Disorders of the Ear

Question 1

why are kids more susceptible to ear infections?

Answer 1

their eustachian tubes are more horizontal

Question 2

what does cerumen do in the ear?

Answer 2

• “washes”- keeps clear of bacteria and microbes
• creates acidic environment (fungus don’t like this)
• vinegar to clean fungus in ear

Question 3

perichondritis

Answer 3

rare but serious
infection of ear cartilage
(doesn’t respond well to injury b/c bad blood supply)
-cause: usually trauma and psuedomonas

Question 4

Dx perichondritis vs cellulitis

Answer 4

cellulitis will infect soft tissues as well (ear lobes) and is more likely to be bilateral than periC.

Question 5

what is otitis externa?

Answer 5

generic term for inflamm disorders of EAR CANAL

1. swimmer’s ear (H2O dries out canal, like irritation contact derm )
2. often fungal infection

Question 6

txt for OE? fungal, bacterial, swimmers

Answer 6

lidocaine to numb then wick to get drops in
fungal: 2%HAc aka vinegar
bacterial- abx w/ anti-inflamm (steroid) OR 2%HAc if pseudomonas
swimmers: alcohol

Question 7

ceruminosis

Answer 7

excessive cerumen production

Question 8

what is AOM?

Answer 8

acute otitis media: bacterial infection of the middle ear

cause: S. Pneumo, M. Cat, H. Flu (3 most common for any URI)
* usually preceded by URI

Question 9

if there is no effusion can it be AOM?

Answer 9

NO

Question 10

AOM vs OME in terms of effusion?

Answer 10

AOM: purulent effusion, S&S of inflammation
OME: serous effusion, no S&S of inflammation

Question 11

when looking at TM, Dx of AOM?

Answer 11

mild TM bulge AND ear pain or intense TM erythema

• may respond to POSITIVE pressure on pneumatic otoscopy
• should see altered position of cone of light

Question 12

those at risk for AOM?

Answer 12

6m-18m
males 
daycare
pacifier user 
parents who smoke
bottle-feeder (instead of breast)

Question 13

what must you document for AOM according to the AAP?

Answer 13

evidence of TM immobility (by tympanogram or pneumatic otoscopy)

Question 14

a flat Tymp. test result means what?

Answer 14

immobile TM?

Question 15

meds for AOM: ibuprofen vs tylenol?

Answer 15

ibuprofen: anti-flamm
tylenol: just for pain

Question 16

when looking at the TM, Dx of OTE?

Answer 16

TM: neutral or retracted

-responds to NEGATIVE pressure on pneumatic otoscopy

Question 17

2 AOM txt goals

Answer 17

1. decrease pain and fever
2. prevent developmental delays
   most heal spontaneously, if not give abx (75% do well regardless of txt)

Question 18

Hadley’s “SNAP”

Answer 18

“safety net abx prescription”
tell pt, if symptoms don’t improve w/in 48-72 hrs of the onset of symp, THEN fill Rx
=reduced pointless abx usage

Question 19

AOM guidelines for txt depend on what 3 pt factors?

when to treat with abx?

Answer 19

severe or nonsevere symptoms
unilateral or bilateral
age
*otorrhea, bilat and severe symp? TREAT w/ Abx

Question 20

txt abx 1st and 2nd lines for AOM?

Answer 20

1st: Amox
2nd: Augmentin

Question 21

pt should improve after how many days on abx for AOM?

if they dont?

Answer 21

3 days

if not- give broad spectrum ABX

Question 22

how long can effusion last for AOM?

Answer 22

12 wks

Question 23

what can help prevent ear infections?

Answer 23

NOT chemoprophalaxis (no longer reccomended) 
Vaccines do! against invasive pneumococcal disease (H.Flu) and influenza 
-tymp tubes

Question 24

H. Flu txt?

Answer 24

it is BetaLact. resistant. txt w/ augmentin

Question 25

better name for OME would be? why?

Answer 25

MEE (middle ear effusion)
there is NO infection, fluid is serous
effusion w/out acute symptoms

Question 26

what meds are of no value for OME?

Answer 26

Abx: b/c it is not an infection

Anti-histamines and decongestants: no longterm value

Question 27

OME concerns

Answer 27

hearing loss–>effect on speech, language and learning
-at-risk populations need to be evaluated sooner
(young-speech delay, development disorder)
-non at-risk: 3 months is ok to go w/out hearing

Question 28

primary diagnostic method to distinguish OME from AOM?

Answer 28

pneumatic otoscopy

-tympanometry is an option as well (more expensive)

Question 29

hearing test guidelines: level of decibels for normal or not normal

Answer 29

0-20dBs = normal hearing (this refers to the amount of volume raised in order to hear the sound)
21-39dB is abnormal (mild hearing loss)
>40dB is abnormal (moderate hearing loss)

Question 30

what is BPPV?dx? txt?

Answer 30

benign paroxysmal (comes and goes) positional vertigo 
Dx: positional change = nausea
 txt: antiemetics, otolith repositioning, habituation

Question 31

what is vertigo?

Answer 31

brain is getting mixed signals from inside the semicircular canals (rocks moving around and bending cilia- they get stuck and continuously stimulate cilia cells)

Question 32

what is the dix-hallpike maneuver?

Answer 32

to localize labryinthe dysfunction

-positive test w/ affected ear down = nystagmus (lateral eye twitch) towards affected ear

Question 33

what is the epley maneuver?

Answer 33

to fix vertigo - reposition otoliths

* you can also habituate vertigo by performing movements that produce symptoms over and over

Question 34

what is the pathophys cause of meniere’s disease?

Answer 34

inner ear disorder aka idiopathic endolymphatic hydrops (extra endolymph fluid in cochlea)= pressure=vertigo

Question 35

what is the triad of symptoms with meniere’s disease? what about w/ back attacks?

Answer 35

1. hearing loss
2. tinnnitus
3. vertigo
   * fall-down with bad attacks, difficulty walking

Question 36

Ddx for meniere’s should include what disease that is commonly included in many Ddx?

Answer 36

syphilis

Question 37

txt for meniere’s ?

Answer 37

send to ENT
-meclizine for nausea
-scolpolamine patch behind ear
diuretics and low sodium diet (reduce fluid)
endolymph shunt (surgical- drain in cochlea)

Question 38

what is vestibular neuronitis?

Answer 38

suddent onset of vertigo related to neural afferents W/OUT inflamm.

• possible HSV cause (in vestibular ganglia)
• may have hearing loss

Question 39

what is labyrinthitis?

Answer 39

inflamm disorder of inner ear or labyrinth

• URI preceding- but can be bacterial or viral
• ALWAYS has hearing loss but does NOT recur (unlike Vest. N)