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Senior - ENT > 1 - External Ear > Flashcards

1 - External Ear Flashcards

1
Q

Otalgia

A

Ear pain

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2
Q

Otorrhea

A

Discharge from the ear

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3
Q

External auricular canal anatomy?

A

Slide 10

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4
Q

TM anatomy

A

Slide 11

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5
Q

The ossicles are?

A

Malleus - hammer
Incus - anvil
Stapes - stirrup

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6
Q

Openings of the middle ear?

A

Oval window

  • deep to the stapes
  • opens to the vestibule/semicircular canals

Round window
- connects to the cochlea

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7
Q

Structures of the inner ear?

A

Cochlea
- organ of corti

Semicircular canals
- responsible for vestibular control

CN VIII

  • vestibular nerve branch
  • cochlear nerve branch

Eustachian tube

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8
Q

What is the mastoid process?

A

Portion of temporal bone

  • numerous air cells
  • communacates w mid ear space
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9
Q

MC malignant neoplasm of auricle?

A

Basal cell carcinoma

- 45% of auricular carcinoma

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10
Q

Typical BCC is?

A

Nodular lesion that may be:

  • ulcerated
  • bleeding

Often caught early (slow growing)

Rare to mets

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11
Q

BCC variations?

A

Nodular
- single nodule

Superficial spreading BCC
- spread out multi lesions

Pics on slide 20

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12
Q

20% of cutaneous malignant neoplasms and especially common in males?

A

Squamous cell carcinoma (SCC) of the auricle

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13
Q

Risk factors for SCC?

A 
Immunosuppression
Age
Non-healing ulcer
Chemical exposure
UV radiation
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14
Q

Presentation of SCC?

A

Plaque
Nodule
Ulceration
Prone to bleeding

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15
Q

How aggressive is SCC?

A

More aggressive than BCC
- gen req excision of larger margin

6-18% mets

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16
Q

Precursor to SCC?

A

Actinic keratosis (AK)

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17
Q

Unpredictable tumor that affects all ages and has high mortality?

A

Malignant melanoma

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18
Q

Presentation of malignant melanoma?

A

Pigmented lesion that changes by:

  • Growth
  • color
  • margin
  • ulceration
  • bleeding
  • deeply pigmented

Begins in epidermis and invades dermis

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19
Q

Prognosis of malignant melanoma?

A

Related to depth of invasion

  • thin - 10% mets
  • thick - 90% mets
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20
Q

Epidermal inclusion cyst presentation?

A

Mass often w Central punctum that is:

  • Well defined
  • Non-tender
  • Soft,
  • mobile
  • Cystic
  • slow growing
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21
Q

Tx for EIC?

A

Often spontaneously resolve and leak foul smelling fluid

Or

Inj small amount of triamcinolone (kenalog) into surrounding dermis
- speeds resolution of inflammation and prevent i/d

Or

Excision
- wait 4-6 weeks till not inflamed so the wall wont be ruptured

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22
Q

Why do auricular hematomas occur?

A

Blunt trauma leads to blood accumulation

The cartilage lacks blood supply so it gets stuck there

  • hematoma develops
  • necrosis can develop
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23
Q

Clinical presentation of auricular hemnatoma

A

Ear with

  • Edematous
  • Flucculant
  • Ecchymotic
  • Loss of land marks
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24
Q

Tx for auricular hematoma?

A 
Evacuate hematoma
Pressure dressing/splinting
Prophylactic abx (doxy/cephalexin)

Refer to ENT if >7 days old

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25
Q

Complications of auricular hematoma?

A

Necrosis/infection
Cauliflower deformity
- if not tx in 48-72hrs

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26
Q

The auricle is innervated by

A
  1. Auriculotemporal nerve
    - superiorly and anteriorly
  2. Greater auricular and lesser occipital nerve
    - posteriorly and inferiorly
  3. Vagus nerve
    - concha and ext auditory meatus
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27
Q

With lacerations to ear you may need to?

A

Use local anesthetic to facilitate evaluation

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28
Q

Warning signs that your ear trauma may include the middle ear?

A 
Hemotympanum
Amber/clear fluid in ear
Otorrhea
HL w webber/rinne
Retroauricular hematoma (battle sign)
Facial nerve dysfunction
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29
Q

Warning signs for basalar skull fx?

A

CSF in ears/nose
Deficits of CN VIII
- webber rinne testing

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30
Q

Which ear lacerations need referral?

A

Plastic, maxillofacial surgeon, ENT or neuro if:

  • auricular avulsion
  • laceration w EAC extension
  • laceration w middle or inner ear injury
  • Lacerations w basilar skull fx
  • chronically split earlobe or cleft (heavy earrings or allergy to metal)
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31
Q

Fixing lacerations in the ear (basics)

A

Primary closure - preferred
- delayed >24hrs or infected

Pressure dressing to prevent edema/hematoma

32
Q

What type of abx should be given for ear lacerations

A

Cartilage-penetrating abx

- quinolones

33
Q

When doing ear anastheisia you should never use?

A

No epi - nothing with a tip

34
Q

Local block vs regional block for ear lacerations?

A

Local block - sufficient for most simple lacerations

Regional block - extensive lacerations
- doesnt distort the tissue

The how to is on slides 43-45 if you want to learn how to do it

35
Q

Cellulitis, perichondritis, chondritis?

A

Infection of:

  • Cellulitis - skin
  • Perichondritis - tissue around the cartilage
  • Chondritis - cartilage
36
Q

Clinical presentation of the auricle -itises?

A

Often indistinguishable from each other

  • swollen
  • warm
  • TTP
  • erythematous

Pain w deflection of auricle (pinch auricle)

37
Q

Tx for the auricular -itises?

A

Mild - PO floroquinolone f/u 24 hrs

Moderate-severe - IV abx

  • flouroquinolone
  • aminoglycosides (maybe)
  • semisynthetic penicillin

Surgical debridement (PRN)

Send them to ENT to avoid poor cosmesis

38
Q

Diseases of external auditory canal (EAC)

- list

A 
Cerumen impaction
FOB
Traumatic external otitis
AOE
Pruritis
MOE
Exostosis and osteomas
Neoplasm
39
Q

Purpose of cerumen?

A

Protects the skin of the canal

  • acidifies to prevent bacteria/fungus
  • hydrophobic (lipid rich) preventing skin penetration and maceration
40
Q

Who gets cerumen impaction?

A

Kids 1:10

Adults 1:20

41
Q

What causes cerumen impaction?

A
  1. Obstruction form EAC disease
    - exotoses
    - infection/derm disease
    - cutaneous manifestations of systemic (SLE etc)
  2. Narrowing of EAC
    - tumors, hiar, cartilage collapse, trauma
  3. Failure of epithelial migration
    - aging, atrophy, hearing aids, q tips
  4. Overproduction
    - local trauma, retained water, idiopathic
42
Q

Clinical presentation of cerumen impaction?

A

Usually asymptomatic

Symptomatic

  • hearing loss
  • otalgia
  • fullness
  • itching
43
Q

Tx of symptomatic vs asymptomatic cerumen impaction?

A

Symptomatic
- remove it, it’ll help their hearing

Asymptomatic
- leave it alone

44
Q

Therapeutic options for cerumen impaction?

A

Cerumenolytic agents
- primary care 1st line
Irrigation
Manual removal

No method is “superior”

45
Q

Who should not get cerumenolytics?

A

Pts with TM damage

  • otorrhea
  • otalgia
  • h/o freq infections
46
Q

Types of cerumenolytics?

A

Mineral oil + peroxide

Carbamide peroxide 6.5% (deprox)

47
Q

Cerumenolytics complications?

A 
Allergic reaction
Otitis externa
Earache
Transient HL
Dizziness
48
Q

What type of fancy medical water is used for cerumen impaction irrigation?

A

Tap water or saline
- dont get fancy

It says you can use a syringe but it takes way more water than that, trust me

49
Q

What should you follow irrigation with?

A

Acidification

- 2% acetic acid or boric acid powder

50
Q

Complications of irrigation

A 
Retention of water behind cerumen
- maceration and infection 
TM perforation
HL
Tinnitus
Vertigo 
Pain
51
Q

When should you make ENT do the cerumen removal?

A

When its complex and needs their fancy microscope guidance machine

  • TM perf
  • recurrent impaction
  • doesnt respond to routine measures
  • h/o chronic otitis media or TM perf
52
Q

Guidance for pts w recurrent cerumen impaction (2/2 a disease usually)

A
  1. Cotton ball dipped in mineral oil and in EAC x 10-20 min once/week
  2. Removal of hearing aid during sleep
  3. Routine cleaning by you 6-12 mo
53
Q

When dealing with FOB in ear sometimes flushing will help. When should you avoid irrigation?

A

Organic objects

  • beans
  • insect
  • etc
54
Q

If you look in a kids ear and see a bug what should you do?🐜

A

Hit it with 2% viscous lidocaine

  • kills bug
  • anesthetizes skin of eac
55
Q

External otitis is aka?

A

AOE

Swimmers ear

56
Q

Otitis extrena clinical presentation?

A

Its pretty basic ear infection

Slide 81 if you wanna look. You should be able to get it though

57
Q

AOE tx?

A

Mild

  • 2% acetic acid (VoSol)
  • Vosol (rx)
Moderate
- polymyxin B/hydrocortisone (cortisporin)
- aminoglycosides (gentamicin sulfate)
Quinolones (ciprofloxacin or ofloxacin)
- Ofloxacin otic
58
Q

Why may you consider not using aminoglycosides (gentamicin) on the ear balls?

A

May be ototoxic

59
Q

AOM plus (list) is prob getting combo therapy of ototipic and systemic meds

A 
Cellulitis 
DM
Aids
h/o ear radiation 
Severe otitis externa
Sig edema (blocking access to canal)
60
Q

During AOM tx pts should?

A

Avoid promoting factors

  • no water in ear
  • cotton ball w Vaseline in ear during bathing
  • no water sports x 10 days
  • education on proper ear hygiene
61
Q

What is necrotizing otitis externa aka malignant otitis externa?

A

Sever bacterial infection of EAC at skull base

  • pseudomonas
  • spreads to bone and wreck it ralph’s your head
62
Q

Malignant otitis externa diagnosis?

A

CT w bone windows

63
Q

Presentation of necrotizing otitis?

A 
External otitis spreads to bone
Deep otalgia
EAC granulation
Foul otorrhea
CN palsies (bad sign)
64
Q

Why is it called malignant?

A

The look and high mortality of the infection

  • not actually cancer
65
Q

Tx for necrotizing otitis externa?

A

ENT consult
IV ciprofloxacin
Oral cipro (select pts)
Meds x several months

Surgical debridement if refractory

66
Q

How effective is tx for necrotizing otitis externa?

A

With early diagnosis and tx 90-100%

67
Q

Usual cause of ear pruritis?

A

Self induced from excoriation or excessive cleaning

68
Q

Tx for ear pruritis?

A 
Avoid causes
Avoid soap in ear
Mineral oil to hydrate
Kenalog topically
Oral Antihistamines 
Topical isopropyl etoh (drying)
69
Q

Structural ear canal d/o?

A

Exostoses

  • multi EAC lesions, firm, bony, broad-based lesions
  • composed of lamellar bone,
  • reactive bone formation

Osteomas
- pedunculated bony EAC lesion attached to tympanosquamous or tympanomastoid suture line

70
Q

How are structural ear canal d/o diagnosed?

A

Exostoses and osteomas are usually asymptomatic so generally found incidentally

though can also cause occlusion of EAC

  • impaction
  • external otitis
  • HL
71
Q

Tx for structural ear canal d/o?

A

Single/small - observe

Multi/large - surgical removal

72
Q

MC neoplasm of ear canal?

A

Squamous cell carcinoma

73
Q

When to suspect SCC?

A

Apparent otitis externa doesn’t resolve on therapy

Suspect malignancy

74
Q

EAC neoplasm prognosis?

A

High 5 yr mortality

- invades lymph of cranial base

75
Q

Tx for EAC neoplasm?

A

Wide surgical resection

Radiation

76
Q

Which neoplasms are generally more indolent?

A

Adenomatous tumors originating from the ceruminous glands

77
Q

So i sent that bitch an ear

A

Bitches love ears

- Vincent van Gogh

Senior - ENT (8 decks)

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