestibular portion of CN 8
* **Labyrinthitis:** vestibular neuritis **_AND_** hearing loss/tinnitus (from cochlear involvement)
**_Clinical manifestations_**
_Vestibular symptoms_
1. peripheral vertigo (usually continuos)
* nystagmus HORIZONTAL and rotary (away from the affected side)
2. dizziness
3. nausea/vomiting
4. gait disturbances
_Cochlear symptoms_
1. hearing loss (usually resolve in weeks)
**_Management_**
* 1st line: corticosteroids
* If symptomatic: antihistamines (Meclizine)
* If symptomatic: benzodiazepines
36
**_Vestibular Neuritis+ Labyrinthitis_**
Clinical manifestations (vestibular (4) and cochlear (1))
**_Clinical manifestations_**
_Vestibular symptoms_
1. peripheral vertigo (usually continuos)
* nystagmus HORIZONTAL and rotary (away from the affected side)
2. dizziness
3. nausea/vomiting
4. gait disturbances
_Cochlear symptoms_
1. hearing loss (usually resolve in weeks)
**_Management_**
* 1st line: corticosteroids
* If symptomatic: antihistamines (Meclizine)
* If symptomatic: benzodiazepines
**_Pathophysiology_**
* **Vestibular Neuritis:** Inflammation fo the vestibular portion of CN 8
* **Labyrinthitis:** vestibular neuritis **_AND_** hearing loss/tinnitus (from cochlear involvement)
37
**_Vestibular Neuritis+ Labyrinthitis_**
Management
**_Management_**
* 1st line: corticosteroids
* If symptomatic: antihistamines (Meclizine)
* If symptomatic: benzodiazepines
**_Pathophysiology_**
* **Vestibular Neuritis:** Inflammation fo the vestibular portion of CN 8
* **Labyrinthitis:** vestibular neuritis **_AND_** hearing loss/tinnitus (from cochlear involvement)
**_Clinical manifestations_**
_Vestibular symptoms_
1. peripheral vertigo (usually continuos)
* nystagmus HORIZONTAL and rotary (away from the affected side)
2. dizziness
3. nausea/vomiting
4. gait disturbances
_Cochlear symptoms_
1. hearing loss (usually resolve in weeks)
38
**_Vestibular Neuritis+ Labyrinthitis_**
Describe the nystagmus expected
nystagmus HORIZONTAL and rotary (away from the affected side)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Pathophysiology_**
* **Vestibular Neuritis:** Inflammation fo the vestibular portion of CN 8
* **Labyrinthitis:** vestibular neuritis **_AND_** hearing loss/tinnitus (from cochlear involvement)
**_Clinical manifestations_**
_Vestibular symptoms_
1. peripheral vertigo (usually continuos)
* nystagmus HORIZONTAL and rotary (away from the affected side)
2. dizziness
3. nausea/vomiting
4. gait disturbances
_Cochlear symptoms_
1. hearing loss (usually resolve in weeks)
**_Management_**
* 1st line: corticosteroids
* If symptomatic: antihistamines (Meclizine)
* If symptomatic: benzodiazepines
39
**_Acute Otitis Media_**
Primary differences between Acute Otitis Media and Otitis Media with Effusion
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. S. pneumo (most common)
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
40
**_Acute Otitis Media_**
Pathophysiology
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. S. pneumo (most common)
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
41
**_Acute Otitis Media_**
Primary organisms (4)
**_Organisms_**
1. S. pneumo (most common)
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
42
**_Acute Otitis Media_**
Most common organism responsible
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
43
**_Acute Otitis Media_**
Risk factors
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
44
**_Acute Otitis Media_**
Peak age
Peak age 6-18 months.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
45
**_Acute Otitis Media_**
Often preceded by what?
Most commonly preceded by a viral URI
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
46
**_Acute Otitis Media_**
Clinical manifestations
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
47
**_Acute Otitis Media_**
Expected clinical manifestation if TM perforation? How long to heal?
If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
48
**_Acute Otitis Media_**
Expected result on pneumatic otoscopy
Decreased tympanic membrane mobility on pneumatic otoscopy
\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
49
**_Acute Otitis Media_**
physical exam findings: what organism should you suspect if bullae are present?
If bullae on TM, suspect Mycoplasma pneumoniae
\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
50
**_Acute Otitis Media_**
physical exam findings
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
51
**_Acute Otitis Media_**
management
**_Management_**
1. Antibiotics:
* 1st: Amoxicillin treatment. Cefixime in children.
* 2nd: Amoxicillin/clavulanic acid (augmentin) or cefaclor.
* If PCN allergic: Erythromycin-sulfisoxazole, azithromycin, trimethoprim/sulfamethoxazole.
2. Severe/recurrent cases:
* Myringotomy (surgical drainage)
* Tympanostomy if recurrent or persistent
3. Otitis Media with effusion: observation in most cases
* In children with recurrent otitis media: iron deficiency anemia work up and CT scan
**_Acute Otitis Media v. Otitis Media with effusion_**
* Acute: rapid onset and signs/symptoms of inflammation
* OM with effusion: asymptomatic/no inflammation
**_Pathophysiology_**
* Infection of the middle ear, temporal bone, and mastoid air cells
* Most commonly preceded by a viral URI
* URI causes eustachian tube edema, resulting in negative pressure and transudation of fluid and mucus in middle ear
* Secondary: colonization by bacteria and flora
**_Organisms_**
1. **S. pneumo (most common)**
2. H. influenza
3. Moraxella catarrhalis
4. Strep pyogenes
**_Risk Factors_**
1. Eustachian tube dysfunction (ETD)
2. Young (Eustachian tube is wider, shorter, and more horizontal). Peak age 6-18 months.
3. Day care
4. Pacifier/bottle use
5. Parental smoking
6. Not being breastfed
**_Clinical Manifestations_**
1. Fever
2. otalgia (ear pain)
3. Ear tugging in infants
4. conductive hearing loss
5. stuffiness
6. If TM perforation: rapid relief of pain and otorrhea (will heal in 1-2 days)
**_Physical Exam_**
1. Bulging, erythematous tympanic membrane with effusion
* Loss of landmarks
* Decreased tympanic membrane mobility on pneumatic otoscopy
2. If bullae on TM, suspect Mycoplasma pneumoniae
52
**_Chronic Otitis Media_**
Etiologies
**_Etiologies_**
Complication of:
1. acute otitis media,
2. trauma, or
3. due to cholesteatoma
**_Organisms_**
1. Pseudomonas
2. S. aureus
3. Gram negative rods (proteus)
4. anaerobes
5. Mycoplasma
**_Clinical manifestations_**
1. Perforated TM
2. Persistent or recurrent purulent otorrhea
3. May/may not have pain
4. May have varying degrees of conductive hearing loss
5. May/may not have cholesteatoma
**_Management_**
1. Topical antibiotics (first line treatment) ex. Oflaxacin or Ciprofloxacin
2. Surgical
* tympanic membrane repair/reconstruction
* If severe, mastoidectomy
3. Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
53
**_Chronic Otitis Media_**
Organisms
**_Organisms_**
1. Pseudomonas
2. S. aureus
3. Gram negative rods (proteus)
4. anaerobes
5. Mycoplasma
**_Clinical manifestations_**
1. Perforated TM
2. Persistent or recurrent purulent otorrhea
3. May/may not have pain
4. May have varying degrees of conductive hearing loss
5. May/may not have cholesteatoma
**_Management_**
1. Topical antibiotics (first line treatment) ex. Oflaxacin or Ciprofloxacin
2. Surgical
* tympanic membrane repair/reconstruction
* If severe, mastoidectomy
3. Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Etiologies_**
Complication of:
1. acute otitis media,
2. trauma, or
3. due to cholesteatoma
54
**_Chronic Otitis Media_**
clinical manifestations
**_Clinical manifestations_**
1. Perforated TM
2. Persistent or recurrent purulent otorrhea
3. May/may not have pain
4. May have varying degrees of conductive hearing loss
5. May/may not have cholesteatoma
**_Management_**
1. Topical antibiotics (first line treatment) ex. Oflaxacin or Ciprofloxacin
2. Surgical
* tympanic membrane repair/reconstruction
* If severe, mastoidectomy
3. Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Etiologies_**
Complication of:
1. acute otitis media,
2. trauma, or
3. due to cholesteatoma
**_Organisms_**
1. Pseudomonas
2. S. aureus
3. Gram negative rods (proteus)
4. anaerobes
5. Mycoplasma
55
**_Chronic Otitis Media_**
Management
**_Management_**
1. Topical antibiotics (first line treatment) ex. Oflaxacin or Ciprofloxacin
2. Surgical
* tympanic membrane repair/reconstruction
* If severe, mastoidectomy
3. Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Etiologies_**
Complication of:
1. acute otitis media,
2. trauma, or
3. due to cholesteatoma
**_Organisms_**
1. Pseudomonas
2. S. aureus
3. Gram negative rods (proteus)
4. anaerobes
5. Mycoplasma
**_Clinical manifestations_**
1. Perforated TM
2. Persistent or recurrent purulent otorrhea
3. May/may not have pain
4. May have varying degrees of conductive hearing loss
5. May/may not have cholesteatoma
56
**_Chronic Otitis Media_**
Management: If TM rupture, what do you avoid?
Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
\_\_\_\_\_\_\_\_
**_Management_**
1. Topical antibiotics (first line treatment) ex. Oflaxacin or Ciprofloxacin
2. Surgical
* tympanic membrane repair/reconstruction
* If severe, mastoidectomy
3. Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Etiologies_**
Complication of:
1. acute otitis media,
2. trauma, or
3. due to cholesteatoma
**_Organisms_**
1. Pseudomonas
2. S. aureus
3. Gram negative rods (proteus)
4. anaerobes
5. Mycoplasma
**_Clinical manifestations_**
1. Perforated TM
2. Persistent or recurrent purulent otorrhea
3. May/may not have pain
4. May have varying degrees of conductive hearing loss
5. May/may not have cholesteatoma
57
**_Mastoiditis_**
Etiology/pathophysiology
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
58
**_Mastoiditis_**
Clinical manifestation
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
59
**_Mastoiditis_**
At what time of day do you expect the deep ear pain to be worse?
Deep ear pain (usually worse at night)
\_\_\_\_\_\_\_\_\_
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
60
**_Mastoiditis_**
What might develop in relation to the mastoid tenderness?
Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
\_\_\_\_\_\_\_\_\_
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
61
**_Mastoiditis_**
Complications
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
62
**_Mastoiditis_**
Diagnosis
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
63
**_Mastoiditis_**
Management
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
64
**_Mastoiditis_**
Complications: which cranial nerve is at risk for paralysis?
CN VII/7 paralysis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Complications_**
1. hearing loss
2. labyrinthitis
3. vertigo
4. CN VII paralysis
5. brain abscess
**_Management_**
**First line:**
* IV antibiotics (same as acute otitis media antibiotics) AND middle ear/mastoid drainage via myringotomy with or without tympanostomy tube placement.
* Tympanocentesis can be performed to obtain a middle ear culture
**If refractory or complicated:**
* mastoidectomy
**_Etiology/Pathophysiology_**
* Inflammation of the mastoid air cells of the temporal bone
* Usually a complication of prolonged or inadequately treated otitis media
* All patients with acute otitis media have some degree of mastoiditis because the mastoid and middle ear are connected
**_Clinical manifestations_**
1. Deep ear pain (usually worse at night)
2. Fever
3. Mastoid tenderness (may develop cutaneous abscess) (fluctuance)
**_Diagnosis_**
1. CT scan is 1st line diagnostic test
65
**_Otosclerosis_**
pathophysiology
**_Pathophysiology_**
* Abnormal bony overgrowth of the stapes bone
* This leads to conductive hearing loss due to blocked conduction
**_Clinical manifestation_**
1. slowly progressive conductive hearing loss
2. tinnitus
3. vertigo is uncommon
**_Management_**
* stapedectomy with prosthesis
* Hearing aid
* Cochlear implantation if severe
66
**_Otosclerosis_**
clinical manifestation
**_Clinical manifestation_**
1. slowly progressive conductive hearing loss
2. tinnitus
3. vertigo is uncommon
**_Management_**
* stapedectomy with prosthesis
* Hearing aid
* Cochlear implantation if severe
**_Pathophysiology_**
* Abnormal bony overgrowth of the stapes bone
* This leads to conductive hearing loss due to blocked conduction
67
**_Otosclerosis_**
management
**_Management_**
* stapedectomy with prosthesis
* Hearing aid
* Cochlear implantation if severe
**_Pathophysiology_**
* Abnormal bony overgrowth of the stapes bone
* This leads to conductive hearing loss due to blocked conduction
**_Clinical manifestation_**
1. slowly progressive conductive hearing loss
2. tinnitus
3. vertigo is uncommon
68
**_Cholesteatoma_**
pathophysiology
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
69
**_Cholesteatoma_**
Commonly due to what?
Commonly due to Eustachian Tube Dysfunction
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
70
**_Cholesteatoma_**
Describe the otorrhea discharge
* painless
* brown/yellow discharge with strong odor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
71
**_Cholesteatoma_**
clinical manifestation
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
72
**_Cholesteatoma_**
diagnosis
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
73
**_Cholesteatoma_**
management
**_Management_**
* surgical excision of the debris/cholesteatoma
* reconstruction of the ossicles
**_Pathophysiology_**
* Abnormal keratinized collection of desquamated squamous epithelium (mastoid bony erosion)
* Commonly due to Eustachian Tube Dysfunction such that:
* chronic negative pressure inverts part of the tympanic membrane
* the granulation tissue erodes the ossicles over time,
* resulting in conductive hearing loss
**_Clinical Manifestation_**
1. painless otorrhea (brown/yellow discharge with strong odor)
2. May/may not have vertigo/dizziness
**_Diagnosis_**
* Otoscope:
* Granulation tissue (cellular debris)
* May/man not have perforation of the tympanic membrane
* Peripheral vertigo
* Conductive hearing loss
* weber lateralization to affected ear
* rinne: BC\>/equal to AC
74
**_Eustachian Tube Dysfunction_**
Pathophysiology
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to negative pressure
* Often follows viral URI or allergic rhinitis
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
75
**_Eustachian Tube Dysfunction_**
What type of pressure?
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
_**\_\_\_\_\_\_\_\_\_\_\_**_
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
* Often follows viral URI or allergic rhinitis
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
76
**_Eustachian Tube Dysfunction_**
clinical manifestations
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
* Often follows viral URI or allergic rhinitis
77
**_Eustachian Tube Dysfunction_**
diagnosis
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
* Often follows viral URI or allergic rhinitis
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
78
**_Eustachian Tube Dysfunction_**
management
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
* Often follows viral URI or allergic rhinitis
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
79
**_Eustachian Tube Dysfunction_**
complications
**_Complications_**
1. Acute serous otitis media (non infectious fluid in middle ear)
2. The above may become colonized by bacteria and result in infectious otitis media if prolonged
**_Pathophysiology_**
* Eustachian tube swelling inhibits ET's autoinsuffflation ability
* This leads to **_negative pressure_**
* Often follows viral URI or allergic rhinitis
**_Clinical manifestations_**
1. Ear fullness
2. popping of ears/underwater feeling
3. intermittent sharp ear pain
4. disequilibrium
5. fluctuating CHL
6. tinnitus
**_Diagnosis_**
* Otoscopic findings usually normal
* May, may not have fluid behind TM if acute serous otitis media
**_Management_**
1. Decongestants (lowers ET edema): pseudoephedrine, phenylephrine, oxymetazoline nasal spray
2. Autoinsufflation (swallowing, yawning, blowing against a slightly pitched nostril)
3. Intranasal corticosteroids
80
**_Tympanic membrane perforation_**
Most common causes
**_Most common cause_**
* Occurs due to penetrating or noise trauma or otitis media
* Most commonly occurs at pars tensa
**_Clinical manifestations_**
* Acute ear pain
* hearing loss
* may, may not have bloody otorrhea
* may, may not have tinnitus and vertigo
**_Diagnosis_**
* Otoscope exam: perforated TM. May lead to cholesteatoma development
* may, may not have CHL
* Weber: lateralization to affected ear
* Rinne: BC\>/equal to AC
**_Management_**
* Most perforated TM will heal spontaneously. Follow to ensure resolution. Surgical options available.
* Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
81
**_Tympanic membrane perforation_**
clinical manifestation
**_Clinical manifestations_**
* Acute ear pain
* hearing loss
* may, may not have bloody otorrhea
* may, may not have tinnitus and vertigo
**_Diagnosis_**
* Otoscope exam: perforated TM. May lead to cholesteatoma development
* may, may not have CHL
* Weber: lateralization to affected ear
* Rinne: BC\>/equal to AC
**_Management_**
* Most perforated TM will heal spontaneously. Follow to ensure resolution. Surgical options available.
* Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Most common cause_**
* Occurs due to penetrating or noise trauma or otitis media
* Most commonly occurs at pars tensa
82
**_Tympanic membrane perforation_**
diagnosis
**_Diagnosis_**
* Otoscope exam: perforated TM. May lead to cholesteatoma development
* may, may not have CHL
* Weber: lateralization to affected ear
* Rinne: BC\>/equal to AC
**_Management_**
* Most perforated TM will heal spontaneously. Follow to ensure resolution. Surgical options available.
* Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Most common cause_**
* Occurs due to penetrating or noise trauma or otitis media
* Most commonly occurs at pars tensa
**_Clinical manifestations_**
* Acute ear pain
* hearing loss
* may, may not have bloody otorrhea
* may, may not have tinnitus and vertigo
83
**_Tympanic membrane perforation_**
management
**_Management_**
* Most perforated TM will heal spontaneously. Follow to ensure resolution. Surgical options available.
* Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture
**_Most common cause_**
* Occurs due to penetrating or noise trauma or otitis media
* Most commonly occurs at pars tensa
**_Clinical manifestations_**
* Acute ear pain
* hearing loss
* may, may not have bloody otorrhea
* may, may not have tinnitus and vertigo
**_Diagnosis_**
* Otoscope exam: perforated TM. May lead to cholesteatoma development
* may, may not have CHL
* Weber: lateralization to affected ear
* Rinne: BC\>/equal to AC
