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13 ENT > Approach To Otorrhea and Otalgia > Flashcards

Approach To Otorrhea and Otalgia Flashcards

1
Q

acute vs chronic onset

A

acute <4 wks

chronic >12 wks

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2
Q

middle ear lining vs external ear lining

A

middle: ciliated cuboidal epithelium (secretory), discharge is mucopurulent (like nose)
external: ssqe (like skin), discharge is serous/ watery/ scanty mucoid/ purulent if with pustule

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3
Q

choleasteatoma forms in the ___ quadrants

A

superior quadrants

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4
Q

also known as swimmer’s ear or tropical ear and involves rapid onset (<48 h) of signs and symptoms of ear canal inflammation

A

acute otitis externa

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5
Q

how does swimming affect the ear

A

water exposure changes ph, makes it basic (should be acidic)

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6
Q

etiology of acute otitis externa

A

pseudomonas aeruginosa!!
staph epidermidis
s aureus

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7
Q

symptoms of acute otitis externa

A
  • moderate to severe otalgia worsened by manipulation of pinna (tragal tenderness)
  • swollen, edematous, erythematous with scanty serous/purulent discharge
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8
Q

treatment of acute otitis externa

A

topical: polymyxin B + neomycin + dexamethasone / flucinolone, ciprofloxacin + dexamethasone

aural toilet, wick to deliver drug

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9
Q

oral antibiotics are effective in acute otitis externa treatment

A

false

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10
Q

what is otomycosis

A
  • cc: ear pruritus and/or pain
  • onset: chronic or acute
  • etiology: aspergillus or candida
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11
Q

treatment of otomycosis

A
  • debridement / aural toilet

- topical antifungal: clotrimazole +/- beclomethasone, tolnaftate, vinegar + 70% isopropyl alcohol

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12
Q

classically known as “malignant otitis externa”

A

necrotizing otitis externa

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13
Q

etiology of necrotizing otitis externa

A 
p aeruginosa
s aureus
s epidermidis
proteus mirabilis
hiv: aspergillus fumigatus
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14
Q

clinical manifestations of necrotizing otitis externa

A
  • long standing otalgia
  • involves cn 7-11
  • life threatening
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15
Q

risk factors for necrotizing otitis externa

A
  • patient with glucose intolerance (DM)
  • pharmagologic immunosuppression
  • hiv +
  • myeloid malignancies
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16
Q

diagnostics for necrotizing otitis externa

A
  • ct scan / mri
  • technetium scan 99
  • radioisotope scans (monitoring)
  • esr: elevated
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17
Q

treatment for necrotizing otitis externa

A

early: ciprofloxacin po
advanced: parenteral for >6 wks or until esr is normal or normal gallium scan
fungal: amphotericin b, itraconazole, voriconazole

18
Q

what is external auditory canal or temporal bone malignancy

A
  • squamous cell carcinoma
  • common in old age group
  • presentation: eac mass with chronic history of bloody diarrhea
  • treatment: surgery + radio +/- chemo
19
Q

vzv infection of auricle and eac

A

herpes zoster oticus

20
Q

hxo + cn 7 paralysis = ___

A

ramsay hunt syndrome

21
Q

clinical presentation of hzo

A
  • prodrome: otalgia (unrelieved severe burning)
  • vesicular eruption in concha and/or eac
  • facial nerve paralysis or palsy
  • dysgeusia (chorda tympani)
  • decreased tearing (cn 7 and 8)
22
Q

treatment for hzo

A
  • topical antibiotics + steroids

- <72 hrs: valacyclovir / acyclovir, high dose prednisone

23
Q

infection of the auricular perichondrium or cartilage

A

perichondritis due to trauma or extension of otitis externa

etiology: p aeruginosa

24
Q

clinical manifestations of perichondritis

A
  • fluctuance (fluid)

- if not treated, can form cauliflower ear (auricular chondropathy)

25
Q

treatment for perichondritis

A

incision and drainage, placement of drain, antibiotics

26
Q

inflammatory condition that involves lateral surface of tympanic membrane and medial portion of canal wall

A

bullous myringitis, associated with urtis

etiology: m pneumonia or viral

27
Q

65% of patients with bullous myringitis have ____ hearing loss

A

sensorineural or mixed hearing loss, 60% will have resolution

28
Q

treatment for bullous myringitis

A

clarithromycin, lance or puncture bullae, pain medications

29
Q

acute inflammation of the middle ear with or without middle ear effusion <3-4 wks

A

acute otitis media

30
Q

acute otitis media is most common in ___

A

pediatric age group (6-11 mos) due to shorter and horizontally oriented eustachian tube

31
Q

common etiologies for acute otitis media

A

s pneumoniae
h influenzae
moraxella catarrhalis

32
Q

stages of acute otitis media

A

hyperemia, exudation, suppuration, coalescence/surgical mastoiditis, resolution/complication

33
Q

treatment for acute otitis media

A

<6 mos: antibiotics always
>6 mos: unilateral: observe, follow up; bilateral: antibiotics
>2 yo: unilateral observe, bilateral treat

amoxicillin, amoxicillin-clavulanate, ceftriaxone

Elicit TB history/test if not responding

34
Q

complications of otitis media

A

MATHFLAPS

intracranial: meningitis abscess thrombophlebitis hydrocephalus
extracranial: facial nerve paralysis, labyrinthitis, subperiosteal abscess, petrositis, sensorineural hearing loss

35
Q

chronic inflammation of middle ear (>12 wks) with mucopurulent discharge through perforated tympanic membrane resulting from acute/recurrent infection

A

chronic otitis media without cholesteatoma (ct/mri)

36
Q

treatment for chronic otitis media without cholesteatoma

A
  • topical antibiotics +/- steroids

- surgery(for hearing rehab, remove irreversibly diseased bone, mastoid and middle ear aeration)

37
Q

com with keratinized mass in the middle ear or mastoid

A

com with cholesteatoma (smells like rotten fish)

38
Q

treatment for com with cholesteatoma

A
  • surgery!! (excision and mastoidectomy)
39
Q

___ is an extension of infection from mastoid air cell tract into pneumatized anterior or posterior petrous apex

A

petrous apicitis (complication of otitis media)

40
Q

triad of gradenigo syndrome

A

deep facial pain, otitis media, lateral rectus palsy or abducens nerve palsy

41
Q

treatment for gradenigo syndrome

A

control of infection, antibiotics, surgery for failed management

13 ENT (18 decks)

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