Week 1 ENT 1 of 4

Question 1

Using an otoscope to examine the adult ear, what do you do?

Answer 1

pull the auricle UP and BACK

Question 2

Using an otoscope to examine an infant/child’s ear, what do you do?

Answer 2

pull the auricle DOWN and OUT

Question 3

What is important to ensure regarding the otoscope when using?

Answer 3

• brightly lit

- proper tip

Question 4

This d/o occurs when there is an excessive amount of cerumen that occludes the external canal:

Answer 4

Impacted Cerumen

Question 5

Subjective findings for impacted cerumen:

Answer 5

• fullness of the canal
• itching
• pain
• cough
• vertigo
• hearing loss

Question 6

Objective findings of Impacted cerumen:

Answer 6

Hard/soft cerumen occluding external canal

-unable to visualize TM

Question 7

Mgmt and Health Promotion for Impacted cerumen:

Answer 7

Mgmt:
- Removal of cerumen by warm water irrigation for symptomatic pts.
-Be mindful of foreign objects
HP:
- no using cotton swabs
-OTC products work well for cerumen removal

Question 8

Inner Ear Disturbances include:

Answer 8

• Labyrinthitis
• Meniere’s Disease
• Tinnitus

Question 9

Inflammation of what CN can cause vertigo sensations?

Answer 9

CN 8 - Vestibulocochlear nerve

Question 10

Subjective findings of inner ear disturbances:

Answer 10

severe vertigo
N/V
disequilibrium

Question 11

Objective findings of inner ear disturbances:

Answer 11

there may be no objective findings

Question 12

Mgmt of Labyrinthits:

Answer 12

prednisone tapered dose

Meclizine 25mg prn (for vertigo)

Question 13

Mgmt of Meniere’s Dx:

Answer 13

otolaryngologist referral

Question 14

Mgmt of Tinnitus:

Answer 14

otolaryngologist referral to R/O neuroma

Question 15

Additional causes of tinnitus:

Answer 15

• large/fast doses of IV Lasix
• lidocaine toxicity (? 5mcg plasma concentration)
• EPIDURAL turned venous

Question 16

Explain how tinnitus can be associated with an epidural:

Answer 16

Epidural test dose is an epi and lidocaine mixture. when administered, if venous the pt will c/o of:

• numbness
• tingling
• and/or TINNITUS

Question 17

Functions of the Eustachian Tube:

Answer 17

1. allows air into the middle ear
2. Equalizes Pressure in the middle ear (d/t altitude)
3. Drain normal secretions of the middle ear.
4. Drains secretions into the nasopharynx

Question 18

how do the eustachian tubes allow for middle ear secretions to drain?

Answer 18

1. by a mucociliary transport system

2. repeated active tubal opening and closing

Question 19

cellulitis of the external auditory canal that may extend to the auricle is:

Answer 19

otitis externa

Question 20

Causes of Otitis externa:

Answer 20

• excessive moisture

- any condition that compromises the integrity of the external ear

Question 21

Subjective findings with otitis externa:

Answer 21

• Pain and tenderness of external ear and/or canal

- itching

Question 22

Objective findings with otitis externa:

Answer 22

• redness and irritation of the canal
• slough or exudate
• edema of the canal

Question 23

Mgmt and HP for otitis externa:

Answer 23

Mgmt:

• topical abx (corisporine otic suspension)
• pain control w/NSAIDS
• Wick

HP - decrease moisture in canal

• gentle use of blow dryer
• 1:2 mix of vinegar/rubbing alcohol

Question 24

an inflammatory or infectious process that occurs in the middle ear from an accumulation of fluid is likely:

Answer 24

Otitis media

Question 25

Otitis media may result in what forms:

Answer 25

- bacterial - fungal - viral

Question 26

Subjective findings for otitis media:

Answer 26

pain hearing loss stuffiness of ear congestion

Question 27

Chronic congestion /chronic otitis media may potentially cause what in young children

Answer 27

speech delays

Question 28

Objective findings for otitis media:

Answer 28

-decreased /absent mobility of TM is Diagnostic -erythema or bulging of the TM (with obscure landmarks)

Question 29

-Mgmt and HP for otitis media:

Answer 29

Mgmt: - analgesics and auralgen (unless bacterial) - Amoxicillin if 1st line for bacterial HP: -assess each case carefully before RX meds/abx

Question 30

auralgen is

Answer 30

an ear gtt with: - benzocaine (pain) - Antipyrine (an anti-inflammatory) - glycerin (to soften ear wax; protect the ear)

Question 31

what % of otitis media cases are bacterial?

Answer 31

< 25%

Question 32

First line abx therapy for otitis media:

Answer 32

amoxicillin

Question 33

any tear in the integrity of the TM is known as:

Answer 33

TM rupture

Question 34

TM rupture can be caused by

Answer 34

- Trauma - Infection - Neoplasm "TIN for TiM"

Question 35

Subjective findings for TM rupture

Answer 35

pain | hearing loss

Question 36

objective findings for TM rupture

Answer 36

actual tear in the TM

Question 37

Mgmt and HP for TM rupture

Answer 37

Mgmt: - most heal spontaneously unless infx was the cause. - referral for surgical intervention HP: - R/O cholesteatoma formation - monitor hearing function

Question 38

A cholesteatoma is an

Answer 38

abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum. It may be a birth defect, but it's most commonly caused by repeated middle ear infections. A cholesteatoma often develops as a cyst, or sac, that sheds layers of old skin

Question 39

$$ Examples of Conductive Hearing Loss:

Answer 39

``` Foreign body Impacted cerumen Infection Cholesteatoma Otitis media Otosclerosis Trauma Tumor ```

Question 40

$$ examples of sensorineural Hearing loss:

Answer 40

``` Acoustic tumor Trauma Congenital or hereditary Infection Meniere’s Ototoxic medications Neurological disorders Presbycusis ```

Question 41

Otosclerosis

Answer 41

is the abnormal growth of bone of the MIDDLE ear. This bone prevents structures within the ear from working properly and causes hearing loss. For some people with otosclerosis, the hearing loss may become severe.

Question 42

Presbycusis

Answer 42

is the most common type of Sensorineural Hearing Loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher pitched (higher frequency) sounds.

Question 43

For patients with PE tubes, ruptured TM or recent ear surgeries, what otic drops would be a better option for them?

Answer 43

Ciprodex | Otofloxin

Question 44

Pearls for ear examination:

Answer 44

1. look carefully - repeatedly looking improves skills 2. watch for foreign bodies (kids like ears) 3. secure the head of kids during exam to reduce R/O trauma during exam

Question 45

Types of Ear Pain (broadly broken down)

Answer 45

1. Primary - originating within ear STRUCTURES | 2. Secondary - referred to the ear from OTHER REGIONS

Question 46

ear pain referred to the ear from another area is known as

Answer 46

secondary ear pain

Question 47

infections and inflammations of middle and external ear structures and mastoid tissues are considered what type of ear pain?

Answer 47

primary

Question 48

Examples of secondary ear pain

Answer 48

- TMJ (dental and periodontal problems) - sinus/ nasopharyngeal infections - lesions of the tongue - cervical musculoskeletal problems - Neuralgias

Question 49

Name the components of physical ear exam:

Answer 49

1. inspection - general appearance, external ear, inspection of ear w/an otoscope 2. Palpation - each ear separately by pulling the pinna OUT and BACK, and either Up/Down. - apply pressure to the tragus

Question 50

functions of the ear include:

Answer 50

1. interpreting and identifying sound 2. detecting the direction of sound 3. maintaining equilibrium

Question 51

Major parts of the ear include

Answer 51

1. external ear (pinna or auricle & the ear canal 2. middle ear (tympanic cavity) 3. inner ear

Question 52

the hearing process begins here by collecting sound waves and channeling them through the ear canal

Answer 52

external ear

Question 53

This part of the ear contains the structures for balance and hearing through a series of connecting chambers and tubes

Answer 53

the inner ear

Question 54

functions as a conduit for hear and as a regulator of the ventilation pressure

Answer 54

the inner ear

Question 55

undiagnosed ear disorders may contribute to

Answer 55

- poor language development - delayed learning - social isolation - hearing loss - risk for falls - missed dx of respiratory and oral infx's