Chapter 20: Ears Flashcards
Tophi
build up of uric acid crystals on helix/antihelix
small, hard, whitish-yellow, nontender
Battle’s Sign
Bruising Behind the ear and Base of skull
sign of BiBasilar skull fracture
concern for CSF drainage
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)
Characteristics of OE
pain to external ear - worse w/ movement
swelling (can impair hearing)
redness
drainage (clear or purulent)
Treatment of OE
combo of antibiotics and steroidal ear gtts
if involves lymph nodes = oral antibx
keep ears dry
Impacted Cerumen
pain, feeling of fullness, itching occlusion = vertigo, tinnitus vagal response (EAC is innervated by CN X)
Ossicles
malleus, incus, stapes
attached to TM and oval window that separates the inner and middle ear
Eustachian Tubes
connects the nasopharynx to the middle ear
equalized pressures from inner and outer surfaces of the TM (prevents rupture)
Acute Otitis Media (AOM)
inflammation of the middle ear
can cause obstruction of the ET causing fluid accumulation behind the TM
Causes of AOM
viral URI will often precede onset of AOM
S. pneumoniae and S. pyogenes (bacterial)
RSV and H. influenzae (viral)
Symptoms of AOM
abrupt onset of s/sx
deep, throbbing pain
worse with lying flat
feeling of fullness in ears - may hear popping/crackling
Signs of AOM
distorted/displaced/absent light reflex
TM red, bulging
if pain stops abruptly = ruptured TM
cervical lymphadenopathy
Associated Infections of AOM
meningitis postauricular swelling (mastoiditis) if infx spreads beyond temporal bone = facial nerve (CN VII) paralysis labrynthitis brain abscess
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
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
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
Treatment of Otosclerosis
hearing aids
injection of Na fluoride = slow calcification
surgery (stapes prosthesis)
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
