Rosas--Ear Diseases Flashcards Preview

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Flashcards in Rosas--Ear Diseases Deck (22):
1

Tuning Fork Tests-512 Hz

Rinne

AC >BC (Normal)
BC>AC (CHL--conductive hearing loss)

 

Weber

Midline (Normal)

Lateralizes to CHL or to better ear

2

Otoacoustic Emission Testing

  • Outer Hair Cells emit low intensity sound following acoustic stimulation


Newborn Screening Test
Testing for kids < 2 yrs

3

Presbycusis

Etiology of Sensorineural Hearing Loss

  • most common (50% of >75 yo) loss of hair cells, progressive

4

Etiology of Sensorineural Hearing Loss

Infectious

OM, viral, syphilis

5

Etiology of Sensorineural Hearing Loss

Neoplastic

Vestibular schwannoma

6

Otosclerosis

  • Autosomal Dominant incomplete penetrance
  • 60 % have family Hx
  • Fluoride prevents
  • Rx: hearing aids or Stapedectomy

7

Temporal Bone Fracture

Head Trauma

  • Sympt: Headache, vertigo, SNHL (sensorineuroal = inner ear), CHL (conductive = outer ear), facial nerve paralysis, CSF leak via ear canal or nose
  • Rx: Neurosurgical unit observation, sx relief, lumbar drain, audio, possible ossicular reconstruction

8

Acoustic Neuroma

  • Asymmetric SNHL (sensorineural)
  • Vertigo
  • Facial nerve paralysis
  • Aural Fullness
  • Trigeminal numbness (impingment)
  • Diplopia
  • Dx: MRI of IACs with contrast
  • Rx: OBS vs SURG vs XRT
  • LOOK AT FIRST AID

9

Subjective Tinnitus

Perception of sound in the absence of acoustic, electrical or external stimulus  (Assoc w High Freq SNHL 3-5 kHz)

SNHL: presbycusis, menieres, neuromas

Rx: ASA/NSAIDS, aminoglycosides, anti HTN,  antidepressants, anticancer agents many more

Trauma: Noise, Whiplash, Concussion, Baro

Systemic Diseases: HTN, depression, anxiety, multiple sclerosis, stroke, meningitis

Metabolic: Hyper-Hypothyroidism,  hyperlipidemia, Vit A, Vit B, zinc deficiency

 

10

Objective Tinnitus

Perception of sound  caused by internal body sound or vibration,  May be exacerbated by Conductive Hearing  Loss

  • Vascular Causes:  Benign intracranial HTN, AVM, arterial bruits, venous hums, HTN, vascular tumors
  • Patulous eustachian tube
  • Palatal myoclonus
  • Tensor tympani/stapedius syndrome
  • Spontaneous otoacoustic emissions

11

Vestibular Disorders

  • Vertigo: illusion of movement (ie rocking, rotary, ground rolling, since of falling forward/backward), commonly episodic
  • Dysequilibrium: sense of poor coordination with erect posture or movement, usually continuous
  • Imbalance: implies orthopedic or neuro problem
  • Dizziness: all-encompassing term (ie light-headed, orthostatic, hypoglycemic, inability to concentrate)

12

Most common cause of Peripheral Vertigo

Benign paroxysmal positional vertigo (BPPV)

13

Differential Diagnosis of Central Vertigo

  • Multiple sclerosis
  • Stroke
  • Cerebellar lesions
  • Diabetes
  • Vertebrobasilar insufficiency
  • Migraines
  • Vascular loop compression syndrome

14

Benign Paroxysmal Positional Vertigo

(EXAM)

  • Most common peripheral vertigo
  • Cause: post trauma, post viral infection
  • SSx: recurrent brief positional vertigo, latency, fatigability
  • Dx: Hx, Dix-Hallpike
  • Ppys: canalithiasis
  • Normal Hearing

15

INFLAMMATORY LESIONS OF THE PINNA

  • RELAPSING POLYCHONDRITIS
  • NODULARIS CHRONICUS HELICUS
  • KELOIDS
  • CELLULITIS

16

OTITIS EXTERNA

  • VERY PAINFUL RED SWOLLEN CANAL WITH PURULENCE
  • SEEN IN SWIMMERS, Q TIP USERS, DIABETICS, IMMUNOSUPRESSION
  • RX ANTIBIOTIC DROPS AND SYSTEMIC ANTIBX
  • TOPICAL SUCTIONING AND DEBRIDEMENT
  • PSEUDOMONAS, E COLI, STAPH CORYNEBACTER
  • HEARING MAY BE AFFECTED

17

HERPES ZOSTER OTICUS

  • PURULENT ULCERS IN AND AROUND EAR
  • DECREASED HEARING
  • SEVERE PAIN
  • FACIAL NERVE PARALYSIS
  • ANTIVIRAL RX AND PAIN RELIEF
  • IMMUNOCOMPROMISE MAJOR RISK FACTOR

 

18

Cerumenectomy

Procedure to remove ear wax

  • May be performed with half strength H2O2 irrigation with syringe or water Pick
  • Otologists prefer instrument techniques such as suctioning, curetting, or grasping with alligators
  • Complications include pain, laceration of canal skin, TM perforation, perilymph fistula, vertigo and deafness

19

Tympanosclerosis

White plaques on TM

  • Hyalin or Calcium deposition
  • PPx prior Otitis Media or Trauma (PE Tubes)
  • Normal hearing if limited to the TM
  • If middle ear involved there may be conductive hearing loss

20

Cholesteratoma 

  • Squamous epithelium in middle ear
  • Causes bone and soft tissue destruction of ear structures pressure necrosis, secondary infection and proteolytic enzyme release by cholesteatoma.
  • SOFT BALL OF KERATIN
  • CAUSES BONE EROSION
  • SURGERY IS ALMOST ALWAYS INDICATED TO EXCISE TO PREVENT DESTRUCTION OF EAR = tympanomastoidectomy

21

acute otitis media 

  • Acute middle ear space infection (< 3 wk)
  • 2nd most common disease in children (URI #1)
  • PPx Eustachian tube dysfunction causes negative middle ear pressure
  • middle ear pressure resulting in transudative fluid collection in middle ear space and subsequent infection (EXAM)
  • S. pnemoniae, H. influenza, Mor. Catarrhalis most common pathogens (EXAM)

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