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Neuro Block 3 - KJ > Diseases of the Ear > Flashcards

Diseases of the Ear Flashcards

1
Q

What is the most common cause of benign peripheral vertigo?

A

Benign Paroxysmal Positional Vertigo (BPPV)

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2
Q

What are the characteristics of Benign Paroxysmal Positional Vertigo?

A
  • 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
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3
Q

What does an acute otitis media (acute suppurative otitis media) look like?

A

It looks red, purulent, sometimes ruptures, can see fluid behind

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4
Q

What is important about acute otitis media?

A
  • 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
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5
Q

What does serous otitis media look like?

A

Fluid shows when looking in ear, looks a little orangey and reflective

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6
Q

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)
A

Risk Factors for Otitis Media!

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7
Q

What are signs and symptoms of AOM?

A
  • 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
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8
Q

How do you manage AOM?

A
  • 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.
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9
Q

How is Otitis Media surgically managed?

A
  • Myringotomy (cutting TM to releave pressure and fluid) and Tubes (PE)
  • Adenoidetomy
  • Mastoidectomy
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10
Q

What does mastoidectomy do?

A
  • Creates a safe ear by irradicating infection
  • Approach to remove cholesteatoma
  • Goal is to preserve hearing and vestibular function
  • Reconstruction of middle ear structures
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11
Q

What is the cholesteatoma?

A

Destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process - they often result in chronically draining ears

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12
Q

What are some complications of Otitis Media?

A
  • Acute Mastoiditis
  • Subperiosteal Abscess
  • Petrous Apicitis
  • Labyrinthine Fistula
  • Facial Nerve Paralysis
  • Meningitis
  • Epidural Abscess
  • Brain Abscess
  • Lateral Sinus Thrombosis
  • Otitic Hydrocephalus
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13
Q

What is allergic rhinitis?

A
  • IgE-mediated hypersensitivity of the nasal mucosa to foreign substances
  • It is inflammation and swelling of mucosa in nose
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14
Q

What percentage of the US pop does allergic rhinitis affect?

A

20% of US pop

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15
Q

When does allergic rhinitis present? What population is it predominant in?

A
  • Rarely occurs before age 2, almost always presents before age 20.
  • Male predominance in children, equalizes in adults
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16
Q

What is atopy in terms of allergic rhinitis?

A

Genetic predisposition to respond to environmental allergens with the production of specific IgE antibodies.

17
Q

How to diagnose/what are the symptoms of allergic rhinitis?

A
  • 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
18
Q

What should you check for in a physical exam of allergic rhinitis?

A
  • 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
19
Q

What two tests are used to diagnose allergic rhinitis?

A
  1. Skin testing

2. In vitro testing - radioallergosorbent testing (RAST) and enzyme - linked immunosorbent testing (ELISA)

20
Q

What is Skin testing for Allergic rhinitis?

A

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
21
Q

How does in vitro testing (RAST and ELISA) work for allergic rhinitis?

A
  • 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
22
Q

What are the therapeutic options for allergic rhinitis?

A
  • Avoidance
  • Intranasal steroids
  • Antihistamines
  • Decongestants
  • Anticholinergics
  • Cromolyn
  • Leukotriene modifiers
  • Systemic steroids
  • Immunotherapy
23
Q

What does the Rinne test tell you?

A

AC > BC (Normal)

BC> AC (CHL) - conductive hearing loss

24
Q

What does the weber test tell you?

A

Place tuning fork midline

  • Normal lateralizes
  • CHL is heard in better ear
25
Q 
Ear Wax Impaction
Otitis Media
Tympanic  Perforation
Cholesteatoma
Tympanosclerosis
Ossicular Erosion
Otosclerosis
Congenital Absence of external or middle ear structures
A

Causes of Conductive Hearing Loss

26
Q

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

A

Causes of Sensorineural Hearing Loss

Neuro Block 3 - KJ (16 decks)

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