Common Ear Disorders - Brown Flashcards
Identify the condition and describe the management:
pt is a rugby player and recieved a blow to the ear, he has an accumulation of blood in the subperichondrial space
Auricular Hematoma -
aka cauliflower ear
complications: cartilaginous necrosis, permanent disfigurment
tx: within 7 days, surgical evacuation refer to ENT
Identify the condition and describe the management:
pt’s ear appears pale and cyanotic
pt was sledding with some friends and didn’t wear a hat
upon rewarming pt reports pain; erythema and blisters are noted
Auricular Frostbite
due to prolonged exposure to cold, vasoconstriction, dehydration and freezing of auricular tissue
early on reversible, increased time necorsis results
tx: rapid rewarming, refer to ENT
Identify the condition and describe the management:
pt complains of otalagia, aural fullness, pruritus and tenderness upon palpation
otoscopic exam shows:
Otitis Externa
Staph aureus and Pseudomonas aeruginosa
pathogenesis: heat, humidity, maceration result in edema and occlusion of apopliosebaceous units
other findings: can also have otorrhea and occlusion of EAC
management:
- clean EAC - irrigation, enhances drop penetration
- treat inflamamtion and infection -
- acidifying agents, antiseptics, topical steroids and antibiotics (Cipro HC, Corticosporin, Tobrdex, Pred-G)
- systemic antibiotics - quinolones
- control pain - oral analgesics, oral anti-inflammatories
- culture in severe cases
- avoid promoting factors
* keep ear dry during recovery
follow up: 1-2 weeks, should improve 36-48 hours
Describe the causes, managment, and complications of a perforated Tympanic Membrane.
Causes:
- trauma
- barotrauma
- AOM
Management:
- protect from moisture
- small perforations can heal on own
- surgery for larger perforations
Complications:
- can have hearing loss depending on the location of perforation
- cholesteatoma
- chronic perforation
Eustachian Tube Dysfunction
causes, symtpoms, treatment
causes:
- URI
- allergies
- inflammatory causes
symptoms:
- aural fullness
- fluctuating hearing
- discomfort
treatment:
- meds
- autoinflation techniques
Barotrauma
causes, treatment
Causes
- poor eustachain tube function
- flying, driving, abrupt altitude changes
Treatment
- preventative medications
- autoinflation
- myringotomy
Describe the complications of Acute Otitis Media:
Extracranial
- acute mastoiditis
- labyrinthitis
- petrositis
- CN VII paresis or paralysis
- cholesteatoma
- perforation & tympanosclerosis
Intracranial
- meningitis
- epidural abscess
- subdural abscess
- brain abscess
- otitic hydrochephalus
- sigmoid sinus thrombosis
Identify the condition and describe the management:
pt was seen last week for AOM
pt presents with fever 38 C, postauricular pain and erythema
Mastoiditis
cause: inadequately treated otitis
management:
- CT scan
- admit and treat aggressively
- surgery may be required
Identify the condition and describe the management:
pt was seen last week for AOM
pt is lethargic, presents with a fever, headache and nausea
ophthalmoscopic examination shows papilledema
Sigmoid Sinus Thrombosis
septic thrombophlebitis of sigmoid sinus
diagnosis: MR venography
tx: IV antibiotics, surgical debridement
Identify the condition and describe the management:
pt complains of tinnitus, hearing loss and purulent otorrhea
otoscopic exam shows TM retraction with a small perforation, purulent otorrhea, some ossicle erosion
Cholesteatoma
pathophysiology: chronic negative middle ear pressure leads to retraction of TM, disrupting migratory pattern of squamous epithelium resulting in the accumulation of keratin debris - cholesteatoma sac
diagnosis: imaging can help but is not definitive
managment:
- non-surgical: otopical antibiotics/steroids
- pseudomonas, strep, staph, proteus
- surgical: removal, high rate of recurrence, yearly follow up
Indications for Cerumen Removal
- hearing loss
- poorly functioning hearing aid
- ear pain
- ear fullness
- unexplained fever
- unexplained facial paralysis
- unexplained dizziness
Complications of Cerumen Removal
- lacerations
- further impaction
- otitis externa
- perforation
- pain
- hearing loss
- vertigo
