Ch. 8 Adult ENT (E1) Flashcards by Danielle Perez

3 types of hearing tests

Whisper
Weber
Rinne

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Cerumen Impaction treatment

Detergent ear drops (3% hydrogen peroxide or 6.5% carbamide peroxide)

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when should irrigation be performed with cerumen impaction

when the tympanic membrane is known to be intact

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“swimmers ear”

otitis externa

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Presents with otalgia with associated external auditory canal edema and purulent discharge
Surrounding periauricular cellulitis
Pain with manipulation of the auricle
-When the canal skin is very edematous, may be impossible to visualize the tympanic membrane

Otitis Externa

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osteomyelitis of the skull base seen in immunocompromised patients

malignant otitis externa

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treatment of otitis external with cellulitis of the periauricular tissue

ciprofloxacin (fluroquinolones are affective against pseudomonas)

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what should be suspected if otitis externa does not resolve with therapy

malignancy, need biopsy

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connects the middle ear to the nasopharynx and provides ventilation and drainage for the middle ear

Eustachian tube

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when is the Eustachian tube normally closed

yawning and swallowing

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most common causes of Eustachian tube dysfunction

viral URI and seasonal allergies

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c/o sense of fullness in the ear and mild to moderate impairment of hearing
and Popping or crackling sound with swallowing or yawning

Eustachian tube dysfunction

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what do you expect to find on an exam with Eustachian tube dysfunction

retraction of the tympanic membrane

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treatment of Eustachian tube dysfunction

systemic and intranasal decongestants (pseudoephedrine & oxymetazoline)

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Typically occurs with an upper respiratory tract infection, with barotrauma or with chronic allergic rhinitis.

Serous Otitis Media

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examination results:
- Tympanic membrane is dull and hypomobile
- conductive hearing loss

Serous otits media

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treatment of serous otitis media

Oral corticosteroids (Prednisone 40mg x7days)
Oral antibiotics (Amoxicillin 250 TID x 7days)

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treatment of barotrauma

oral and topical decongestants (pseudoephedrine 60-120mg, 1% phenylephrine or oxymetazoline nasal spray)

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what is an absolute contraindication to diving

tympanic membrane perforation

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bacterial infection of the mucosally lined, air-containing spaces of the middle ear

acute otitis media

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s/s
- otalgia
-aural pressure
- decreased hearing
- fever

Acute otitis media

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Examination results
- erythema
- decreased mobility of the tympanic membrane
- occasional bullae on tympanic membrane

acute otitis media

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dx
- pain, postauricular erythema, and occasionally proptosis of the auricle.
- Frank swelling over the mastoid bone or the association of cranial neuropathies or central findings indicates severe disease

acute mastoiditis

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treatment of acute otitis media

amoxicillin 1g PO q8 x5-7 days

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recurrent acute otitis media can cause ---

chronic otitis media

Examination results: - Perforation or retraction of the tympanic membrane may be present - Purulent aural discharge - Increased draining with upper respiratory infection or following water exposure - No c/o pain - conductive hearing loss from destruction of the tympanic membrane or ossicular chain

Chronic otitis media

treatment of chronic otitis media

oflaxacin or ciprofloxacin with dexamethasone drops (oral cipro if fighting psudomonas)

most common intracranial complication of ear infections

otogenic meningitis

tympanic membrane perforation may occur from

impact injury or explosive acoustic trauma

ototoxic substances that can cause irreversible hearing loss in therapeutic doss (3)

aminoglycosides loop diuretics antineoplastic agents (Cisplantin)

what is it important to avoid with a perforated tympanic membrane

ototoxic ear drops (neomycin, gentamycin)

treatment: c/o --> sudden loss of hearing in one ear aural fullness tinnitus dizziness

corticosteroids (intratympanic and oral)

excessive sensitivity to sound after hearing loss

hyperacusis

__ is the cardinal symptom of vestibular disease

vertigo

dx s/s: sudden onset of severe vertigo (inability to stand/walk) N/V tinnitus and hearing loss

peripheral vestibular disease

2 types of vertigo testing

Dix hallpike and Fuduka

singular vertigo attack without accompanying impairment of auditory function and persists for several days before going away

vestibular neuronitis

treatment for vestibular neuronitis

Diazepam (vestibular suppressant) Oral corticosteroids

vertigo triggered by neck movements

cervical proprioceptive dysfunction

dx: c/o head pressure, visual/motion/auditory sensitivity, photosensitivity symptoms worsen with lack of sleep or stress/anxiety

Migrainous vertigo

__ resembles meunière disease but without hearing loss or tinnitus

Migrainous vertigo

lesions of the ___ can produce hearing loss and dizziness

8th cranial nerve and central audiovestibular pathways

DX: c/o unilateral hearing loss with a deterioration of speech discrimination exceeding that predicted by the degree of pure-tone loss

Vestibular Schwannoma (Acoustic Neuroma)

ANY UNILATERAL OR ASYMMETRIC SENSORINEURAL HEARING LOSS SHOULD BE EVALUATED FOR ___

AN INTRACRANIAL MASS LESION

__ can lead to acute bacterial sinusitis and acute otitis media, asthma, cystic fibrosis, and

Viral rhinosinusitits

Nasal examination shows: - Erythematous, edematous mucosa and a watery discharge.

Viral rhinosinusitis

treatment for viral rhinosinusitis

psudoephederine OTC analgesics rest and hydration

persistence of acute viral rhinitis beyond 10 days with purulent green or yellow nasal secretions and unilateral facial or dental pain

secondary acute bacterial rhinosinusitis

c/o - Acute onset of symptoms - Purulent, yellow/green nasal discharge or expectoration - Facial pain or pressure over the affected sinus or sinuses - Nasal obstruction - Associated cough, malaise, fever, and headache

bacterial rhinosinusitis

most common form of bacterial rhinosinusitis

acute maxillary sinusitis

when and how do you treat bacterial rhinosinutistis

treat symptoms lasting >10 days or when symptoms include fever, facial pain, and swelling of the face treat with intranasal corticosteroids and antibiotcs

dx s/s: * extreme facial pain * clear/straw colored nasal drainage * black eschar on the middle turbinate (not always visible) * pale and dry mucosa

invasive fungal sinusitis

dx physical exam findings - Mucosa is pale or violaceous - Nasal polyps that are yellowish boggy masses of hypertrophic

allergic rhinitis

treatment of allergic rhinitis

- intranasal corticosteroids (Beclomethasone, Flunisolide, Mometasone furoate, Budesonide, Fluticasone propionate) - antihistamines (Loratadine, Desloratadine, Fexofenadine, Cetirizine) - antileukotriene (Montelukast/cromolyn sodium)

a white plaque-like lesion that can not be removed by rubbing the mucosal surface

Leukoplakia

Early lesions appear as leukoplakia or Erythroplakia; more advanced lesions will be larger, painful, and can involve the tongue, gums, hard palate, inner lining of the lips or cheek. Ulceration may be present

Oral cancer

Most commonly presents as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy

Oral lichen planus

Similar to leukoplakia except that it has a definite erythematous component

erythroplakia

treatment of hair leukoplakis

acyclovir, valacyclovir, and famciclovir

dx: s/s - painful - white areas are easily rubbed off (unlike leukoplakia or lichen planus) - angular cheilitis (also seen in nutritional deficiencies)

Oral candidiasis (thrush)

treatment of oral candidiasis (thrush)

Fluconazole, Ketoconazole, Nystatin rinses

a red, smooth-surfaced tongue s/t inflammation of the tongue with loss of filiform papillae

Glossitis

dx: s/s - Burning and pain of the tongue – may occur with or without glossitis - “burning mouth syndrome” - Benign – no infection

glossodynia

Dx: S/S - painful acute gingival inflammation and necrosis - bleeding - halitosis - fever - cervical lymphadenopathy

Ulcerative Gingivitis (Trench mouth, Vincent Angina)

treatment for Ulcerative Gingivitis (Trench mouth, Vincent Angina)

oral PCN and warm half-strength peroxide rinses

Appear as painful small round ulcerations with yellow-gray fibrinoid centers surrounded by red halos

Aphthous Ulcer (Canker Sore, Ulcerative Stomatitis)

treatment of Aphthous Ulcer (Canker Sore, Ulcerative Stomatitis)

Topical corticosteroids for symptom relief and Cimetidine for maintenance therapy

dx: s/s - fever or 38C - tender anterior cervical adenopathy - lack of a cough - pharyngotonsillar exudate

Group A streptococcal pharyngitis

dx: s/s Marked lymphadenopathy; shaggy, white-purple tonsillar exudate

mononucleosis

if mono is suspected, which antibiotic should be avoided

ampicillin

how to diagnosis Group A streptococcal pharyngitis

single saw throat culture or rapid antigen detection testing

what is the centor criteria for group A streptococcal pharyngitis

exudate or swelling on tonsils, anterior cervical adenopathy, fever, lack of cough 0-1 - no testing or antibiotics necessary 2-3- testing needed to determine antibiotics all 4- no testing needed, prescribe antibiotics

treatment for Group A streptococcal pharyngitis

PO antibiotics-- PCN V potassium, cefuroxime axetil or amoxicillin clindamycin, erythromycin, or azithromycin for PCN allergy patients

Treatment for mild peritonsillar abscesses and cellulitis

amoxicillin, augmentin, or clindamycin x 7-10 days

treatment for Ludwig angina

PCN + metronidazole ampicillin-sulbactam clindamycin selective cephalosporins