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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
What vascular abnormalities can be indicated in a person with pulsatile tinnitus -- five things?
glomus tumor, venous sinus stenosis, carotid vaso-occlusive disease, ateriovenous malformation. aneurysm
26
What is staccato tinnitus?
rapid series of pops or clicks with sensation of ear fluttering
27
What is labyrinthitis?
acute onset of continuous, severe vertigo causing an abnormal sensation of movement; also involves tinnitus and hearing loss
28
What causes labyrinthitis?
unknown but tends to occur after URI
29
How do you treat labyrinthitis?
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
30
What are two examples of vestibular suppressants and what do they treat?
help to treat labyrinthitis; diazepam and meclizine
31
What is the recovery process of labyrinthitis like? Does hearing return to normal?
gradual recovery with improvement over several weeks; hearing may return to normal or be permanently affected
32
Meniere's Disease/Syndrome is also known as...
endolymphatic hydrops
33
What is Meniere's Disease?
vertigo syndrome due to peripheral lesion
34
What is the pathophysiology of Meniere's Disease?
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
What causes Meniere's Disease?
unknown in most cases; some cases caused by syphillis and head trauma
36
How do patients with Meniere's Disease present (four things)?
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
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?
Meniere's Disease
38
How do you diagnose Meniere's Disease?
referral to ENT/audiology; caloric testing
39
How is Meniere's Disease treated?
diuretics, low salt diet, intratympanic corticosteroid injection, surgical intervention if symptoms progress
40
What three surgeries can be used for Meniere's Disease?
endolymphatic sac decompression vestibular ablation with gentamycin labyrinthectomy
41
What are endolymphatic hydrops?
found in Meniere's DIsease; a type of swelling of the endolympatic compartment that leads to permanent damage of the inner ear structures
42
An acoustic neuroma is also called..
vesticular schwannoma
43
Is an acoustic neuroma a common or rare intracranial tumor?
It is one of the most common intracranial tumors!
44
An acoustic neuroma is a ____ tumor of cranial nerve __ that begins in the ___. It gradually grows to compress the __, causing ___.
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
Are acoustic neuromas usually bilateral or unilateral?
unilateral
46
How are acoustic neuromas diagnosed?
MRI
47
How do acoustic neuromas present (two things)?
unilateral hearing loss and continuous dyequilibrium
48
How are acoustic neuromas treated?
observation, surgical excision, ratiotherapy
49
What is the definition of vertigo?
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
Vertigo's association with ___ is a key to diagnosis.
hearing loss
51
Differentiation of __ vs. ___ causes is important in diagnosing vertigo.
central vs. peripheral
52
central vertigo vs. peripheral vertigo: onset
``` central = gradual onset peripheral = sudden onset ```
53
central vertigo vs. peripheral vertigo: auditory symptoms
Central doesn't have auditory symptoms like tinnitus; peripheral does -- tinnitus and hearing loss
54
Which type of vertigo involves horizontal nystagmus?
peripheral
55
What four conditions lead to peripheral lesions/vertigo?
Meniere’s Disease Labyrinthitis Benign Paroxysmal Positional Vertigo (BPPV) Perilymphatic Fistula
56
What five conditions lead to central lesions/vertigo?
``` Brainstem vascular disease Arteriovenous malformations (AVMs) Tumors of brainstem and cerebellum Multiple sclerosis (MS) Vertebrobasilar migraine ```
57
What kind of vertigo is severe enough that the patient cannot walk or stand?
peripheral
58
What kind of vertigo is associated with nausea and vomiting?
peripheral (important in the diagnosis!)
59
How long are the episodes in peripheral vertigo?
seconds, minutes, hours, days -- varies!
60
What are four triggers of peripheral vertigo?
high salt diet, stress, fatigue, bright lights
61
What would be two physical examination findings in a patient with peripheral vertigo?
eye motion in response to head turning; nystagmus (horizontal with rotary component, fast phase beats away from affected side)
62
What manuever can be used to differentiate peripheral vs. central vertigo? What is a "positive finding," and how is the test done?
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
When a central vertigo is suspected, what diagnostics are indicated?
audiometry caloric stimulation MRI other diagnostics
64
What does BPPV stand for?
benign paroxysmal positional vertigo
65
What is the most common vestibular disorder?
benign paroxysmal positional vertigo
66
Benign paroxysmal positional vertigo appears in clusters that lasts for...
several days
67
Benign paroxysmal positional vertigo is associated with changes in __ position.
head position, like rolling over in bed
68
How does benign paroxysmal positional vertigo differ from central vertigo?
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
How is benign paroxysmal positional vertigo treated?
physical therapy or occupational therapy, Epley maneuver, pharmaceutical agents, bed rest if severe
70
Patients with vertigo are at risk for __.
falls
71
Because BBPV is associated with _____, the Epley maneuver addresses this.
free floating otoconia/canaliths within the semicircular canal
72
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
B. Consult ENT emergently!
73
What causes acute mastoiditis?
extension of infection from middle ear space into mastoid air cells
74
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?
the facial nerve courses through the middle ear and can become inflamed leading to paresis
75
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?
``` high dose IV antibiotics insertion of tympanostomy tube for drainage emergent mastoidectomy (maybe) ```

Foundations II (11 decks)

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