Chapter 20: Ears Flashcards by Callie Rumfelt

Tophi

build up of uric acid crystals on helix/antihelix

small, hard, whitish-yellow, nontender

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Battle’s Sign

Bruising Behind the ear and Base of skull
sign of BiBasilar skull fracture
concern for CSF drainage

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Otitis Externa (OE)
Swimmer's Ear

water in the external ear canal = inflammation and decreased cerumen; caused by bacteria, fungi, allergies, or trauma (cleaning, scratching, hearing aids)

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Characteristics of OE

pain to external ear - worse w/ movement
swelling (can impair hearing)
redness
drainage (clear or purulent)

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Treatment of OE

combo of antibiotics and steroidal ear gtts
if involves lymph nodes = oral antibx
keep ears dry

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Impacted Cerumen

pain, feeling of fullness, itching
occlusion = vertigo, tinnitus
vagal response (EAC is innervated by CN X)

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Ossicles

malleus, incus, stapes

attached to TM and oval window that separates the inner and middle ear

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Eustachian Tubes

connects the nasopharynx to the middle ear

equalized pressures from inner and outer surfaces of the TM (prevents rupture)

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Acute Otitis Media (AOM)

inflammation of the middle ear

can cause obstruction of the ET causing fluid accumulation behind the TM

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Causes of AOM

viral URI will often precede onset of AOM
S. pneumoniae and S. pyogenes (bacterial)
RSV and H. influenzae (viral)

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Symptoms of AOM

abrupt onset of s/sx
deep, throbbing pain
worse with lying flat
feeling of fullness in ears - may hear popping/crackling

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Signs of AOM

distorted/displaced/absent light reflex
TM red, bulging
if pain stops abruptly = ruptured TM
cervical lymphadenopathy

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Associated Infections of AOM

meningitis
postauricular swelling (mastoiditis)
if infx spreads beyond temporal bone = facial nerve (CN VII) paralysis
labrynthitis 
brain abscess

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Otitis Media with Effusion (OME)

“Glue ear”

fluid accumulation in the middle ear
no infection
can occur with changes in atmospheric pressue
usually accompany viral URI

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Clinical Manifestations of OME

pain
sensation of fullness
TM has clody appearance, amber-yellow color
may see air-fluid level or air bubbles behind TM

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Otosclerosis

autosomal dominant disorder
formation of new spongy bone that become calcified = decreased transmission of sound, affecting both ears
voice sounds louder than external noise

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Treatment of Otosclerosis

hearing aids
injection of Na fluoride = slow calcification
surgery (stapes prosthesis)

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Cholesteatomas

overgrowth of epidermal tissue in the middle ear/temporal bone
usually occurs after TM perforation
pearly-white cheesy appearance
unilateral hearing loss/tinnitus

Bony labyrinth

located in temporal bone
filled with a watery fluid called perilymph
divided into vestibule, semicircular canals, cochlea

Membranous Labyrinth

balloon-like sac inside the bony labyrinth

filled with thicker fluid called endolymph

Otoliths

uricle and saccule
sensitive to static or changing head movements depending on cilia movement in the endolymph
BALANCE

Balance is maintained by…

proprioceptive system (muscle & joints), visual system (eyes), and vestibular system (labyrinth)

Organ of Corti

end of organ of hearing that lies in the cochlea

Tinnitus

perception of abnormal ear or head noises
ringing, buzzing, hissing, or humming sound
can be constant or intermittent
can be unilateral or bilateral

Causes of Tinnitus

``` impacted cerumen otosclerosis Menieres Disease head trauma acoustic neuromas uncontrolled HTN damage to CN VIII Vitamin B 12 deficiency Ototoxic drugs ```

Ototoxic drugs

furosemide aminoglycosides (erythromycin) salicylates (aspirin)

Meds that reduce intensity of tinnitus

SSRIs TCAs melatonin

Conductive Hearing Loss

loss of air conduction sound waves do not reach the inner ear BC > AC or AC=BC (Rinne) Lateralizes to affected side (Weber)

Causes of Conductive Hearing Loss

``` impacted cerumen foreign bodies perforated or scarred TM OE, AOM, OME trauma tumors otosclerosis ```

Sensorineural Hearing Loss

lose ability to hear through bone conduction signifies pathology of inner ear, CN VII, or auditory areas of cerebral cortex AC > BC but not twice as long (Rinne) sound lateralizes to unaffected side (Weber)

Causes of Sensorineural Hearing Loss

``` ototoxic medications presbycusis sustained/repeated exposure to loud noise acoustic neuroma demyelineating disorders (MS) ```

Vertigo

an illusion of motion - caused by mismatch of sensory input | subjective (person spinning) or objective (room is spinning)

Central Vertigo

constant but mild vertigo

Peripheral Vertigo

severe but episodic

Risk Factors for Vertigo

``` medications head injury cerebral vascular dx family hx tumor migraine headaches ```

Medications that can cause vertigo

salicylates, antiepileptics, antihypertensives, benzodiazepines

Treatment for Vertigo

mexclizine (antivert) diazepam change positions slowly smoking cessation

Motion Sickness

normal physiologic vertigo caused by repeated rhythmic stimulation of vestibular system (overstimulation) easier to preven than treat

Symptoms of Motion Sickness

``` vertigo malaise N/V Severe motion sickness = autonomic s/sx hypotension, tachycardia, diaphoresis ```

Meniere's Disease

excess of endolymph Tinnitus unilateral sensorineural hearing loss vertigo (at least 20 min to 24 hours)

Cochlear Meniere's

``` fluctuating progressive sensorineural hearing loss tinnitus pressure in ear/ear fullness ```

Vestibular Meniere's

recurrent attacks of vertigo that become more incapacitating

Benign Paroxysmal Positional Vertigo

most common cause of pathologic vertigo develops after age 40 brief periods of vertigo with head movement symptoms usually subside with CONTINUED head movement