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Foundations II and III > Disorders of the Ear > Flashcards

Disorders of the Ear Flashcards

1
Q

Describe the Weber test

A

Tuning fork placed atop of head.

If sound lateralizes to Crummy (bad) ear = Conductive hearing loss.

If lateralizes to Super (good) ear = Senorineural loss.

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2
Q

Describe the Rinne test

A

Tuning fork placed on mastoid process, once pt cannot hear move fork in front of ear canal, pt should then be able to hear sound again, this is normal bc AC > BC.

If BC > AC abnormal Rinne test.

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3
Q

List disorders of the external ear

A

Cerumen impaction
FBs
Otits Externa “swimmers ear”
Hematoma

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4
Q

When would you NOT irrigate for cerumen impaction?

A

if TM is not intact or if known hx or risk of perforation

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5
Q

Describe treatment options for cerumen impaction?

A
  • Detergent ear drops - Debrox earwax removal kit, carbamide peroxide is generic
  • Mechanical removal w curette
  • Irrigation - if TM intact, body temp water only, canal must be dried after irrigation
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6
Q

Describe tx of FB in ears

A

Urgent if button batteries, live insects, or penetrating FB

Firm objects should be removed with loop or irrigation avoiding pushing closer to TM.

Organic FBs NOT irrigated but removed. Immobilize living insects - can use Lidocaine

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7
Q

Describe causes of Otitis Externa

A
  • Infection * most common
    Allergic
    Dermatological conditions (psoriasis)
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8
Q

What is Otitis Externa (OE)?

A

Inflammation of external auditory canal (EAC)

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9
Q

Bacteria associated with otitis externa

A

1 Pseudomonas - gram neg rod

S areus
S epidermidis

Also.. fungi (2-10% cases) Aspergillus and Candida

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10
Q

Describe clinical presentation of otitis externa

A
  • Otalgia (pain)
  • Pruritis (more common in fungal infection)
  • Purulent discharge
  • Hearing loss
  • Fullness
  • Hx of recent water exposure, mechanical trauma, perforation, perforation bc of topical drops
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11
Q

PE findings of Otitis Externa

A
  • Erythema/edema of ear canal skin
  • Purulent exudate
  • Tenderness
  • TM may be mildly erythematous
  • TM remains mobile with pneumatic otpscopy
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12
Q

DDx of otitis externa

A

Middle ear infection
Contact dermatitis
Psoriasis
Chronic suppurative otitis media
Squamous cell carcinoma of external canal
Radiation therapy
Herpes simplex virus - Ramsay Hunt Syndrome

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13
Q

What is Ramsay Hunt Syndrome?

A

An outer ear infection that is rare, characteristic vesicles on out ear canal with lateral facial paralysis, caused by herpes simplex virus

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14
Q

Tx of otitis externa

A

7-10 days topical aminoglycoside or fluoroquinolone Abx w or w/o corticosteroid (otic suspension)

Keep canal dry, avoid scratching, remove debris, can use wick if swelling significant

Severe OM w/ cellulitis of periauricular tissue need oral Abx

Refer to ENT if persistent OE or if pt immunocompromised or diabetic

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15
Q

Pts that are immunocompromised or diabetic are at risk for what complication of OE?

A

Malignant otitis externa aka necrotizing otitis externa -

increase risk for osteomyelitis of temporal bone/skull base

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16
Q

Describe presentation of malignant otitis externa?

A

Foul-smelling discharge, granulations in ear canal, deep otalgia, cranial nerve palsies, HA

Dx: CT – osseous erosion
Treatment-IV antibiotics (quinolones), surgery

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17
Q

Describe hematoma of external ear

A

often due to injury - wrestlers esp

traumatic auricular hematoma, must be recongnized promptly

Tx is drainage
Complication - cauliflower ear

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18
Q

Most common causative organisms of acute otitis media?

A 
#1 Streptococcus pneumonia 
#2 Haemophilus influenza 
#3 Moraxella catarrhalis

and also
S. pyogenes (group A step)
S. aureus

recurrent cases often associated with allergies or second hand smoke exposure

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19
Q

Describe pathophysiology of Acute Otitis Media

A
  • bacterial infections of middle ear, usu precipitated by URI - eustachian tubes obstruct, fluid/mucous accumulates becomes secondarily infected
  • underlying poor drainage from eustachian tubes due to age, inflammation/edema, congenital malformation
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20
Q

Clinical presentation and epidemiology of AOM

A

Otalgia/pressure
Hearing loss
Fever (children > adults)
URI symptoms

Most common in children 4-24 months, increased during winter and fall.

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21
Q

A tympanic membrane with bullae is associated with what microorganism?

A

mycoplasma

22
Q

PE of AOM

A

TM immobile
erythematous and bulging
possible TM rupture

23
Q

1st line treatment of AOM**

A

high dose amoxicillin (80-90 mg/kg/day divided twice daily)

24
Q

2nd line Tx of AOM

A

High-dose amoxicillin-clavulanate or 2nd or 3rd generation cephalosporin

25
Q

Tx of AOM with perforated TM

A

Include topical antibiotic with low ototoxicity (ofloxacin)

26
Q

Describe observation vs antibiotics for AOM

A

Observation
if 6 mo-2yr with unilateral AOM and mild sxs
if >2yr with unilateral or bilateral AOM and only mild sxs

Abx if worsening or no improvement in 48-72hrs

Immediate Abx if
under 6 mo
under 2yr with severe AOM, moderate or severe sxs, pain >48hrs, Temp > 102.2 F (39C), bilateral AOM

27
Q

Complications of AOM

A
  • Labyrinthitis. -inflammation into the semicircular canals
  • Hearing loss
  • Mastoiditis (high risk in immunocompromised, Tx IV Abx or mastoidectomy)
  • Non-response to meds (resistant organisms, change Abx)
  • Reccurent infections (may require tympanostomy - pressure equalizing tubes)
28
Q

Describe presentation and PE of chronic otitis media

A 
Chronic otorrhea (drainage) 
PE - perforated TM and conductive hearing loss
29
Q

Tx for chronic otitis media

A
  • Removal of infected debris
  • Earplug use (recc to prevent water/moisture)
  • Topical or oral antibiotics (that are not ototoxic)

-Surgery – TM repair

30
Q

Describe serous otitis media aka otitis media with effusion

A

Eustachian tube stays blocked for a prolonged time, negative pressure moves fluid into middle ear.

Children > adults, tubes more narrow and horizontal

Adults occurs after URI, barotrauma, or chronic allergies

31
Q

PE of serous otitis media

A

TM dull and hypOmobile
Bubbles visible
Conductive hearing loss

32
Q

Describe a cholesteatoma

A

specific type of chronic otitis media
creates sac lined w squamous epithelium that produces keratin, can get secondarily infected (pseudomonas or proteus)

presentation may be asymptomatic or hearing loss, possible ear drainage

33
Q

Describe tx and complications of a cholesteatoma

A

Tx- Abx drops, surgical removal

Complications- erosion into inner ear, facial nerve, brain, abscess

34
Q

Describe eustachian tube dysfunction

A

edema of tubal lining traps air in middle ear causing negative pressure can be caused by viral URI or allergies

on PE retraction of TM and decreased mobility of TM on pneumatic otoscopy

35
Q

Tx options for ET dysfunction

A 
Decongestants (topical intranasal or systemic oral) 
Autoinflation 
Desensitization therapy (allergies) 
Intranasal corticosteroids 
Surgery
36
Q

What is Labyrinthitis? Describe its presentation

A

inflammation into the semicircular canals - a possible complications of AOM, often occurs post viral infection

acute onset of severe continuous vertigo
\+/- hearing loss and tinnitus
N/V
gait impairment 
*cerebellar hemorrhage/infarct risk?*
37
Q

Describe conductive hearing loss

A

usually a dysfunction of external and middle ear in transmitting sound to inner ear (cochlea)

air conduction measures conductive hearing

38
Q

Describe sensorineural hearing loss

A

Sensory loss – dysfunction of cochlea from loss of hair cells

Neural loss – dysfunction of CN 8 (vestibulocochlear) or central auditory pathway

Most common = presbycusis (aging)

39
Q

Tinnitus is associated with what kind of hearing loss?

A

Sensory hearing loss

Tinnitus is perception of sound in ear or head. Variability exists in sound quality, pitch, and duration

40
Q

Peripheral causes of vertigo

A 
Vestibular neuritis/Labyrinthitis
Meniere disease
BPPV
Ethanol intoxication
Inner ear barotrauma
Semicircular canal dehiscence
41
Q

Central causes of vertigo

A 
Seizure
Multiple sclerosis
Wernicke encephalopathy
Chiari malformation
Cerebellar ataxia syndromes
42
Q

What should you be concerned of with Labyrinthitis/not miss?

A

cerebellar hemorrhage or infarct

  • evaluate nystagmus
  • other neuro sxs
  • risk category

consider neuroimagining

43
Q

Differentiate clinical presentation of Central vs Peripheral Vertigo

A 
Central: 
gradual onset 
progressive increase in severity 
Nystagmus - usu vertical or torsional 
no auditory sxs
Peripheral: 
sudden onset 
acutely severe sxs 
N/V 
tinnitus, hearing loss 
Nystagmus- usu horizontal
44
Q

When is Dix-Hallpike maneuver used?

A

When assessing vertigo.

Positive test: delayed onset fatigable nystagmus in most peripheral causes

if nystagmus not fatigable, indicates central cause

45
Q

What is BPPV?

A

Benign paroxysmal positional vertigo

Peripheral cause of vertigo

caused by sediment in semicircular canals, provoked by changes in head position

  • acute vertigo x 10-60 seconds, imbalance x several hours
  • episodes brief in duration often recurrent
  • appear in clusters lasting several days
46
Q

Describe treatment options for BPPV

A

Particle repositioning maneuvers - Epley maneuver

PT/OT referral

Pharmaceutical agents (vestibular suppressants)

Bed rest if severe

Pt ed, risk for falls

47
Q

What is another name for Meniere Disease

A

Endolymphatic hydrops

48
Q

Describe Meniere Disease

A

Def: vertigo syndrome due to a peripheral lesion

Distention of endolymphatic compartment of inner ear, pressure rises and falls - sxs wax and wane. Can permanently damage inner ear structures.

49
Q

Clinical presentation of Meniere Disease

A

-episodic vertigo, spells lasting 20 mins - several hrs
(vs BPPV vertigo lasting <1 min)

  • fluctuating sensorineural hearing loss (low frequency!)
  • tinnitus
  • sensation of unilateral ear pressure (aural fullness)
50
Q

Describe Pathophys of vestibular schwannoma aka acoustic neuroma

A

one of most common intracranial tumor; benign tumor of CN 8 begins in internal auditory canal, gradually grows to compress pons and causes hydrocephalus

usually unilateral

51
Q

Clinical presentation, Dx, and Tx of acoustic neuromas

A

Unilateral hearing loss - most common
Continuous dysequlibrium
Tinnitus

Dx: Audiometry, MRI

Tx:
Observation, Surgical excision, Radiotherapy

52
Q

Epley maneuver is used to treat what vestibular disorder?

A

BPPV

  • pt upright, legs extended
  • head rotated 45degrees (towards side of + Dix-Halpike test)
  • pt quickly and passively forced down in supine position, 30 degrees neck extension
  • observe for primary stage nystagmus, 1-2 minutes
  • pt head rotated 90 degrees, held in position 1-2 mins
  • pt roles on shoulder, pt looking down at 45 degree angle, remains here 1-2 mins
  • pt slowly brought upright maintaining 45 degree rotation of head, for 30 secs

Foundations II and III (10 decks)

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