Diseases of the Ear Flashcards
What is the most common cause of benign peripheral vertigo?
Benign Paroxysmal Positional Vertigo (BPPV)
What are the characteristics of Benign Paroxysmal Positional Vertigo?
- Most common cause of peripheral vertigo
- Cause: post trauma, post viral infection
- SSx: Recurrent brief positional vertigo, latency, fatigability
- Dx: Hx, Dix-Hallpike
- Ppys: canalithiasis
- Patient has NORMAL HEARING
What does an acute otitis media (acute suppurative otitis media) look like?
It looks red, purulent, sometimes ruptures, can see fluid behind
What is important about acute otitis media?
- Acute middle ear space infection (< 3 wk)
- 2nd most common disease in children (URI #1)
- PPx Eustachian tube dysfunction causes negative middle ear pressure
- Middle ear pressure resulting in transudative fluid collection in middle ear space and subsequent infection
- S. pneumoniae, H. influenza, Mor. Catarrhalis most common pathogens
What does serous otitis media look like?
Fluid shows when looking in ear, looks a little orangey and reflective
What are these:
- Day care attendance
- Smoke exposure
- Bottle feeding
- Allergy to foods
- Nasal allergy
- Recurrent UTI
- Craniofacial/Skull Base Anomalies
- Adenoid hypertrophy
- Gastroesophageal reflux
- Immunologic disorders (IgA IgG def)
- Ciliary Dysfunction
- Nasal Intubation (NT NG)
- Nasopharyngeal Tumors
- Cholesteatoma
- Genetics (PPGP)
Risk Factors for Otitis Media!
What are signs and symptoms of AOM?
- Otalgia causing irritability and ear tugging
- Aural fullness, something is blocking ear
- Hearing loss
- Tinnitis
- Fever
- Red or Creamy Yellow TM that Bulges and is Immobile
- Remember TM turns red with crying
How do you manage AOM?
- Majority of cases will spontaneously resolve in 24-72 hours
- Oral antibiotics
- Topical antibiotic otic drops if TM perforated
- Pain relief, decongestants, antipyretics
- Prophylactic antibiotics indicated for recurrent infections
- Myringotomy for severe otalgia or toxic pts.
How is Otitis Media surgically managed?
- Myringotomy (cutting TM to releave pressure and fluid) and Tubes (PE)
- Adenoidetomy
- Mastoidectomy
What does mastoidectomy do?
- Creates a safe ear by irradicating infection
- Approach to remove cholesteatoma
- Goal is to preserve hearing and vestibular function
- Reconstruction of middle ear structures
What is the cholesteatoma?
Destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process - they often result in chronically draining ears
What are some complications of Otitis Media?
- Acute Mastoiditis
- Subperiosteal Abscess
- Petrous Apicitis
- Labyrinthine Fistula
- Facial Nerve Paralysis
- Meningitis
- Epidural Abscess
- Brain Abscess
- Lateral Sinus Thrombosis
- Otitic Hydrocephalus
What is allergic rhinitis?
- IgE-mediated hypersensitivity of the nasal mucosa to foreign substances
- It is inflammation and swelling of mucosa in nose
What percentage of the US pop does allergic rhinitis affect?
20% of US pop
When does allergic rhinitis present? What population is it predominant in?
- Rarely occurs before age 2, almost always presents before age 20.
- Male predominance in children, equalizes in adults
What is atopy in terms of allergic rhinitis?
Genetic predisposition to respond to environmental allergens with the production of specific IgE antibodies.
How to diagnose/what are the symptoms of allergic rhinitis?
- HISTORY
- Recurrent episodes of sneezing, rhinorrhea (nose filled with mucous), nasal congestion, and lacrimation
- Pruritis (itchy) (nasal, ocular, oral, pharyngeal) is highly suggestive of allergy
- Post-nasal drip, throat clearing
- Eustachian tube dysfunction - ear popping and clicking
- Systemic symptoms: fatigue, irritability, sleep disturbance
- Inquire about personal or family history asthma, eczema, atopic dermatitis, allergic rhinitis
- Exposure to exacerbating substances - tobacco smoke, smog
What should you check for in a physical exam of allergic rhinitis?
- Head: adenoid facies - elongated face, open mouth, retracted mandible, flattened malaria eminences, pinched nostrils, raised upper lip
- Ears: middle ear effusion or retraction
- Eyes: allergic shiners (venous stasis from chornic nasal congestion)
- Nose:
- –External: supratip crease (allergic salute)
- –Internal: pale, boggy, edematous mucosa; interior turbinate hypertrophy; polyps
- Throat: cobblestoning of the posterior pharyngeal wall
What two tests are used to diagnose allergic rhinitis?
- Skin testing
2. In vitro testing - radioallergosorbent testing (RAST) and enzyme - linked immunosorbent testing (ELISA)
What is Skin testing for Allergic rhinitis?
Antigen introduced via skin puncture versus intradermal injection
- Advantages: rapid, inexpensive, more sensitive
- Disadvantages: affected by antihistamine therapy, cannot be used if patient has dermatographism, potential for systemic reaction
How does in vitro testing (RAST and ELISA) work for allergic rhinitis?
- Radioallergosorbent testing (RAST) and ELISA
- –Identify antigen-specific IgE in the patient’s serum
- –Advantages: No needles, can be used for patients with dermatographism, no potential for systemic reaction
- –Disadvantages: longer turnaround time, more expensive, less sensitive
What are the therapeutic options for allergic rhinitis?
- Avoidance
- Intranasal steroids
- Antihistamines
- Decongestants
- Anticholinergics
- Cromolyn
- Leukotriene modifiers
- Systemic steroids
- Immunotherapy
What does the Rinne test tell you?
AC > BC (Normal)
BC> AC (CHL) - conductive hearing loss
What does the weber test tell you?
Place tuning fork midline
- Normal lateralizes
- CHL is heard in better ear
Ear Wax Impaction Otitis Media Tympanic Perforation Cholesteatoma Tympanosclerosis Ossicular Erosion Otosclerosis Congenital Absence of external or middle ear structures
Causes of Conductive Hearing Loss
Presbycusis: most common (50% of >75 yo) loss of hair cells, progressive
Infectious: OM, viral, syphilis
Trauma: Noise-Induced, barotrauma, head injury
Ototoxic Drugs: ASA/NSAIDS, cisplatin, gent, lasix, antimalarials (quinine, chloroquine)
Autoimmune : HIV, polyarteritis nodosa
Sudden SNHL: Vascular or viral
Congenital/Hereditary: Syndromes, LVAS
Neurologic: MS
Neoplastic: Vestibular schwannoma
Meniere’s Disease
Causes of Sensorineural Hearing Loss