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Foundations II > Disorders of the Ear II > Flashcards

Disorders of the Ear II Flashcards

1
Q

How do you treat a traumatic auricular hematoma?

A

These must be recognized promptly! Treatment involves drainage.

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2
Q

What are some complications of an untreated hematoma of the external ear (auricular hematoma)?

A

If you don’t drain the ear, the patient could have a significant ear deformity or blockage of the canal (cauliflower ear). Also, untreated hematomas can lead to the dissolution of cartilage of the ear.

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3
Q

What is otic barotrauma?

A

involves inability to equalize the pressure exerted on the middle ear during air travel, rapid altitude change, or underwater diving; poor Eustachian tube function

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4
Q

What can cause poor Eustachian tube function (two things)?

A

mucosal edema (can be caused by congestion or a viral URI), or congenital narrowing

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5
Q

How was otic barotrauma present and when are these symptoms most likely felt?

A

otalgia = ear ache or pain in ear; usually occurs during plane descent

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6
Q

How do you treat otic barotrauma?

A

Enhance Eustachian tube function by taking systemic decongestants a few hours before flying, and topical nasal decongestants an hour before descent. And AVOID otic barotrauma!

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7
Q

What can you tell patients to do when they are flying in order to avoid discomfort in the ears?

A

swallow, yawn, or autoinflate frequently during the descent

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8
Q

___ middle ear pressure causes collapse of the ___, creating a blockage.

A

Negative middle ear pressure causes collapse of the Eustachian tube, creating a blockage.

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9
Q

When diving, pain will develop within the first __ feet if pressure is not equalized to the middle ear.

A

15

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10
Q

What two things could happen if a diver does not descend slowly and equilibrate their middle ears in stages?

A
  1. hemotympanum

2. perilymphatic fistula = rupture of oval window, sensory hearing loss, acute vertigo, vomiting

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11
Q

What are some complications that may result from the chronic negative pressure in the middle ear in otic barotrauma?

A

TM rupture (often followed by a middle ear infection), persistent pressure after landing

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12
Q

What procedure can help give immediate relief of severe otalgia and hearing loss?

A

myringotomy

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13
Q

What is a cholesteotoma?

A

a specfic type of chronic otitis media that involves a sac lined with epithelium

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14
Q

How is a cholesteatoma caused?

A

The most common cause is a prolonged Eustachian tube dysfunction. Chronic negative middle ear pressure draws in a part of the TM, creating a sac lined with epithelium.

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15
Q

How does a cholesteatoma present?

A

erosion of bone (ossicles and mastoid), erosion (into inner ear, facial, nerve, and intracranially), and chronic infection

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16
Q

What would you see upon PE of someone with a cholesteotoma?

A

TM pocket or TIM perforation exuding debris

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17
Q

How do you treat a cholesteatoma?

A

surgical marsupialization of sac

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18
Q

What is tinnitus?

A

perception of abnormal ear or head noises

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19
Q

What are the sounds like in tinnitus?

A

mild, high pitched sounds lasting seconds to minutes (tonal tinnitus)

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20
Q

Tinnitus can be associated with __ hearing loss.

A

sensorineural

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21
Q

Tinnitus may be the first symptom in __-induced hearing loss.

A

drug

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22
Q

What complications can severe tinnitus cause?

A

When severe and persistent, can interfere with sleep and concentration causing significant psychological stress

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23
Q

How do you treat tinnitus?

A

avoid exposure to excessive noise and ototoxic agents; masking with music or hearing; medications like oral antidepressants; transcranial magnetic stimulation; implantable brain stimulators

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24
Q

What is pulsatile tinnitus?

A

described as listening to one’s own heartbeat

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25
Q

What vascular abnormalities can be indicated in a person with pulsatile tinnitus – five things?

A

glomus tumor, venous sinus stenosis, carotid vaso-occlusive disease, ateriovenous malformation. aneurysm

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26
Q

What is staccato tinnitus?

A

rapid series of pops or clicks with sensation of ear fluttering

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27
Q

What is labyrinthitis?

A

acute onset of continuous, severe vertigo causing an abnormal sensation of movement; also involves tinnitus and hearing loss

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28
Q

What causes labyrinthitis?

A

unknown but tends to occur after URI

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29
Q

How do you treat labyrinthitis?

A

antibiotics if patient is febrile or with symptoms of a bacterial infection; vestibular suppressants during the acute phase (short term use to prevent LONG term dysequilibrium from inadequate compensation); supportive care

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30
Q

What are two examples of vestibular suppressants and what do they treat?

A

help to treat labyrinthitis; diazepam and meclizine

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31
Q

What is the recovery process of labyrinthitis like? Does hearing return to normal?

A

gradual recovery with improvement over several weeks; hearing may return to normal or be permanently affected

32
Q

Meniere’s Disease/Syndrome is also known as…

A

endolymphatic hydrops

33
Q

What is Meniere’s Disease?

A

vertigo syndrome due to peripheral lesion

34
Q

What is the pathophysiology of Meniere’s Disease?

A

distention of the endolymphatic compartment of the inner ear; symptoms wax and wane as the endolymphatic pressure rises and falls – this can permanently damage inner ear structures!

35
Q

What causes Meniere’s Disease?

A

unknown in most cases; some cases caused by syphillis and head trauma

36
Q

How do patients with Meniere’s Disease present (four things)?

A

recurrent and progressive group of symptoms – dizziness or episodic vertigo with discrete spells lasting 20 minutes to several hours, chronic low frequency sensorineural hearing loss, tinnitus with a low tone/blowing quality, sensation of unilateral ear pressure

37
Q

What condition presents with episodic vertigo with discrete spells lasting 20 minutes to several hours, low frequency sensorineural hearing loss, tinnitus with a low tone/blowing quality, sensation of unilateral ear pressure?

A

Meniere’s Disease

38
Q

How do you diagnose Meniere’s Disease?

A

referral to ENT/audiology; caloric testing

39
Q

How is Meniere’s Disease treated?

A

diuretics, low salt diet, intratympanic corticosteroid injection, surgical intervention if symptoms progress

40
Q

What three surgeries can be used for Meniere’s Disease?

A

endolymphatic sac decompression
vestibular ablation with gentamycin
labyrinthectomy

41
Q

What are endolymphatic hydrops?

A

found in Meniere’s DIsease; a type of swelling of the endolympatic compartment that leads to permanent damage of the inner ear structures

42
Q

An acoustic neuroma is also called..

A

vesticular schwannoma

43
Q

Is an acoustic neuroma a common or rare intracranial tumor?

A

It is one of the most common intracranial tumors!

44
Q

An acoustic neuroma is a ____ tumor of cranial nerve __ that begins in the ___. It gradually grows to compress the __, causing ___.

A

An acoustic neuroma is a benign tumor of cranial nerve VIII that begins in the internal auditory canal. It gradually grows to compress the pons, causing hydrocephalus.

45
Q

Are acoustic neuromas usually bilateral or unilateral?

A

unilateral

46
Q

How are acoustic neuromas diagnosed?

A

MRI

47
Q

How do acoustic neuromas present (two things)?

A

unilateral hearing loss and continuous dyequilibrium

48
Q

How are acoustic neuromas treated?

A

observation, surgical excision, ratiotherapy

49
Q

What is the definition of vertigo?

A

sense of motion when there is no motion, or an exaggerated sense of motion in response to movement; feels like spinning, tumbling, or falling forward/backward

50
Q

Vertigo’s association with ___ is a key to diagnosis.

A

hearing loss

51
Q

Differentiation of __ vs. ___ causes is important in diagnosing vertigo.

A

central vs. peripheral

52
Q

central vertigo vs. peripheral vertigo: onset

A 
central = gradual onset
peripheral = sudden onset
53
Q

central vertigo vs. peripheral vertigo: auditory symptoms

A

Central doesn’t have auditory symptoms like tinnitus; peripheral does – tinnitus and hearing loss

54
Q

Which type of vertigo involves horizontal nystagmus?

A

peripheral

55
Q

What four conditions lead to peripheral lesions/vertigo?

A

Meniere’s Disease
Labyrinthitis
Benign Paroxysmal Positional Vertigo (BPPV)
Perilymphatic Fistula

56
Q

What five conditions lead to central lesions/vertigo?

A 
Brainstem vascular disease
Arteriovenous malformations (AVMs)
Tumors of brainstem and cerebellum
Multiple sclerosis (MS)
Vertebrobasilar migraine
57
Q

What kind of vertigo is severe enough that the patient cannot walk or stand?

A

peripheral

58
Q

What kind of vertigo is associated with nausea and vomiting?

A

peripheral (important in the diagnosis!)

59
Q

How long are the episodes in peripheral vertigo?

A

seconds, minutes, hours, days – varies!

60
Q

What are four triggers of peripheral vertigo?

A

high salt diet, stress, fatigue, bright lights

61
Q

What would be two physical examination findings in a patient with peripheral vertigo?

A

eye motion in response to head turning; nystagmus (horizontal with rotary component, fast phase beats away from affected side)

62
Q

What manuever can be used to differentiate peripheral vs. central vertigo? What is a “positive finding,” and how is the test done?

A

Hallpike Maneuver = quickly lowering the patient to supine position with head extending over the edge and placed 30 degrees lower than the body, turned left or right; positive test would show delayed onset fatiguable nystagmus in most peripheral cases; if the nystagmus is non-fatiguable, it is probably central

63
Q

When a central vertigo is suspected, what diagnostics are indicated?

A

audiometry
caloric stimulation
MRI
other diagnostics

64
Q

What does BPPV stand for?

A

benign paroxysmal positional vertigo

65
Q

What is the most common vestibular disorder?

A

benign paroxysmal positional vertigo

66
Q

Benign paroxysmal positional vertigo appears in clusters that lasts for…

A

several days

67
Q

Benign paroxysmal positional vertigo is associated with changes in __ position.

A

head position, like rolling over in bed

68
Q

How does benign paroxysmal positional vertigo differ from central vertigo?

A

There is a brief latency period following head movement before the symptoms occur, about 15 seconds, in BPPV. But in central vertigo there is no latent period.

69
Q

How is benign paroxysmal positional vertigo treated?

A

physical therapy or occupational therapy, Epley maneuver, pharmaceutical agents, bed rest if severe

70
Q

Patients with vertigo are at risk for __.

A

falls

71
Q

Because BBPV is associated with _____, the Epley maneuver addresses this.

A

free floating otoconia/canaliths within the semicircular canal

72
Q

A child with a recent history of acute otitis media presents with painful swelling of the area behind his right ear. The child is febrile and looks very ill. You notice he has a right facial paresis. On exam, you find a hyperemic and bulging right TM with purulent effusion. The TM is immobile to pneumatic testing. What is the most appropriate next step?
A. Insert a wick and start antibiotic drops
B. Consult ENT emergently
C. Prescribe high dose oral amoxicillin
D. Perform close outpatient follow up the following day after prescribing a nasal decongestant

A

B. Consult ENT emergently!

73
Q

What causes acute mastoiditis?

A

extension of infection from middle ear space into mastoid air cells

74
Q

A child with a recent history of acute otitis media presents with painful swelling of the area behind his right ear. The child is febrile and looks very ill. You notice he has a right facial paresis. What could be causing this?

A

the facial nerve courses through the middle ear and can become inflamed leading to paresis

75
Q

A child with a recent history of acute otitis media presents with painful swelling of the area behind his right ear. The child is febrile and looks very ill. You notice he has a right facial paresis. On exam, you find a hyperemic and bulging right TM with purulent effusion. The TM is immobile to pneumatic testing. What does the patient need treatment-wise?

A 
high dose IV antibiotics
insertion of tympanostomy tube for drainage
emergent mastoidectomy (maybe)

Foundations II (11 decks)

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