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ENT > Disorders of the Ear > Flashcards

Disorders of the Ear Flashcards

1
Q

What are the disorders of the ear?

A
  1. ET Dysfunction

2 Otitis Media

  1. Otitis Externa
  2. TM Perforation
  3. Barotrauma
  4. Foreign Body of the Ear
  5. Cerumen Impaction
  6. Mastoiditis
  7. Acoustic neuroma
  8. Vertigo Syndromes
  9. BPPV
  10. Labryinthitis
  11. Meniere’s disease
  12. Presbycusis
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2
Q

What are the types of otitis media? 4

A
  1. Acute Otitis Media (AOM)
  2. OM with effusion
  3. Chronic Suppurative Otitis
  4. Cholesteoma
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3
Q

What are the landmarks that should be visible for the TM?

A
  1. UMBO
  2. Handle of MALLEUS:
  3. LIGHT reflex
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4
Q

The pneumatic attachment of the otoscope is used to evaluate what in the TM?

A

mobility

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5
Q

What is the valsalva manuever used to observe?

A

Observe for motion and pain.

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6
Q

Describe the following for the Weber and Rinne test:

  1. Purpose
  2. Fork placement
  3. Normal hearing
  4. Conductive Loss
  5. Sensorineural loss
A

See picture

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7
Q

What is the problem with Eustachian tube dysfunction?

A

Classically described as a blockage of the eustachian tube.

The eustachian tube does not open or close properly in response to pressure changes within the middle ear or outside the ear.

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8
Q

Describe the setting for acute ETD?

2

A
  1. Acute ETD may occur in the setting of pressure changes (e.g., plane travel) or
  2. acute upper airway inflammation (e.g., URI, sinusitis).
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9
Q

Chronic ETD may lead to what?

6

A
  1. negative middle ear pressure,
  2. retracted tympanic membrane,
  3. serous effusions,
  4. otitis media,
  5. adhesive otitis media
  6. cholesteatoma.
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10
Q
  1. What is Patulous eustachian tube?
  2. How does it manifest?
A

is failure of the eustachian tube to close. It is often manifested as autophony,

when an individual’s own breathing and voice sounds excessively loud.

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11
Q

Eustachian tube functions?

4

A
  1. Ventilation/regulation of middle ear pressure
  2. Protection from nasopharyngeal secretions
  3. Drainage of middle ear fluid
  4. ET is closed at rest and opens with yawning, swallowing, and sneezing.
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12
Q
  1. Normally the Eustachian tube is closed, but it can open to let a small amount of air through to prevent damage by what?
  2. Pressure differences cause conductive hearing loss by what process?
  3. Various methods of ear clearing such as yawning, swallowing, chewing gum, or performing the valsalva maneuver may be used for what?
  4. When this happens, a small ___________is heard, an event familiar to aircraft passengers, scuba divers or drivers in mountainous regions.
A
  1. damage by equalizing pressure between the middle ear and the atmosphere.
  2. decreased motion of the tympanic membrane and ossicles of the ear.
  3. intentionally to open the tube and equalize pressures.
  4. popping sound
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13
Q

Cycle of dysfunction: Structural or functional obstruction of the ET compromises 3 functions of this system?

A
  1. Negative pressure develops in middle ear.
  2. Serous exudate is drawn from the middle ear mucosa by negative pressure or refluxed into the middle ear if the ET opens momentarily.
  3. Infection of static fluid causes edema and release of inflammatory mediators, which exacerbates cycle of inflammation and obstruction.
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14
Q
  1. ETD is most common in what age group?
  2. In children, a horizontally oriented ET predisposes to difficulties with what?
  3. Shorter ET predisposes what?
  4. ETD can be associated with what?4
  5. When should we refer to an ENT?2
A
  1. children under 5
  2. ventilation and drainage
  3. Shorter ET predisposes to reflux
  4. Can be associated with
    - URI,
    - adenoid hypertrophy,
    - allergic rhinnitis, or
    - GERD
  5. Refer to an otolaryngologist if
    - hearing loss or recurrent or
    - chronic middle ear infections.
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15
Q
A
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16
Q

ETD Risk Factors

Pediatric:

9

A
  1. 2nd-hand smoke
  2. Prematurity and low birth weight
  3. Young age
  4. Craniofacial abnormalities (e.g., cleft palate, Down syndrome)
  5. Day care, exposure to many other children
  6. Crowded living conditions
  7. Low socioeconomic status
  8. Prone sleeping position
  9. Prolonged bottle use
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17
Q

ETD Commonly Associated Conditions

12

A
  1. Hearing loss
  2. Middle ear effusion
  3. Cholesteatoma
  4. Allergic rhinitis
  5. Chronic sinusitis
  6. URI
  7. Adenoid hypertrophy
  8. GERD
  9. Cleft palate
  10. Down syndrome
  11. Obesity
  12. Nasopharyngeal carcinoma or other tumor
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18
Q

Decongestants: There are common ingredients in many OTC brands; encourage patients to read labels. In general, avoid what with these meds?

3

A
  1. prolonged use >3 days;
  2. avoid in patients with hypertension or
  3. cardiac risk factors):
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19
Q

What are examples of the decongestants being used with ETD?

3

A
  1. Phenylephrine (Neosynephrine topical, Sudafed PE oral)
  2. Pseudoephedrine (Sudafed)
  3. Oxymetazoline (Afrin)
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20
Q
  1. What would be beneficial with ETD patients with allergic rhinitis?
  2. What are the options? 5
  3. Another drug that might be useful?
  4. 4 options
A
  1. Nasal steroids: (May be beneficial for those with allergic rhinitis):

2.

  • Beclomethasone (Beconase, Vancenase)
  • Budesonide (Rhinocort)
  • Flunisolide (Nasarel, Nasalide)
  • Fluticasone (Flonase)
  • Ciclesonide (Omnaris) (prodrug)
    3. 2nd-generation H1 antihistamines (May be beneficial for those with allergic rhinitis):

4.

  • Loratadine (Claritin)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
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21
Q

ETD antihistamine nasal sparys? 4

Antibiotics? 1

A

Antihistamine nasal sprays:

  1. Olotpatadine (Patanase) (antihistamine)
  2. Astelin (Azelastine) (antihistamine)

Antibiotics (Not routinely used unless ETD is associated with acute OM):

  1. Amoxicillin, 1st-line

Treatment for 10 days is most effective

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22
Q
  1. How should we treat ETD if Tympanic membrane perforation or ventilation tube present? 2
  2. For pain control and inflammation how should we treat?
A
  1. Consider topical antibiotic drops with topical steroid in setting of discharge alone
    - Neomycin–polymyxin–hydrocortisone suspension (Cortisporin)
    - Ciprofloxacin–hydrocortisone suspension (Cipro HC ), others
  2. Pain control, anti-inflammatory:
    - Acetaminophen, NSAIDs
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23
Q

How is recurrent AOM defined?

2

A

3 or more AOM in 6 months or 4 or more AOM in 1 year.

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24
Q

Definition of otitis media?

A

An infection of the middle ear with acute onset, presence of middle ear effusion (MEE), and signs of middle ear inflammation

AAP/AAFP

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25
Q

What is the peak incidence for otitis media?

A

Peak incidence 6-18 months, declines after age 7.

Male > female

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26
Q

Risk factors for otitis media?

6

A
  1. Bottle feeds while supine
  2. Day care
  3. Formula feeding
  4. Smoking in house
  5. Male gender
  6. Family HX of middle ear disease
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27
Q

Signs and symptoms of otitis media?

6

A
  1. Earache (discomfort, pressure), Otalgia (ear pain). As the infection worsens, so does the discomfort
  2. Tugging on ears
  3. Fever, although more often afebrile (not required for dx). As the infection worsens, likelihood of fever goes up
  4. Accompanying URI symptoms*****
  5. Irritability
  6. Difficulty sleeping
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28
Q

Otoscope Exam in otitis media would show what?

4

A
  1. Decreased visibility of landmarks
  2. TM mobility decreases
  3. Bulging TM, opaque, red
  4. Pus in middle ear (bacteria in the middle ear effusion)
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29
Q

Diagnosis of acute otitis media (AOM)

Note symptoms in taking a history of the illness. What are the symptoms that lead to diagnosis?

5

A
  1. Discomfort, ache, pain
  2. Fever
  3. Tugging at ears
  4. Hearing loss
  5. Bulging TM/red
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30
Q

What are the bacterial culprits for otitis media?

3

A
  1. Streptococcus pneumoniae (30-35%)
  2. Haemophilus influenzae (20-25%)

Up to 50% produce beta-lactamases

  1. Moraxella catarrhallis (10-15%)

90% of these produce beta-lactamases

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31
Q

Expected course/prognosis for OM?

2

A
  1. Symptoms usually spontaneously resolve in 2/3 of children by 24 hrs and 80% at 2-10 days.
  2. Children treated immediately with antibiotics had one less day of symptoms.
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32
Q

Antibiotic treatment for OM?

4

Treatment for pain and fever?

3

A

Antibiotic Treatment

  1. Amoxicillin
  2. Augmentin
  3. Cephalosporins
  4. Erthyromycin, Azithromycin

Treatment of pain and fever

  1. Ibuprofen
  2. Tylenol
  3. Auralgan
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33
Q
  1. When should we have a patient follow up with OM?
  2. What should we do at the followup?

3

  1. If the symtpoms resolve when should we see them and what are we looking for?
A
  1. Failure to improve after 48-72 hrs of abx

2.

  • Confirm DX
  • Evaluate other causes
  • Determine if new abx is warranted
    3. Reexamined 14-21 days after initial presentation
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34
Q

According to the guidelines, management of AOM should include what?

A

an assessment of pain. Analgesics, particularly acetaminophen and ibuprofen, should be used to treat pain whether antibiotic therapy is or is not prescribed.

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35
Q

Antibiotics should be prescribed for bilateral or unilateral AOM in children aged at least 1._______with severe signs or symptoms (moderate or severe otalgia, otalgia for 48 hours or longer, or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 2.________.

A
  1. 6 months
  2. 6 to 23 months
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36
Q
  1. On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6-23 months or nonsevere AOM in older children may be managed either with what? 2
  2. Amoxicillin is the antibiotic of choice unless what? 3
A
  1. antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset

2.

  • the child received it within 30 days,
  • has concurrent purulent conjunctivitis, or
  • is allergic to penicillin;

in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage

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37
Q

What is OM with effusion or serous OM defined as?

What are the symptoms of this? 6

A

Defined as:

The presence of middle ear effusion (MEE) in the absence of acute signs of infection.

Symptoms of otitis media with effusion

1. Hearing loss

2. Fullness in ear

3. Tugging at ear or repeatedly inserting finger in ear

4. Delayed speech and language development or unclear speech

5. In young children, an unsteady gait may occur

6. Pain rarely occurs

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38
Q

What will you see on the otoscope exam with OM with effusion?

4

A
  1. TM is dull and retracted (usually not bulging).
  2. No mobility of TM
  3. Straw or tan color of ear drum or translucent gray
  4. Sterile fluid in middle ear
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39
Q

What is the is the single most recommended diagnostic method to establish the diagnosis of otitis media with effusion?

A

Pneumatic otoscopy (or even better is typanography)

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40
Q

Treatment of otitis media with effusion (OME) by current guidelines:

Watchful waiting includes what:

  1. Treatment?
  2. Testing?
  3. 75%-90% resolve when?
  4. If the middle ear effusion lasts longer than 3 months, 30% resolve within what time?
A
  1. No treatment for three months after onset
  2. No hearing testing in first three months
  3. 75 - 90% resolve spontaneously in 3 months
  4. If the middle ear effusion lasts longer than 3 months, 30% resolve within 12 months
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41
Q

Treatment of otitis media with effusion (OME)

During the “watchful waiting” period, do the following:

4

A
  1. Speak in close proximity to the child
  2. Face the child when speaking, and speak clearly
  3. Repeat phrases when misunderstood

4 Preferential seating in the classroom

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42
Q

Medication for EOM:

Which medications do not work? 4

A
  1. Antihistamines and
  2. decongestants are of no value and are not recommended
  3. Antibiotics and
  4. steroids do not have long-term efficacy
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43
Q

After ______months of “watchful waiting”, hearing should be tested

Language testing should be conducted for children with what?

A

three

hearing loss

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44
Q

What surgeries can we do to correct OME?

2

A

Surgery (tympanostomy and tube)

45
Q

Chronic supportive otitis is defined as?

2

  1. What is the cause?
  2. What does the cycle look like? 4
A
  1. A perforated tympanic membrane with persistent drainage from the middle ear.
  2. Chronic otorrhea (>6-12wks) through a perforated TM
  3. initial episode of acute infection
  4. Cycle: inflammation>ulceration>infection>granulation of tissue

Risks:

46
Q

What are the risks of chronic supportive otitis?

4

A
  1. Hx of multiple episodes of AOM
  2. Living in crowded conditions
  3. Daycare
  4. Being a member of a large family
47
Q

Chronic suppurative otitis bacterial culprits? 3

Describe the sequelae? 2

A

Bacterial culprits:

  1. Pseudomonas aeruginosa (50-98%)
  2. Staph Aureas (15-30%)
  3. Klebsiella and Proteus

Sequelae:

  1. Conductive hearing loss
  2. Intracranial complications
48
Q

Presentation of chronic suppurative otitis?

7

A
  1. Continually draining ear (otorrhea)
  2. Fever, pain and vertigo may indicate intracranial or intratemproal complications.
  3. External canal may/may not be edematous
  4. Usually not tender
  5. Granulation tissue often seen in medial canal of middle ear space.
  6. Middle ear mucosa visualized thru the perforated TM may be edemtous, polypoid, pale or erythematous
  7. Discharge- Fetid, purulent, cheeselike to clear and serous
49
Q

Chronic suppurative otitis is associated with what?

3

A

Craniofacial anomalies.

  1. Cleft palate,

2 Down syndrome,

  1. microcephaly
50
Q

Chronic suppuratove otitis:

Labs?

Imaging?

testing?

A

Labs:

Culture the drainage for sensitivity

Imaging:

CT Scan, MRI

Usually not done unless suspecting neoplasm, cranial complications, or unresponsive to medical treatment

Audiogram

51
Q

CSO: treatment?

3

A
  1. Removal of exudate from canal tissue

50% peroxide with sterile water (WITHOUT pressure)

  1. Antibiotic Otics

?????

  1. Systemic antibiotics (reserved for failed cases)

Ciprofloxin PO

52
Q
  1. Cholesteoma is defined as?
  2. Takes the form as what?
  3. Sheds what?
  4. Increases in size which results in what?
A
  1. A skin growth that occurs in the middle ear behind the eardrum
  2. Takes the form of a cyst or pouch
  3. Sheds layers of old skin
  4. Increases in size and destroys surrounding delicate bones of the middle ear.
53
Q

Cause of cholesteoma?

2

A
  1. Repeated infection
  2. Poor Eustachian tube function
54
Q

Cholesteoma presentation?

6

A
  1. Otorrhea
  2. Feeling of fullness or pressure in ear
  3. Hearing loss
  4. Achy ear (especially at night)
  5. Dizziness
  6. Facial weakness on affected side
55
Q

Cholesteoma:

Diagnostics? 4

Treatment? 1

A

Diagnostics:

1. Otoscopy

2. Audiometry

3. Xray and CT of mastoid may be necessary

4. Refer to ENT

Treatment:

1. Surgical treatment

56
Q

Otitis Externa

Defined as?

Causes? 3

A

Defined as:

Inflammation of the external auditory canal or auricle

Causes:

  1. Infectious
  2. Allergic
  3. Dermal disease
57
Q

What are the major risk factors for developing OE?

2

A
  1. Q tip use
  2. Swimming
58
Q

Bacterial externa:

Bacterial culprits 3

Signs and symptoms 5

A

Bacterial culprits

  1. Staph aureus
  2. Pseudomonas aeruginosa (swimmers ear)
  3. Proteus

Signs and Symptoms:

  1. Otalgia
  2. Pain at tragus or when auricle is pulled!!!!!
  3. Pruritis
  4. Discharge
  5. Hearing loss
59
Q

What will the otoscope exam show on otitis externa?

4

A
  1. Edematous and erythematous ear canal

2 .May see yellow, brown, white or grey debris

  1. Should be no middle ear fluid (if you can see it!)
  2. TM should be mobile (if you can see it!)
60
Q

Treatment of otitis externa

4

A
  1. Cleaning of ear canal
  2. Irrigate with 1:1 dilution of 3% hydrogen peroxide AT BODY TEMPERATURE (GENTLY – No high pressure if you cannot see TM!)
  3. Protect ear canal from water
  4. Treatment of inflammation and infection (Caution: ALWAYS USE SOLUTION if you have NOT confirmed an intact TM)
61
Q

What are the solutions for otitis externa?

3

A

Cortisporin

Cipro HC

Tobradex

62
Q

Mailgnant external otitis/necrotizing otitis externa

defined as?

A

Defined as:

An invasive infection of the external auditory canal and skull base.

63
Q

Mailgnant external otitis/necrotizing otitis externa:

  1. typically occurs in what pts? 3
  2. Caused almost exclusively by? 1
A
  1. Typically occurs in elderly with diabetes mellitus
  2. Increasing in patients with AIDS
  3. Immunocompromised patients
  4. Caused by Pseudomonas aeruginosa (95%)
64
Q

MEO/NOE:

  1. Clinical manifestations? 2
  2. Otoscope exam?
  3. Comoplications? 4
A

Clinical Manifestations:

  1. Exquisite otalgia and otorrehea
  2. Pain is more severe than external otitis

Otoscopic Exam:

  1. Granulation in the inferior portion of the external auditory canal.

Complications:

  1. Osteomyelitis of the base of the skull
  2. Mastoiditis
  3. TMJ osteomyelitis
  4. Cranial nerve palsies
65
Q

Malignant OE diagnosis? 3

Malignant OE treatment? 2

A

Diagnosis:

  1. Elevated ESR
  2. Positive culture
  3. Imaging

Treatment:

  1. Ciprofloxin 750mg PO BID for 6-8 weeks
  2. No role for topical abx
66
Q

TM perforations

  1. Clinical manifesations? 4
  2. Causes? 6
A

Clinical Manifestations:

  1. Clear, pus-filled or bloody drainage from ear
  2. Sudden decrease in ear pain followed by drainage from that ear
  3. Hearing loss
  4. Tinnitus

Causes:

  1. Middle ear infection
  2. Airplane ear (barotrauma)
  3. Acoustic trauma
  4. Direct injury, such as the ear is struck squarely with an open hand
  5. Foreign objects in ear
  6. Loud, sudden noise–such as from an explosion or a firearm/Hearing loss may be great, tinnitus is severe
67
Q

TM perforations treatment? 5

A
  1. Most heal on their own
  2. Usually no abx or topicals, but can consider Cortisporin Otic or Cipro HC otic
  3. Keep ear dry
  4. Ear drum patch
  5. Tympanoplasty
68
Q
  1. Barotrauma usually begins with what?
  2. Whats the most frequent cause?
  3. Clinical manifesations? 4
A
  1. Usually begins with Eustachian tube dysfunction, either congenital of acquired mucosal edema.
  2. Most frequent cause is flying.
    - Descent is worse than ascent
    - Similar results from diving.
  3. Clinical manifestations
    - Pressure in the ear
    - Pain due to stretching of the TM
    - Hearing loss
    - Tinnitus
69
Q

Barotrauma treatment? 3

Barotrauma prevantion? 3

A

Treatment:

  1. Valsalva maneuver
  2. Decongestants
  3. Myringotomy

Prevention:

  1. Avoidance
  2. Pre flight decongestants
  3. Chewing gum, yawning or swallowing during airplane descent
70
Q

1. Who most commonly acquires foreign bodies in the ear?

2. Firm materials are removed with a what?

3. Don’t irrigate organic foreign bodies, (beans, insects). Why?

4. What if the insect is still alive in the ear?

A
  1. children
  2. loop or hook.
  3. Incase the TM is perforated
  4. kill it and remove it
71
Q

Foreign body in the ear

treatment?

4

A
  1. Can be difficult to remove
  2. Attempts can push foreign body further into the canal and lodge it.
  3. Adequate visualization, appropriate equipment, a cooperative patient, and a skilled provider are the keys to successful foreign body removal.
  4. Otherwise, referral to ENT for removal
72
Q

Most often cerumen impaction is self-induced

Different removal techniques 4

A

1.Hydrogen peroxide

2 Debrox

3. Irrigation

4. suction

73
Q
  1. Irrigate with water at body temperature.

Why?

  1. Stream should be directed at ear canal wall where?
  2. Irrigation should only be performed when what?
A
  1. So as not to induce veritgo
  2. adjacent to the cerumen plug.
  3. the TM is known to be intact
74
Q
  1. Mastoiditis is a complication of what?
  2. Evolves following what?
  3. Develops when middle ear inflammation spreads to the mastoid air cells, resulting in what?
  4. Characterized by what? 3
A
  1. A complication of otitis media
  2. Evolves following several weeks of inadequately treated acute otitis media
  3. infection and destruction of the mastoid bone.
  4. Characterized by:
    - Postauricular pain and erythema
    - Spiking fever
    - Tender mass
75
Q

Mastoiditis diagnosis? 3

What will ENT do? 2

A

Diagnosis and Treatment

  1. ENT consult
  2. CT Scan
  3. MRI if intracranial involvement is suspected

What ENT will do

  1. Myringotomy fluid for culture, acid fast and Gram stain.
  2. Audiogram before and after treatment
76
Q

Mastoiditis

Patient admission for IV abx

Immediate antibiotic treatment:

How many days?

Which antibitiocs? 4

A

21 days

  1. Ceftriaxone (Rocephin)
  2. Piperacillin and tazobactam sodium (Zosyn)
  3. Oxacillin (Bactocill)
  4. Gentamicin (Garamycin)
77
Q

Acoustic Neuroma

  1. Unilateral or Bilateral?
  2. Median age at diagnosis?
  3. Why are they dangerous?
  4. 5% are associated with what?
A
  1. Usually unilateral
  2. Median age at diagnosis is 50
  3. Are benign lesions but grow to eventually compress the pons resulting in hydrocephalus
  4. 5% are associated with Neurofibromatosis type 2 (bilateral)
78
Q

Acoustic neuroma risk factors?

4

A
  1. Exposure to loud noise
  2. Neurofibromatosis type 2
  3. Hx of parathyroid adenoma
  4. Cell phones?? (remains controversial)
79
Q

What are symptoms due to in acoustic neuroma?

3

A

Symptoms are due to

  1. cranial nerve involvement,
  2. cerebellar compression and
  3. tumor progression.
80
Q

What does compression of the following nerves cause in acoutic neuroma:

  1. Cochlear nerve?
  2. Vestibular nerve?
  3. Trigeminal nerve? 2
  4. Facial nerve? 2
A

Cochlear nerve

  1. Hearing loss and tinnitus

Vestibular nerve

  1. Unsteadiness while walking

Trigeminal nerve

  1. Facial numbness
  2. Hypesthesia and pain

Facial nerve

  1. Facial paresis
  2. taste disturbances
81
Q

Acoustic Neuroma/Vestibular Schwannoma

Diagnosis? 4

Treatment? 4

A

Diagnosis:

  1. Demonstration of asymmetric sensorineural hearing loss or other cranial nerve deficits
  2. MRI or CT
  3. ENT referral
  4. Audiometry

Treatment:

  1. Surgery
82
Q
  1. Vertigo syndromes are defined as?
  2. Appears as? 3
  3. Caused by?
A
  1. Defined as:

A symptom of illusory movement

  1. Appears as:
    - Transient spinning dizziness
    - A sense of swaying or tilting
    - A sense of falling backwards
  2. Caused by:

Asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem.

83
Q

Signs of peripheral vertigo syndromes? 3

Signs of central vertigo syndomes? 5

A

Peripheral

  1. Sudden onset of vertigo
  2. Nystagmus is usually horizontal with a rotary component; the fast phase usually beats away from the diseased side.
  3. Visual fixation inhibits nystagmus

Central

  1. Onset of vertigo is gradual
  2. Nystagmus can be in any direction, usually vertical
  3. Visual fixation does not stop nystagmus
  4. Other signs of brainstem dysfunction.
  5. instability
84
Q

Symptoms of peripheral vertigo syndromes? 9

Symptoms of central vertigo symdromes? 7

A

Peripheral

  1. Blurred vision
  2. Fatigue, headache
  3. Palpitations
  4. Imbalance
  5. Inability to concentrate
  6. Increased risk for motion sickness
  7. Nausea and vomiting
  8. Reduced cognitive function Sensitivity to bright lights and noise
  9. Sweating

Central

  1. Double vision (diplopia)
  2. Headache (may be severe)
  3. Impaired consciousness
  4. Inability to speak due to muscle impairment (dysarthria)
  5. Lack of coordination
  6. Nausea and vomiting
  7. Weakness
85
Q

Benign Paroxysmal Positional Vertigo: Dizziness is thought to be due to what?

A

debris which has collected within a part of the inner ear. This debris can be thought of as “ear rocks”, although the formal name is “otoconia”. Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the “utricle“ .

86
Q

Benign Paroxysmal Positional Vertigo: how can the utricle be damaged to produce the otoconia?

A

The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover. They are probably dissolved naturally as well as actively reabsorbed by the “dark cells” of the labyrinth

87
Q

Benign Paroxysmal Positional Vertigo

  1. Describe the onset and progression?
  2. What precipitates symptoms? 2
  3. What kind of nystagmus?
  4. Lacking what kind of symtpoms?
A
  1. Recurrent and brief episodes (lasting less than 1 minute)

2.

  • Predictable head movements or
  • positions precipitate symptoms
    3. Horizontal nystagmus
    4. No neuro or auditory symptoms
88
Q

Whats the best test for diagnosing Benign Paroxysmal Positional Vertigo?

What are two others that are alos involved? 2

A
  1. Dix-Hallpike maneuver is best for determining BPPV.
  2. Romberg
  3. Weber-Rinne tests
89
Q

What is the Dix-Hallpike Maneuver?

A

In this test, a person is brought from sitting to a supine position, with the head turned 45 degrees to one side and extended about 20 degrees backward.

A positive Dix-Hallpike tests consists of a burst of nystagmus. The eyes jump upward as well as twist so that the top part of the eye jumps toward the down side.

90
Q

Benign Paroxysmal Positional Vertigo: treatment?

2

A

Treatment

  1. Wait it out
  2. Epley Maneuver
91
Q

What is the epley maneuver?

A

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure.

It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

92
Q
  1. Labyrinthitis is defined as?
A

Inflammation of the inner ear.

93
Q

Labyrinthitis Clinical course:

  1. Main symtpom?
  2. Describe is resolution?
  3. Maybe accompianed by what?
  4. Cause? 2
A
  1. Vertigo - a sensation of spinning or whirling-that may be severe enough to cause nausea or vomiting.
  2. Gradually goes away over a period of several days to weeks.
  3. May be accompanied by hearing loss, which is usually temporary.

4.

  • Often triggered by an upper resp. infection (viral)
  • Less often, may develop after a middle ear infection
94
Q

Labyrinthitis: Treatment? 3

A
  1. Usually goes away on its own.
  2. Normally requires several weeks.
  3. Medications may also be used to control nausea and vomiting caused by the vertigo.
95
Q

Labyrinthitis: Medications may also be used to control nausea and vomiting caused by the vertigo.

3

A
  1. Prochlorperazine (Compazine)
  2. Meclazine (Antivert)
  3. Diazepam/Lorazepam
96
Q

What is Meniere’s (Endolymphatic Hydrops)?

A

Results from distention of the endolymphatic compartment of the inner ear.

97
Q

Meniere’s (Endolymphatic Hydrops) Clinical presentation?

4

A
  1. Episodic vertigo lasting 1-8 hours. Rotary or rocking and can be associated with N/V
  2. Low frequency sensorineural hearing loss
  3. Tinnitus- Low tone and blowing
  4. Sensation of aural pressure
98
Q

Diagnostic criteria for Meniere’s (American Academy of Otolaryngology and Head and Neck Surgery)

3

What does the literature suggest testing the patient for?

A
  1. 2 spontaneous episodes of rotational vertigo lasting at least 20 minutes
  2. Audiometric confirmation of sensorineural hearing loss
  3. Tinnitus and/or perception of aural fullness

Literature suggests testing patient for syphilis

99
Q

Meniere’s (Endolymphatic Hydrops) treatment:

Dietary? 3

Medications? 5

A

Dietary restrictions

  1. Caffeine
  2. Tobacco
  3. Salt

Medications

  1. Diuretics
  2. Antiemetics
  3. Anxiolytics
  4. Antihistamines
  5. Scopolamine
100
Q
  1. What is presbycusis?
  2. Characteristically involves what? 3
A
  1. Refers to sensorineural hearing impairment in elderly individuals.
  2. Characteristically involves
    - bilateral high-frequency hearing loss associated with
    - difficulty in speech discrimination and
    - central auditory processing of information
101
Q

Histologic changes associated with aging occur throughout the auditory system from the hair cells of the cochlea to the auditory cortex in the temporal lobe of the brain. These changes may correlate with different clinical findings and auditory test results, depending on what? 2

A
  1. severity of the changes and the

2, anatomic level at which they occur.

102
Q
  1. What does sensory presbycusis refer to?
  2. Neural presbycusis refers to what?
A
  1. This refers to epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti.
  2. This refers to atrophy of nerve cells in the cochlea and central neural pathways.

Atrophy occurs throughout the cochlea, with the basilar region only slightly more predisposed than the remainder of the cochlea.

103
Q
  1. Metabolic (ie, strial) presbycusis: is a result of what?
  2. What usually maintains the chemical and bioelectric balance and metabolic health of the cochlea?
  3. Atrophy of this results in what?
A
  1. This condition result from atrophy of the stria vascularis.
  2. The stria vascularis
  3. Atrophy of the stria vascularis results in hearing loss represented by a flat hearing curve because the entire cochlea is affected.
104
Q

Mechanical (ie, cochlear conductive) presbycusis: results from what?

A

This condition results from thickening and secondary stiffening of the basilar membrane of the cochlea. The thickening is more severe in the basal turn of the cochlea where the basilar membrane is narrow.

105
Q

Presbycusis clinical presentation?

4

A

Patients typically may have more

  1. difficulty understanding rapidly spoken language,
  2. vocabulary that is less familiar or more complex, and
  3. speech within a noisy, distracting environment
  4. Localizing sound is increasingly difficult as the disease progresses.
106
Q

Prebycusis treatment?

4

A
  1. Amplification devices:

Properly fitted hearing aids may contribute to the rehabilitation of a patient with presbycusis.

Older patients with arthritis in their fingers and visual difficulties need extra help in learning to use hearing aids.

Patients using hearing aids may still experience difficulties with speech discrimination in noisy situations.

  1. Lip reading
  2. Cochclear implants
  3. Assistive listening devices:

Range from a simple amplification of the telephone signal to a device on the television that sends a signal across the room to a headset worn by a patient with hearing loss.

107
Q

Some patients with presbycusis benefit from cochlear implants. Patients with what are the best candidates? 2

A
  1. Patients with cochlear changes and
  2. relatively intact spiral ganglia and central pathways

appear to be the best candidates.

108
Q
A

ENT (8 decks)

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