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HEENT > Chap 4 Ear MDT > Flashcards

Chap 4 Ear MDT Flashcards

1
Q

Accumulation of blood in the subperichondrial space, usually secondary to blunt trauma

Tearing of the cartilage and the blood vessels can result in necrosis

A

Auricular hematoma

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2
Q

Superichondrial collection can lead to stimulation of the overlying perichondrium, which can lead to new cartilage formation and deformity.

A

Cauliflower ear

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3
Q

Treatment of:

Auricular hematoma

A

Local anesthesia

Semicircular incision to drain hematoma

Irrigation

Topical antibiotics and bandage

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4
Q

Symptoms and physical exam:

  • Specific MOI
  • Muffled sounds
  • Severe pain
  • Hearing disturbances/changes
A

Foreign body in the ear

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5
Q

Instruments of choice for removal of foreign objects in the ear

A

Cerumen loops/scoops, a right-angle hook, and alligator forceps

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6
Q

What should you use to drown live objects in the ear?

A

Lidocaine solution

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7
Q

What should you use for small particles such as sand or cerumen stuck in the ear?

A

Room temperature water

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8
Q

Symptoms and exam findings:

Decrease in hearing and or a sensation of pressure or fullness

Symptoms are often precipitated by the use of cotton-tipped applicators

A

Cerumen impaction

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9
Q

Cerumen impaction:

If irrigation fails, what can you use?

A

Cerumenolytic (Carbamide Peroxide)

-2 to 5 drops BID for 4 days

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10
Q

Complication of acute otitis media

Infection spreads from the middle ear to the mastoid air cells

The mastoid cavity becomes filled and inflamed

A

Mastoiditis

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11
Q

Sx: Postauricular pain and erythema accompanied by a spiking fever
Edema, tenderness, protrusion of the auricle, obliteration of the post auricular crease.

A

Mastoiditis

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12
Q

Labs/Studies:

Mastoiditis

A

Mastoid Radiography

CT

Culture and drainage

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13
Q

Treatment of:

Mastoiditis

A 
IV antibiotics:
-Ceftriaxone 240mg IV q 24 hours
or
-Levofloxacin 750mg IV q24 hours 
or
-Cefazolin 0.5-1.5g IV TID

MEDEVAC (Medical emergency)

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14
Q

Diffuse inflammation of the external ear canal with or without inflammation of the auricle and/or tympanic membrane

A

Otitis Externa

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15
Q

Acute otitis externa is almost exclusively from what two organisms?

A

Pseudomonas aeruginosa

Staphylococcus aureus

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16
Q

Labs/studies:

Otitis externa

A

Gram staining of discharge

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17
Q

Treatment of:

Otitis externa

A

Acidification with drying agent (50/50 isopropyl alcohol/white vinegar)

Otic antibiotic or a suspension of aminoglycoside
-Fluoroquinolone or Neomycin/polymyxin B

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18
Q

Treatment of:

Severe otitis externa

A

Ciprofloxacin 500mg PO BID

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19
Q

Bacterial infection of the mucosal lined air-containing spaces of the temporal bone

Purulent material forms in middle ear and mastoid air cells and petrous apex

Usually precipitated by viral URI that causes blockage of eustachian tube

A

Otitis media

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20
Q

Most common pathogens for otitis media

A

Streptococcus pneumoniae

Haemophilus influenzae

Streptococcus pyogenes

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21
Q

Sx: Otalgia, aural pressure, decreased hearing, and often fever and history of an URI

Erythema and hypomobility of tympanic membrane

Severe: TM bulging (rupture is imminent, Mastoid tenderness

A

Otitis media

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22
Q

Labs/Studies:

Otitis media

A

Tympanocentesis and fungal culture by an experienced physician

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23
Q

Treatment for:

Otitis media

A

Amoxicillin 1g TID 5-7 days
or
Amoxicillin/Clavulanate 2g/125mg PO BID 5-7 days

Nasal decongestants

24
Q

Treatment for:

Otitis media with PCN allergies

A

Ceftriaxone 1g IM one dose
or
Doxycycline 100mg PO BID x 10 days

25
Q

Surgical drainage of the middle ear, reserved for patients with severe otalgia or when complications of otitis have occured

A

Myringotomy

26
Q

Represents a spectrum of disorders involving an impairment in the functional valve of the eustachian tube of the middle ear

A

Eustachian Tube Dysfunction (ETD)

27
Q

Sx: Severe ear pain, fullness or “underwater sensation”, hearing loss or “muffled hearing”, tinnitus, “popping and snapping noises”

A

Eustachian tube dysfunction

28
Q

Labs/studies:

Eustachian tube dysfunction

A

Audiometric testing for conductive hearing loss to established baseline with condition

29
Q

Treatment for:

ETD

A

Pseudoephedrine

Oxymetazoline

Fluticasone propionate (Flonase)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

30
Q

Treatment for:

ETD

A

Pseudoephedrine

Oxymetazoline

Fluticasone propionate (Flonase)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

31
Q

ETD:

Chronic cases, monitor pressure equalization tubes every:

A

6 to 12 months

32
Q

Occur secondary to middle ear infections or as a result of barotrauma, blunt/penetrating/acoustic trauma, or lightning strikes

A

TM Perforation

33
Q

When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the:

A

Pars Tensa (usually anteriorly or inferiorly)

34
Q

Sx: Acute onset of pain and hearing loss; associated vertigo or tinnitus; nausea and vomiting; history of recurrent ear infections

Signs: Visible perforation of the tympanic membrane, otorrhea

A

TM Perforation

35
Q

Treatment of:

TM Perforation

A

Spontaneous healing occurs in most cases

Systemic antibiotics
-Augmentin or Doxycycline

Perforations from penetrating trauma send to otolaryngologist within 24 hours.

36
Q

Benign tumor (composed of stratified squamous epithelium) in the middle ear or mastoid.

Slowly growing lesion that destroys bone and normal ear tissue

A

Cholesteatoma

37
Q

Most common cause of cholesteatoma

A

Prolonged eustachian tube dysfunction

38
Q

Labs/studies:

Cholesteatoma

A

CT to visualize bony destruction

39
Q

Treatment for:

Cholesteatoma

A

Surgical marsupialization of the sac or its complete removal

Refer urgently to ENT

40
Q

Acute ear pain or damage to the tympanic membrane caused by rapid changes in pressure

A

Otic barotrauma

41
Q

Most common etiology of barotrauma

A

Flying

42
Q

Symptoms and physical exam:

  • Middle ear pain
  • Hearing loss due to deformation of tympanic membrane that can hinder membrane mobility
  • Specific MOI to include sx associated with changes in inner ear pressure

SEVERE: Sensorineural hearing loss and vertigo due to damage

A

Barotrauma

43
Q

Treatment for:

Barotrauma

A

Treat underlying illness (URI)

Pseudoephedrine

Nasal decongestants (oxymetazoline)

Antihistamines for symptomatic relief

44
Q

Sudden hearing loss is classified as:

A

3 days or less

45
Q

Sensorineural hearing loss

A

Cochlea, auditory nerve, or centrally auditory processing

46
Q

Conductive hearing loss is:

A

External ear, TM, and ossicles

47
Q

Which hearing loss is more reversible between conductive and sensory?

A

Conductive

48
Q

Most common form of sensory hearing loss

A

Presbycusis (loss with advancing age)

49
Q

Second most common cause of sensory hearing loss

A

Noise trauma

Usually begins in the 4000 Hz

50
Q

Labs/studies for:

Hearing loss

A

Audiogram testing confirms significant hearing loss

Weber and Rinne test

51
Q

Treatment for:

Hearing loss

A

Remove member from exposure

Educate member on wearing earplugs

Refer to ENT if necessary

52
Q

Results from hair damage in the cochlea, carotid artery/jugular vein turbulence, or temporomandibular joint problems

A

Tinnitus

53
Q

Two types of tinnitus

A

Objective and subjective

54
Q

Symptoms and physical exam:

Ringing noise, conductive hearing loss/changes, headache, noise intolerance, vertigo, TMJ dysfunction

A

Tinnitus

55
Q

Labs/studies for:

Tinnitus

A

CBC

TSH

HIV

RPR/autoimmune panel

MRI

CT scan for pulsatile tinnitus

HEENT (6 decks)

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