Clinmed Ear and Sinus Flashcards by Jordan Haskins

Otitis Media

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Treatment for Otitis Media

Amox OR

Erythromycin + Sulfonamide

AND PAIN MANAGE THEM OR THEY WILL COME BACK!

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When would you culture otitis media

recurrent/relapsing episodes after abx tx.

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Chronic Otitis Media

(notice the sclerosis and scarred perf)

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Treatment for an infected chronic otitis media

NO DROPS (could get in the perf)

Oral abx (cipro), remove debris, surg consult

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Mastoiditis

(postauricular pain with erythema)

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Treament for mastoiditis

IV Abx, mastoidectomy

(they are febrile as well)

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Otitis Externa

(otalgia, pruritis, discharge, WITH A NORMAL TM)

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What type of bugs infect otitis externa?

Gram - rods (pseuo, proteus, also fungi)

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Otitis External…has a normal TM, and is treated with what?

Adult: Cipro

Kids: Non-floroquinolones

Ear wick to get the drops in

(can also give cipro with a steroid in it for the swelling CIPRODEX or CIPRO HC)

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Cerumen Impaction

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When do you think about when trying to remove cerumen?

Only remove what you see (no blind sweeps)

NO irrigation if perforated

IF NOT RESOLVED: ENT consult

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What condition results in eustachian tube dysfunction, with otalgia

Barotrauma

(Tx: autoinflation…pop your ears

oral decongestants before flying or diving)

AFRIN for eustachian congestion? Careful with chronic use of afrin for rebound congestions.

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What kind of things cause this?

TM Perforation

Causes: Spontaneous, trauma, otitis media (photo), acoustic trauma.

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TM perf’s heal spontaneously, but if persistent and associated with hearing loss > 3 months, think….

ossicle damage

(May need TM os Ossicle repair)

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Horizontal nystagmus indicates what type of vertigo

peripheral

(up/down nystagmus for central)

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what is the biggest different in the patients history between peripheral and central vertigo?

The time of onset

peripheral: acute/sudden/tiinnitus/hearing loss
central: slow/progressibe/no hearing changes

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what is the maneuver to check for nystagmus and BPV?

Dix-Hallpike Maneuver

(same as epley maneuver)

This condition shows an acute onset of severe vertigo with tinnitus lasting DAYS to WEEKS!

Labyrinthitis

GIVE MECLIZINE

If infectious s/s give abx

This syndrome is similar to labyrnthitis but it is REOCCURING, and EPISODIC from 20 minutes to hours.

Meniere’s Syndrome

(Too much endolymph, needs diuretics and a low salt diet)

(check for siphyllis or head trauma)

This type of hearing loss comes from: Lesions on CN8, acoustic neuralgia, multiple sclerosis, acoustic neuroma, and auditory neuropathy

Neural hearing loss

This type of hearing loss comes from cerumen, middle ear effusion, otosclerosis, or ossicular disruption

Conductive Hearing Loss

This type of hearing loss comes from noise exposure, deterioration of cochlea, systemic diseases, head trauma, etc.

Sensory Hearing Loss

(IT IS NOT CORRECTABLE)

This paitient condition shows red itchy, watery eyes, sneezing and congestion with rhinorrhea, itchy/sore throat with PND, cough.

Allergic Rhinitis

Chronic allergic rhinitis may show what on exam?

Nasal polyps

In the elderly, a differential diagnosis may be what?

Vasomotor rhinitis Increased Vidian Nerve sensetivity (Warm/cold air, odor/scent, particulate)

Tx for Allergic Rhinitis

PO/IN antihistamines IN steroids Avoid allergen exposure

What is the...? 1. Red arrow pointing to? 2. Blue arrow pointing to?

1. Sphenopalatine Artery (20% of bleeds) 2. Kiesselbach's Plexus (80% of bleeds)

First, second, and third line tx for epistaxis?

1. Direct pressure 2. Afrin (vasoconstrictor) 3. Nasal packing or tamponade

What are you concerned about with long term use of nasal packing for epistaxis?

Toxic shock | (give prophylactic antibiotics)

In chronic epistaxis what should you consider about the patient?

Coagulative meds, bleeding disorders, hypertension, trauma, or septal deviation

This persons unilateral parotid gland (or submandibular) swelling is called?

Sialadenitis (notice swelling extends beyond the jawline...R/O dental abcess)

Sialadenitis usually presents with acute swelling and pain post prandial, there may be pus. What organism is frequently responsible for this infection?

Staph

How is the dx usually made?

Palpating for a stone/obstruction near a duct. REFER TO OTOLARYNGO for treatment

What is this condition?

Sailolithiasis (acute painfully swollen submanidublar duct from a calculi)

What is the name of the obstructed duct in the upper lateral aspect of the roof of the mouth in Sailolithiasis?

Whartons Duct Again, palpate for a stone, and refer to ENT

This condition presents with acute onset of purulent yellow-green discharge from the nose, with sinus pressure and pain.

Acute Bacterial SInusitis (cannot R/O viral if symptoms \< 10 days)

Acute bacterial Sinusitis... 1. typically lasts for how many weeks 2. what sinus is commonly affected the most?

1. 1-4 weeks 2. maxillary sinus (ethmoid sinus can accompany max sinus infection)

What is the cause of acute bacterial sinusitis?

an obstructed sinus pore that creates mucous accumulation and secondary infection

What are the two major microbes in sinusitis?

S pneumonia & H Influenza

What % of people show recovery without the use of antibiotics in sinusitis?

80% | (just need motrin and decongestants)

When would you give antibiotics for acute sinusitis?

Fever, facial pain, and swelling

If you HAVE to give an antibiotic for acute sinusitis, what are the..... 1. First Line Treatments 2. Second Line Treatments

First Line: Amox or Doxy Second Line: Amox/Clavulanate (For pen allergics, Levo is the best choice, or go with the second line b/c it has the clavulanate in it)