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Boies > Chapter 6: Diseases of the Middle Ear and Mastoid > Flashcards

Chapter 6: Diseases of the Middle Ear and Mastoid Flashcards

1
Q

Thickened TM is due to…

A

Inflammation

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2
Q

TM that contain white thick patches/entirely white and thick

A

Deposition of hyalinized collagen in its middle layer as a result of previous inflammation (tympanosclerosis)

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3
Q

TM that is thinner from loss of its middle layer (membrana propria)

A

Eustachian tube ventilation dysfunction

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4
Q

Chronic otitis media with drainage…

A

…is always accompanied by a perforations of the TM

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5
Q

Classification of TM perforation

A
  1. Tubal-safe
  2. Central-safe
  3. Marginal-more serious
  4. Pars flaccida-more serious
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6
Q

Inflammation of the TM

A

Myringitis

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7
Q

Most notable finding is bleb formation (bullae) on the TM and adjacent canal wall

A

Hemorrhagic or bullous myringitis

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8
Q

Usually a self limited disease and is associated with infection caused by Mycoplasma pneumoniae
Can caused sensorineural hearing loss

A

Adult hemorrhagic myringitis

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9
Q

Drug of choice for myringitis with systemic manifestation

A

Erythromycin

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10
Q

Relief of pain the blebs or vesicles can be…

A

Disrupted by fine needle or myringotomy knife

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11
Q

Infant eustachian tube

A

Short, wide and horizontal in location

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12
Q

As a child grows, the eustachian tube…

A

Elongates, narrows and develops a downward course medially

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13
Q

Normal ET

A

Closed and opens by active muscular contraction of the tensor veli palatini muscle during swallowing and yawning

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14
Q

Functions of ET

A
  1. Ventilation
  2. Drainage
  3. Protection
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15
Q

Provides equalization of atmospheric pressure on both sides of the TM

A

Ventilation

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16
Q

ET opens by muscular activity when the pressure differential is..

A

20-40 mmHg

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17
Q

Essential for the opening of ET

A

Intact tensor veli palatini muscle

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18
Q

Assessment of ET ventilation

A
  1. Toynbee maneuver

2. Valsalva maneuver

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19
Q

Listening through an auscultation tube while the patient squeezes the nostrils and swallows

A

Toynbee maneuver

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20
Q

Listening through an auscultation tube while patient squeezes the nose and blows hard against the occluded nostrils with a closed mouth

A

Valsalva maneuver

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21
Q

ET protects the middle ear from…

A

Contaminated nasopharyngeal secretions and pathogenic organisms

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22
Q

Disorders affecting the ET

A
  1. Abnormally patent tube
  2. Palatal myoclonus
  3. Obstruction
  4. Cleft palate
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23
Q

Open all the time so that air enters the middle ear with respirations

A

Abnormally patent tube

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24
Q

Significant weight loss–>loss of adipose tissue around the ET

A

Abnormally patent tube

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25
Q

Women on birth control pills

Men taking estrogens

A

Abnormally patent tube

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26
Q

Can produce autophony (hearing one’s respiration)
Sensation of fullness
Plugged up feeling in the ear

A

Abnormally patent tube

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27
Q

Ear exam: abnormally patent tube

A

TM is atrophic and thin and will move in and out with respiration

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28
Q

Method to correct abnormally patent tube

A

Insert a ventilation tube through the tympanic membrane–>decrease the disturbing effects

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29
Q

Rare condition in which the palatal muscles undergo periodic rhythmic contractions–>clicking sound in the ear

A

Palatal myoclonus

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30
Q

Palatal myoclonus association

A 
Vascular lesion
Multiple sclerosis
Aneurysm of the vertebral artery
Tumors
Lesions of the brain stem or cerebellum
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31
Q

Treatment of palatal myoclonus

A

None

Rarely: incision of the tensor tympani muscle of the middle ear

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32
Q

Causes of ET obstruction

A

Nasopharyngitis

Adenoiditis

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33
Q

Ear exam of ET obstruction caused by nasopharyngeal tumor

A

Fluid in the middle ear

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34
Q

Chronic unilateral serous otitis media

A

Nasopharyngeal carcinoma

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35
Q

Other causes of ET obstruction

A
  1. Foreign body (posterior pack for nasal epistaxis)
  2. Mechanical trauma (aggressive adenoidectomy–>scarring and closing of tube)
  3. Operative procedures that interfere with the tensor veli palatini
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36
Q

Results in ET dysfunction due to lack of anchorage of the tensor palatini muscle

A

Cleft palate deformity

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37
Q

Prevents the muscle from exerting sufficient contraction on the ET orifice to open it during swallowing–>inadequate ventilation of middle ear–>inflammation

A

Unrepaired cleft palate

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38
Q

Avoided procedure in patient with cleft palate

A

Adenoidectomy

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39
Q

Adenoidectomy in patients with cleft palate or submucous palate may produce

A
  1. Palatal dysfunction
  2. Nasality of voice
  3. Regurgitation of liquids into the nasopharynx
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40
Q

Damage to tissue caused by changes in barometric pressure which occur during diving or flying

A

Barotrauma

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41
Q

A decrease (expand) or increase (compress) in environmental pressure, a given enclosed volume of a gas

A

Boyle’s law

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42
Q

Most common site of barotrauma because of the complexity of ET function

A

Middle ear

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43
Q

Pressure difference between the environment and the middle ear space becomes to great, the cartilaginous portion of the ET will firmly collapse

A

About 90-100 mmHg

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44
Q

Sequence of injury occurs as the vacuum develops within the middle ear

A

TM is retracted inward (stretches the eardrum–>rupture of small vessels to produce injected appearance and hemorrhagic blebs within the drum)
As the pressure builds, small vessels within the middle ear mucosa also dilate and rupture–>hemotympanum–>occ will rupture the TM

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45
Q

Symptoms of middle ear barotrauma

A
  1. Pain
  2. Feeling of fullness
  3. Decreased hearing
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46
Q

Ear exam of middle ear barotrauma

A

Injected and may exhibit hemorrhagic blebs within the drum or blood behind the eardrum

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47
Q

Treatment of middle ear barotrauma

A
  1. Decongestants

2. Cessation of diving or flying (until the patient can equilibrate middle ear pressure again)

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48
Q

Most cases of middle ear barotrauma resolves within…

A

2-3 days

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49
Q

Severe cases of middle ear barotrauma resolves…

A

4-6 weeks

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50
Q

Pain in middle ear barotrauma indicates…

A

ET collapse

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51
Q

Antibiotics are given in middle ear barotrauma if..

A

Presence of perforation

Occurred in dirty water

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52
Q

Prevention of middle ear barotrauma

A

Avoiding flying or diving with colds

Using proper clearing technique

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53
Q

Symptoms of inner ear damage

A
  1. Persistent tinnitus
  2. Vertigo
  3. Sensorineural hearing loss
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54
Q

Brief episodes of vertigo that occur while ascending or descending…

A

Alternobaric vertigo

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55
Q

Congenital stenosis of the ear plus maxillofacial dysostoses

A

Treacher Collins syndrome

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56
Q

Common cause of conductive hearing loss in adults

A

Otosclerosis

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57
Q

Otosclerosis inheritance

A

Autosomal dominant

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58
Q

Disease of the bony labyrinth, area of otospongiosis (soft bone) forms, esp in front of and adjacent to the footplate–>fixation of the footplate

A

Otosclerosis

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59
Q

Patient usually complains of a hearing loss when a level of 40dB or greater is reached

A

Otosclerosis

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60
Q

Otosclerosis Rinne test

A

Negative

Bone conduction is heard louder than air conduction

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61
Q

TM appearance in otosclerosis

A

Normal or

Pink or orange discoloration due to vascular otospongiosis in the middle ear (positive Schwartze’s sign)

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62
Q

Management of otosclerosis

A

Surgical procedures offer an excellent chance for restoring hearing depending mainly on cochlear function
Complication (postoperative): sensorineural hearing loss

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63
Q

Symptoms of middle ear trauma

A
  1. Pain
  2. Bloody drainage
  3. Hearing impairment
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64
Q

Treated by protecting the ear from water and administering systemic antibiotics if there is pain and inflammtion

A

Clean, traumatic perforations

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65
Q

Heal spontaneously

A

Clean, uncomplicated perforations

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66
Q

Treated with antibiotic ear drops and systemic antibiotics

No attempt at closure is made until the infection resolves

A

Contaminated perforations

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67
Q

Painful and difficult to close by usual means

Heat cauterization of the adjacent tissues which occurs prevents spontaneous closure

A

Perforations caused by hot slag

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68
Q

Significant hearing loss (>25 dB) and vertigo

A

Injury to the ossicular chains

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69
Q

True otologic emergemcy

Immediate exploration of the middle ear and ossicular chain

A

Vertigo and hearing loss (trauma)

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70
Q

Sterile

A

Middle ear

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71
Q

Basic causative factor in acute otitis media

A

Obstruction of ET

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72
Q

Most acute otitis media infections are caused by…

A

Pyogenic bacteria

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73
Q

Most frequently recovered bacteria in AOM

A
  1. S. pneumoniae: all age group
  2. H. influenzae: under 5 years old
  3. Beta-hemolytic streptococci
74
Q

Classic symptoms of acute purulent otitis media

A
  1. Pain
  2. Fever
  3. Malaise
  4. Headache
  5. Anorexia
  6. Nausea and vomiting
75
Q

Ear exam in acute purulent otitis media

A
  1. TM is red and bulging
  2. Vessels over TM and malleus handle become injected and therefore more prominent
  3. Abscess of the middle ear
76
Q

All medications in acute purulent otitis media should be administered for at least…

A

10-14 days

77
Q

In acute purulent otitis media, patient was seen 2 days after initiating treatment, no evidence of resolution…

A

Myringotomy should be performed

78
Q

Otitis-prone child

A
  1. Male
  2. Under age 2
  3. Native American, white
  4. 1st episode usually under age 6 months
  5. S. pneumoniae episode
79
Q

Caused by transudation of plasma from the blood vessels

A

Serous otitis media

80
Q

Results from active secretion from glands and cysts in the lining of the middle ear cleft

A

Mucoid otitis media

81
Q

Major underlying factor in otitis media

A

ET dysfunction

82
Q

Other causative factors in otitis media

A
  1. Hypertrophy of the adenoids
  2. Chronic adenoiditis
  3. Cleft palate
  4. Tumors in the nasopharynx
  5. Barotrauma
  6. Inflammation (sinusitis, rhinitis)
  7. Radiation therapy
  8. Immunologic or metabolic deficiencies
83
Q

Most common cause of hearing loss in school-age children

A

Middle ear effusion

84
Q

Ear exam in serous otitis media

A

Drumhead immobility

Bubbles behind the TM

85
Q

Amber or yellow drumhead

A

Serous otitis media

86
Q

Duller and more opaque drumhead

A

Mucoid otitis media

87
Q

Medical treatment for serous and mucoid otitis media

A
  1. Antibiotics
  2. Antihistamine
  3. Decongestants
  4. ET tube ventilation exercises
  5. Allergic hyposensitization
88
Q

Medical management for mild serous otitis media is continued for a period of…

A

3 months

89
Q

Persistence of fluid is an indication for surgical correction

A
  1. Myringotomy incision
  2. Removal of fluid
  3. Insertion of a pressure equalization tube (act as a vent to allow air to enter the middle ear
90
Q

Indications to proceed myringotomy sooner

A
  1. Thinning of TM
  2. Deep retraction
  3. Significant hearing impairment
  4. Poor school performance
91
Q

Unilateral serous otitis media in an adult requires investigation of the…

A

Nasopharynx for tumor

92
Q

Ventilations tubes are left in place until spontaneously extruded usually within a period of…

A

6 months to 1 year

93
Q

Disadvantage of long-lasting tubes

A

Perforation of a perforation after extrusion

94
Q

Greatest disadvantage of ventilation tubes

A

Need to keep the middle ear dry

95
Q

Was of particular value in evaluating acute mastoiditis

Nearly direct lateral view

A

Law view

96
Q

Determine the position of the mastoid tegmen, sigmoid sinus and the general overall size of the mastoid

A

Law view

97
Q

Not only shows the structures seen in Law position

Permits visualization of the attic or epitympanum

A

Schuller view

98
Q

Angulation of the head 45 degrees
Demonstrates the region of antrum and the head of the malleus
Modification of the direction: demonstrates the incus and the area of epitympanum

A

Mayer view/position

99
Q

Similar to the modification of the Mayer position

Less angulation of the beam provides a better visualization of the ossicles and epitympanic recess

A

Owens view

100
Q

Modification of oblique view

Provides additional information about the structures in the middle ear

A

Chausse III projection

101
Q

View the long axis of the petrous pyramid to demonstrate the internal auditory canal, labyrinth and the antrum

A

Stenvers position

102
Q

Shows both petrous pyramids through the orbits, permitting direct comparison of the petrous pyramids and internal auditory canal on the same film

A

Towne view

103
Q

Structures of the middle ear (view)

A
  1. Standard Schuller
  2. Modified Mayer
  3. Chausse III view
104
Q

Possibility of an acoustic neuroma or abnormality in the petrous region or internal auditory canal (view)

A
  1. Towne
  2. Stenvers
  3. Transorbital views
105
Q

Degree of mastoid cell development

A
  1. Pneumatic
  2. Diploic
  3. Sclerotic
  4. Undeveloped
106
Q

Well developed mastoid air spaces

A

Pneumatic

107
Q

Pneumatization of the mastoid is disturbed by some infectious process–>only a few groups of large cells present

A

Diploic

108
Q

Dense bone in the region of the mastoid, results from osteoblastic activity stimulated by repeated or chronic infection

A

Sclerotic

109
Q

Preferred method of diagnosing middle ear, mastoid and inner ear abnormalities

A

CT scan

110
Q

Signs and symptoms of Acute mastoiditis

A
  1. Fever
  2. Pain
  3. Hearing loss
  4. Bulging TM
  5. Sagging posterior canal walk
  6. Postauricular swelling
  7. Mastoid tenderness (posterior and slightly superior to the level of the external canal–Macewen’s triangle)
  8. Radiographic findings (opacification of the mastoid air cells by fluid and interruption of the normal trabeculations of the cells)
111
Q

Initial treatment of Acute mastoiditis

A
  1. Wide myringotomy
  2. Culture
  3. IV antibiotics
112
Q

Xray of Acute mastoiditis shows loss of trabecular pattern (progression of disease)

A

Urgent and complete mastoidectomy

113
Q

Complications of Acute mastoiditis

A
  1. Petrositis
  2. Labyrinthitis
  3. Meningitis
  4. Brain abscess
114
Q

Chronic otitis media is accompanied by…

A

Chronic mastoiditis

115
Q

Active chronic infection of the middle ear and mastoid refers…

A

Presence of infection with drainage from the ear or otorrhea resulting from underlying pathologic changes such as cholesteatoma (granulation tissue)

116
Q

Inactive chronic infection of middle ear and mastoid refers to…

A

Sequelae from a previously active infection that has burnt out, otorrhea is absent

117
Q

Inactive chronic otitis media changes

A
  1. Tympanosclerosis
  2. Loss of osicles
  3. Fixation or disruption of ossicles from previous infection
118
Q

Thin, watery discharge and a history of painless onset

A

TB

119
Q

Thin, fetid discharge with blood

A

Malignancy

120
Q

Uncommon symptom in chronic middle ear suppuration

A

Pain

121
Q

Pain in chronic middle ear suppuration

A

Complication is impending due to blockage of secretion, exposure of dura or lateral sinus wall or imminent brain abscess formation

122
Q

Vertigo in chronic middle ear suppuration

A

Presence of fistula (erosion of the bony labyrinth, most commonly the horizontal semicircular canal)

123
Q

Requires application of both positive and negative pressure to the TM and thereby across the middle ear space

A

Fistula test

124
Q

TM perforation in chronic middle ear suppuration may be..

A

Marginal or central

125
Q

Perforation in marginal or in the attic

A

Cholesteatoma should be suspected

126
Q

Multiple perforations in the TM

A

Possible TB infection of the middle ear

127
Q

Bone erosion, esp in the area of the attic (scutum missing)

A

Cholesteatoma

128
Q

Conservative treatment for COM

A

1Keep water out of the ear and cleansing with careful spot suctioning (alcohol or hydrogen peroxide)

129
Q

Surgery is planned in COM

A

Systemic antibiotic treatment for several weeks prior to surgery may reduce or eliminate active drainage and enhance surgical results

130
Q

First evident through perforation in the posterior superior quadrant of the TM

A

Cholesteatoma

131
Q

Keratinizing squamous epithelium that becomes entrapped in the middle ear space and mastoid

A

Cholesteatoma

132
Q

Occurs secondarily to invasion of epithelial cells from the adjacent EAC through the attic into the mastoid

A

Cholesteatoma

133
Q

Can cause osseous destruction and severe changes throughout the middle ear and mastoid
Can appear in an immature (soft) and mature (fibrous) form

A

Granulation tissue

134
Q

Develops as a blind epithelium-lined sac with a small bottleneck opening
Gradually expands eroding the surrounding bone

A

Cholesteatoma

135
Q

Primary purpose of surgery: COM

A

Removal of disease and achieved proper healing result

136
Q

Eradicate infected tissue, creating a safe, dry ear

A

Mastoidectomy

137
Q

Preservation and restoration of hearing

A

Tympanoplasty

138
Q

Type of hearing loss in COM

A

Conductive hearing loss

TM is intact, middle ears contains air, disruption of ossicular chain

139
Q

Type of hearing loss in AOM and COM

A

Sensorineural deafness

140
Q

The nerve is affected by purulent material directly in contact with the nerve

A

Facial nerve paralysis (AOM)

141
Q

Facial nerve paralysis treatment (AOM)

A
  1. Immediate wide myringotomy
  2. Obtain culture
  3. IV antibiotics
142
Q

Granulation tissue or cholesteatoma adjacent to the nerve releases toxic products causes pressure

A

Facial paralysis (COM)

143
Q

May result in destruction of the vestibular labyrinth

A

COM esp with cholesteatoma

144
Q

Creating a negative and then a positive pressure against the middle ear and examining the patient for the development of vertigo and associated nystagmus

A

Fistula test

145
Q

Result from extension into a fistula, infection that has invaded the round window, or meningitis resulting from otitis media

A

Suppurative labyrinthitis

146
Q

2 forms of labyrinthitis

A
  1. Serous: chemical toxin cause dysfunction

2. Suppurative: actual pus invades the inner ear

147
Q

Becomes evident when a weakness of the 6th CN occurs in a patient with OM

A

Petrositis

148
Q
  1. Retro-orbital pain
  2. 6th nerve paralysis
  3. Supportive otitis media
A

Gradenigo’s syndrome

149
Q

Pain in extradural complications of COM is due to

A

Irritation of 5th CN

150
Q

Petrositis occurs in individuals with…

A

Pneumatized petrous apetic cells

151
Q

Infectious invasion of the sigmoid sinus as it courses through the mastoid

A

Lateral sinus thrombophlebitis

152
Q

First sign of lateral sinus thrombophlebitis

A

Fever

153
Q

Pain is isolated to the area of the mastoid emissary vessels, which can become red and tender

A

Griesinger’s sign

154
Q

Treatment of Lateral sinus thrombophlebitis

A
  1. Removing the focus of infection in the infected mastoid cells, necrotic lateral sinus plate or an infected and often necrotic lateral wall sinus
  2. Ligation of the internal jugular vein to prevent escape of the infected emboli into the lung and to other part of the body
155
Q

A collection of pus between the dura and the bone overlying either the mastoid cavity or the middle ear

A

Extradural abscess

156
Q

Most frequently associated with chronic suppurative otitis media with granulation tissue or cholesteatoma with erosion of the tegmen

A

Extradural abscess

157
Q

Symptoms of extradural abscess

A
  1. Pulsatile, purulent discharge
  2. Severe earache
  3. Ipsilateral headache
  4. Low grade fever
  5. Develops during episode of acute otitis media
158
Q

May develop as direct extension of an extradural abscess or by extension of thrombophlebitis through the venous channels

A

Subdural abscess

159
Q

Symptoms of subdural abscess

A
  1. Develops from COM
  2. Headache
  3. Fever, restlessness
  4. Focal seizures
  5. Difficulty speaking
  6. Coma
  7. CSF may be normal, no organism
160
Q

Most common intracranial complication from suppurative otitis media

A

Meningitis

161
Q

Two types of meningitis

A
  1. Localized: reveal bacterial organism

2. Generalized: viable microorganisms cannot be recovered from the spinal fluid

162
Q

Clinical features of Meningitis

A
  1. Neck stiffness
  2. Fever
  3. Nausea and vomiting
  4. Headache
163
Q

Symptoms of cerebellar abscess

A
  1. Ataxia
  2. Dysdiadochokinesia
  3. Intention tremor
  4. Past pointing
164
Q

Symptoms of temporal lobe abscess

A
  1. Focal seizure or aphasia
  2. Toxicity
  3. Headache
  4. Fever
  5. Vomiting
  6. Lethargic state
165
Q

Consists of an increase in intracranial pressure with normal CSF findings except for a marked increase in pressure

A

Otitic hydrocephalus

166
Q

Symptoms of Otitic hydrocephalus

A
  1. Intense persistent headache
  2. Diplopia
  3. Blurring of vision
  4. Nausea and vomiting
167
Q

Incision of the TM, either to provide ventilation to the middle ear, to permit drainage of middle ear fluid or to obtain cultures

A

Myringotomy

168
Q

Myringotomy are made in the…

A

Anterior inferior or posterior inferior quadrants (to avoid injury to the ossicular chain)

169
Q

Current indications for myringotomy in AOM

A
  1. Persistent pain after 48 hours of antibiotic treatment
  2. Potential development of complications
  3. Development of otitis media in an immunosuppressed patient
  4. Development of otitis media while on a systemic antibiotic
170
Q

One of the most common indications for myringotomy today

A

Persistent chronic serous otitis media that has failed medical management

171
Q

Current indications for ventilation tube placement at the time of myringotomy

A
  1. Recurrent episodes of AOM in spite of continuous prophylactic antibiotics
  2. Persistent serous otitis media that has not responded to conservative management
  3. Persistent negative middle ear pressure and resultant atelectasis of the TM, esp retraction into the posterior superior quadrant
  4. Development of persistent negative middle ear pressure in patients undergoing hyperbaric oxygen treatment
172
Q

Primary tumors

A
  1. Glomus jugulare or glomus tympanicum
173
Q

Originates from glomus bodies that relate to the jugular bulb in the floor of the middle ear, or they can originate from nerve distributions elsewhere in the middle ear

A

Glommus jugulare or glomus tympanicum tumor

174
Q

Can cause hearing loss and a sense of fullness

May extend to the base of the skull, causing CN and intracranial complications

A

Glomus jugulare

175
Q

Highly vascular tumor and can often be seen as a bulging purplish mass in the floor of the middle ear

A

Glomus jugulare

176
Q

Blanching that occurs by pressure from a pneumatic otoscope

A

Brown’s sign

177
Q

Diagnostic tests for glomus jugulare

A
  1. CT scan with contrast
  2. Angiography
  3. Retrograde jugular venography
178
Q

Preferred modality of treatment for glomus jugulare

A

Surgery

If extensive: surgery + radiotherapy

179
Q

Most common malignant tumors of the middle ear in adults are…

A
  1. Adenoid cystic carcinoma

2. Adenocarcinoma

180
Q

Most common malignancy to extend from the external canal to the middle ear

A

Squamous cell carcinoma

Boies (27 decks)

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