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HEENOT > Clin Med - Ear > Flashcards

Clin Med - Ear Flashcards

1
Q

What bacteria cause acute otitis media

A

S. pneumonia
H. Influenza
Moraxella catarrhalis

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2
Q

non bacterial causes of acute otitis media

A
  • ETD

- Viral URI (negative pressure pulls nasopharyngeal fluid into middle ear)

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3
Q

Risk factors for AOM (8)

A
  • Craniofacial abnormalities
  • Nasal allergies
  • Recurrent URI
  • Daycare attendance
  • Smoking
  • Immunologic disorders
  • Reflux
  • Adenoid hypertrophy
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4
Q

S/S AOM (11)

A
  • Abrupt onset
  • Typically in URI onset
  • Otalgia (tugging, rubbing, irritability, sleep disruption, decreased appetite
  • Fever
  • Aural fullness
  • Tinnitus
  • Hearing loss
  • Fluid/Pus behind TM
  • Bulging TM, loss of TM landmarks
  • Hyperemic/thickened TM
  • Purulent drainage in EAC not related to OE
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5
Q

AOM vs. OE painful to pull pinna

A

YES in OE

NO in AOM

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6
Q

non abx treatment of AOM

A
  • tylenol or acetaminophen
  • warm compress
  • NO topical numbing drops
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7
Q

When use Abx in AOM

A
  • Severe in >6 mo
  • non-severe unilateral 6-23 mo
  • do not use prophylactically
  • *Ok to not use if have a f/u plan with parents
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8
Q

Abx for AOM

A
  • flow chart full details
  • Amoxicillin if simple
  • Augmentin ES if purulent conjunctivitis or abx in 30 days
  • Augmentin ES if hx AOM unresponsive to amox.
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9
Q

AOM monitoring parameters

A
  • 3 weeks still have fluid then f/u 1 month

- still fluid after 3 weeks and 1 month, refer to ENT

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10
Q

Mastoiditis Def

A
  • Middle ear infection spreads to mastoid resulting in osteitis of the mastoid air cells
  • May develop into purulent infection and breakdown of the bony septa and coalescence of air cells
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11
Q

SS Mastoiditis

A
  • Sick individuals
  • Mastoid tenderness
  • Concurrent AOM
  • Edema over the mastoid
  • Fever
  • Adenopathy
  • Protrusion of pinna
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12
Q

Workup Mastoiditis

A
  • Physical exam

- CT temporal bone reveals coalescence or loss of mastoid air cells, presence of fluid

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13
Q

Mastoiditis treatment

A
  • IV abx
  • Tube placement
  • Possible mastoid ectomy if recalcitrant
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14
Q

Cerumen impaction S/S

A
  • ear discomfort
  • aural fullness
  • itching
  • hearing loss
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15
Q

Cerumen impaction treatment

A
  • Irrigation
  • Curette with direct visualization
  • OTC ear wax softening kits or mineral oil
  • NO ear candling
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16
Q

When refer for cerumen impaction

A
  • can’t get out in office
  • unsure about TM status
  • prior sx
  • prior radiation
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17
Q

When should not irrigate ear

A
  • if have tubes
  • known perforation
  • previous otologic
  • previous sx
  • head radiation hx
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18
Q

Keratosis Obliterans

  • definition
  • danger
A

“canal cholesteatoma”

  • Accumulation of cerumen and epithelial debris puts pressure on EAC skin
  • Causes erosion, bony exposure, bone remodeling
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19
Q

Keratosis Obliterans

- frequent location

A

junction of bone and cartilage in EA

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20
Q

Keratosis Obliterans

- S/S

A
  • Pain

- Chronically draining ear

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21
Q

Keratosis obliterans

treatment

A
  • Routine debridement

- Mineral oil drops to soften wax

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22
Q

Exostosis

  • def,
  • cause
A
  • bony outcropping distally in the EAC
  • benign
  • usually from cold water exposure
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23
Q

Exostosis

- s/s

A
  • Hearing loss if traps wax and obstructs canal

- Can cause otitis externa

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24
Q

Exostosis treatment

A

possible surgical removal

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25
Q

Auricular hematoma

  • def
  • cause
A

“Cauliflower ear”

  • Compression or sheering trauma to pinna
  • Hematoma between perichondrium and cartilage
  • Remodeling of cart. over time to form classic appearance

(cart. gets blood supply from perichon.)

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26
Q

Auricular hematoma

tx

A
  • Drain
  • Bolster dressing (dental roll under helix)
  • Through and through suture, remove 2 wks

+/- abx

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27
Q

Perichondritis

def

A

infection of auricular cartilage

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28
Q

Perichondritis

caused by what orgs

A
  • Pseduomonas aeruginosa
  • S. aureus
  • Strep
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29
Q

Perichondritis

  • cause (5)
  • risk if untreated
A
  • Undertreated OE,
  • cellulitis
  • trauma
  • exposed cartilage
  • Risk: cauliflower ear d/t cartilage remodeling
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30
Q

Perichondritis tx

A

Treat aggressively w/ fluoroquinolones

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31
Q

Microtia/Atresia

def

A

Congenital malformation of the pinna, often involving the canal and middle ear; can have associated CHL
- small ear

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32
Q

Microtia/Atresia

Grades

A
  • Grade I: small appearing ear, most normal features present
  • Grade II: helix not fully developed, lobule absent, minimal cartilage present
  • Grade III: disorganized tissue, nubbin, typically no canal
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33
Q

Anotia

A

no external ear features

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34
Q

SS microtia/atresia

A

Usually associated conductive or mixed hearing loss d/t ossicular malformation

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35
Q

Treatment for microtia/atresia

A
  • Reconstructive surgery w/ plastic surgeon for external appearance, and otologist for ossicular reconstruction and canaloplasty
  • Hearing can be rehabilitated w/ hearing aids or osseointegrated bone conduction devices
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36
Q

Foreign body in ear treatment

A
  • If alive, drown it w/ normal saline, mineral oil, lidocaine after verifying TM status
  • Do not remove unless it’s simple to extract
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37
Q

Acute otitis externa (AOE)

organisms (4)

A
  • Pseudomonas aeruginosa
  • staph aurea
  • polymicrobial
    gram negative pathogens 
  • 10% of the time can be fungal – aspergillis
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38
Q

AOE definition

A

Diffuse inflammation of the external ear canal which may involve the pinna or the TM. Cellulitis of the ear canal skin and dermis.

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39
Q

malignant AOE

A

not a malignancy but potentially life threatening infection of the EAC, usually in elderly diabetics or immunocompromised individuals from previous OE that did not respond to tx

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40
Q

SS AOE

A
  • Significant pain w/ manipulation of the pinna and tragus. Pain will often appear out of proportion to exam. AOM will not have this sign
  • Purulent drainage. 
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41
Q

TX AOE 1st step

A

1st: clean out ear canal - can irrigate w/ 1:1 dilution of hydrogen peroxide 

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42
Q

AOE and oral abx

A

not recommended (board) - UNLESS pt is immunocompromised or infection is severe and extends beyond ear canal

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43
Q

mild AOE treatment

A

acetic acid/hydrocortisone - 7 days

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44
Q

Moderate AOE treatment

A
  • topical fluoroquinolone: Cipro HC, Ciprodex, or cortisporin otic (contains neomycin)
  • 7 days
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45
Q

Severe AOE not beyond EAC treatment

A

same topical tx as moderate – 7-14 days plus wick placement

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46
Q

Severe AOE beyond EAC treatment

A

same topical tx as moderate, wick tx,

AND oral fluoroquinolones 7-10 days

47
Q

Monitoring parameters AOE

A
  • adherence

- response to therapy for infection and pain control

48
Q

Eustachian tube dysfunction

risk factors

A
  • Craniofacial abnormality (syndromes, cleft palate, VPI)
  • infancy
  • allergies
  • URI
  • adenoid hypertrophy
  • smoking
49
Q

Eustachian tube dysfunction

  • purpose of ET
  • what does dysfunction cause
A
  • to maintain neutral pressure in the middle ear to keep the TM suspended in normal anatomic position
  • dysfunction is the root cause of most middle ear pathologies
50
Q

Acoustic neuroma def

A

mild intermittent balance complaints

51
Q

Acoustic neuroma ss

A
  • One-sided hearing loss - ringing in the ear
52
Q

Acoustic neuroma diagnostic test

A

MRI

53
Q

Meniere disease

s/s

A
  • Recurrent, spontaneous spells of vertigo.

- Accompanied by: hearing loss, tinnitus, aural fullness

54
Q

Meniere disease meds

A
  • vestibular suppressants
  • Anti-nausea meds
  • Low salt diet
  • ## Diuretics
55
Q

Meniere disease interventions

A
  • Endolymphatic sac decompression
  • Labyrinthectomy
  • Vestibular nerve section
56
Q

Tinnitus causes

A
  • Ototxicity
  • Middle Ear
  • Pathology
57
Q

Tinnitus s/s

A

ringing in ears

58
Q

Tinnitus tx

A

no definitive treatment

  • counseling
  • meds for depression
59
Q

Vestibular Neuritis

def

A

Acute vestibular crisis with gradual improvement

- rare

60
Q

Vestibular neuritis

- cause

A

virus attacks vestibular nerve

61
Q

Vestibular neuritis S/S

A
  • vertigo lasting up to 72 hours
  • Vertigo may fluctuate during this period
  • no auditory sx
  • Vertigo while motionless
  • Failure to return rapidly to normal
62
Q

Vestibular neuritis treatment

A

-high dose steroids

63
Q

Vestibular neuritis

outcome

A
  • complete recovery expected

- mild position or motion-provoked vertigo may persist

64
Q

Viral Endolymphatic Labyrinthitis

def

A

acute vestibular crisis

65
Q

Viral Endolymphatic Labyrinthitis s/s

A
  • Hx similar to vestibular neuritis (sudden onset long lasting vertigo)
  • WITH sudden sensorineural hearing loss
66
Q

Viral Endolymphatic Labyrinthitis outcome

A

hearing loss may recover or persist

67
Q

Benign Paroxysmal Positional Vertigo (BPPV) cause

A

Otolith displacement, free within posterior canal not in utricle or saccule

68
Q

Benign Paroxysmal Positional Vertigo (BPPV) S/S

A
  • short episodes of vertigo
  • provoked by position (lie down, roll over, look up)
  • nystamus as long as rocks are in semicircular canal
69
Q

Benign Paroxysmal Positional Vertigo (BPPV) dx test

A

Hallpike maneuver

70
Q

Benign Paroxysmal Positional Vertigo (BPPV) treatment

A

Epley’s maneuver

71
Q

how to induce nystagmus

A

Cold or hot water

72
Q

Nystagmus induction with water, temp rule

A

COWS

  • cold slow phase to opposite side ear
  • warm slow phase to the same side ear
73
Q

Two very common GI s/s with vestibular issue

A

nausea and vomiting

hardwired to nausea center in brain

74
Q

6 ss of vestibular loss

A
  • tonic vestibular imbalance
  • nystagmus
  • nausea
  • vertigo
  • fixation suppression
  • skew deviation
75
Q

What is the most important way to dx cause of vertigo?

A

H & P!!!

  • ROS
  • PMH
  • MEDICATIONS
  • “define dizziness”
76
Q

What happens when control MA that is associated with vertigo?

A

usually controls dizziness and vertigo!

77
Q

4 H&P tests when dealing with dizzy/vertigo

A
  • neurologic exam
  • Gait
  • Romberg (stand straight and close eyes)
  • Fukuda stepping tests (Romberg with steps in place)
78
Q

What specialist can usually really improve balance and vestibular problems?

A

Physical therapy - train the body to adapt and compensate

79
Q

What type of disorder is often associated with vertigo?

A

psych disorders! if treat psych, often vertigo is gone

80
Q

how does facial nerve exit the skull?

A

stylomastoid foramen

81
Q

definition of vertigo

A
  • illusion of movement

- asymmetric involvement of vestibular pathway, peripheral or central

82
Q

Three inputs to balance

A
  1. visual
  2. proprioception
  3. vestibular system
83
Q

If pt complains of dizzy AND has nystagmus, what should have high suspicion of?

A

inner ear problem

84
Q

How does the horizontal semicircular canal attach ?

A

to the vestibule alone

- has non-ampulated and ampulated ends

85
Q

How do the posterior and superior semicircular canals attach?

A

share a common joining point - the common crus

86
Q

what is the number one sign of an ear emergency?

A

one sided sudden hearing loss

- can be conductive or neural

87
Q

how would you first treat sudden, one sided hearing loss?

A

high dose prednisone taper

- probably from a virus

88
Q

When is tinnitus a worry

A
  • fluctuating
  • pulsatile
  • asymmetric
89
Q

What CN go through internal auditor canal

A

5, 7, 9, 10

90
Q

what CN go across middle ear promontory

A

9, 10

91
Q

how tell difference between vestibular neuritis and viral labyrinthitis

A

viral labyrinthitis has hearing loss

92
Q

OM w/ effusion

A

non infected fluid w/i the middle ear space

93
Q

Cause of OM w/ effusion

A

result of ETD causing transudative collection of fluid or remnant, sterile fluid from treated AOM

94
Q

sx of OM w/ effusion

A

Clear to amber to mucoid colored fluid, a/f meniscus, decreased mobility of TM, patients c/o decreased hearing, aural fullness, pressure, dizziness, off balance, otalgia

95
Q

tx of OM w/ effusion

A

Majority of OME will resolve w/in 3 months (90%) regardless of tx

  • Nasal steroids, antihistamines, mucolytic agents, abx have not been shown to resolve effusions any faster! (However, if they have underlying allergic rhinitis treat accordingly)
  • If persist after 3 mo, consider placement of PET
96
Q

Cause of TM changes

A
  • Atrophy d/t pushing ear drum out w/ ear infection and pulling it in w/ resolve infection over and over
  • Tympanosclerosis results from inflammation of the layers of the drum usually during infection and calcium deposition w/ the layers making the drum stiff and rock hard
97
Q

causes of TM peforation

A
  • R/t chronic ETD, AOM, multiple PET’s, tympanosclerosis, TM atrophy
  • Sometimes r/t trauma (ie. Slap injury/pressure concussion, slag injury, direct puncture)
98
Q

TM perf classifications

A

Classified as central or marginal

  • Marginal extends to annulus, more susceptible to cholesteatoma formation
  • Central are away from annulus
99
Q

Sx of TM changes

A

Usually doesn’t contribute to hearing loss

  • Process can extend to ossicles resulting in CHL
  • Atrophy, thinning of the drum, causes the drum to be hypercompliant (floppy)
  • Can predispose to retraction of the TM and subsequent cholesteatoma formation
  • Can lead to perf w/ infection or tube placement
100
Q

Sx of TM perf

A

Location, size of perf will determine amount of hearing loss

  • Ant/Inf: <10%, low likelihood of hearing loss
  • Post/Sup: >25%, increased likelihood of HL
101
Q

Tx of TM perf

A

Not all perfs need to be repaired but all perfs need to be evaluated by an ENT

102
Q

Barotrauma causes

A

Ambient pressure changes (flying, driving) causes a pressure differential in the middle ear and mastoid

103
Q

Sx of barotraums

A

Otalgia, ETD, middle ear hemorrhage, TM perf

  • Auricular pain & fullness/hearing loss that persists after the eitologic event
  • Inner ear decompression sickness (Caisson disease, “The Bends”)- rapid ascension while diving causes nitrogen to form small gas emboli, which can enter cerebral circulation leading to blindness, deafness, paralysis, or death)
104
Q

Cholesteatoma

A

“Skin in the wrong place”

-Accumulation of keratinizing stratified epithelium within the middle ear or temporal bone

105
Q

cause of congenital cholesteatoma

A

occurs from embryonic epithelial tissue within the temporal bone

106
Q

cause of aquired cholesteatoma

A

forms in a retraction pocket as squamous epithelium begins to collect and becomes trapped. Can form after healing of a TM perf, or an invasion of the middle ear by epithelium that fails to respect the borders of the perf, or temporal-bone fx, bad head injury

107
Q

Sx of cholesteatoma

A

Painless otorrhea (brown/yellow discharge w/ strong odor), conductive hearing loss, “pearly white” mass in middle ear space or within a retraction pocket, or a combo of squamous debris and wax

108
Q

How does a congenital cholesteatoma generally present?

A

as white mass in the anterosuperior middle ear behind an intact drum

109
Q

Complications of cholesteatoma

A

-Ossicular erosion with subsequent CHL. Tegmen, labyrinth or facial nerve dehiscence

110
Q

Tx of cholesteatoma

A

surgical excision of debris/cholesteatoma

111
Q

glomus tumor

A

Slow growing, benign tumor of the chemoreceptive cells along the parasympathetic nerves in the skull, base, neck and chest (paraganglimoa, chemodectoma)

  • Most commonly benign tumor of the temporal bone
  • Locally destructive
112
Q

4 types of glomus tumors

A
  1. Carotid body (most common)
  2. Glomus tympanicum (arise from the promontory along Jaconson’s nerve, back wall of middle ear)
  3. Glomus jugulare (arise from the area of the jugular formane, floor of the middle ear)
  4. Glomus vagale
113
Q

sx of glomus tumor

A

Pulsatile tinnitus, red mass in the middle ear space, aural fullness, conductive hearing loss, crainal nerve palsies, otalgia, ear drainage

114
Q

tx of glomus tumor

A

Surgical excision or XRT (gamma knife)

HEENOT (13 decks)

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