Disorders of the Ear - Waldron Flashcards
What is the most common cause of hearing impairment in the elderly
cerumen impaction (ear wax)
what is within the middle ear
incus, stapes and malleus
what is the inner ear
the bone structure itself
semicircular canals
cochlea
oval window
nerves
what is the placement of the Weber test
top of the head
what is the placement of the Rinne test
mastoid bone behind the ear
What is another name for swimmers ear
otitis externa
what are the potential organisms with swimmers ear
Bacterial: p.aeroginosa, s. aureus, proetus, klebsiella, e.coli
Fungal: aspergillus niger, candida albicans
What is another name for Ramsay-Hunt syndrome
Zoster oticus
what is Ramsay-Hunt syndrome
herpes zoster infection
presents with severe pain with facial paralysis
vesicular eruption (ear, face, or palate)
hearing loss/vertigo
what is a otomycosis
fungal ear infection
what type of otitis externas require ASAP EENT referrals
malignant otitis externa and granulation tissue
what is the treatment of otitis externa
clear ear canal (debris/pus can prevent medications from reaching infection)
acidify ear canal
keep water out of the ear
what is another major concern with Ramsy-Hunt
eyes - need eye care
what are the antibacterial ototopical medications
Cortisporin and Fluoroquinolones
What are the anti-inflammatory ototopical medication
abx combo with steroid to reduce inflammation
-VoSol HC
-Ciprodex
-Cipro HC
-Corticosporin
what antibacterial ototopical medication is not ototoxic
fluorqinolones
what are the antifungal ototopicals
clotrimazole and Nystatin (candida)
voraconizole (aspiergillus)
What is a pope sponge
ear wick
keeps ear canal patent
keeps meds in contact with ear canal
what is auricular hematoma
a blunt/sheer trauma injury that causes a hematoma between the cartilage/perichondrium
what is the treatment for auricular hematoma
I&D - recommended with EENT
compressive dressing
anti-staph antibiotics
What are complications of auricular hematomas
infection/abscess
“cauliflower” ear
what are the three important functions of the eustachian tube
equalizes pressure in middle ear
drains thin mucus produced in middle ear
prevents reflux of fluid into middle ear
what are dangerous foreign objects in the ear canal
beans and button batteries
What is the treatment of ETD
treat underling nasal problems
nasal steroid sprays
for air travel: gum chewing, decongestant spray
what is the treatment of patulous eustachian tube (PET)
estrogen nasal drops (females)
weight stabilization
surgery?
what can cause TM performations
infection
ETD
penetrating trauma (q-tip)
base of skull fracture
barotrauma
what tests are used for TM perforations
Pneumotoscopy
tuning fork examination
audiogram
how do you treat a traumatic TM Perforations
most close with time
keep water out of the ear
otic abx drops?
surgical evaluation if non-healing after 6 weeks
what are the different classification types of otitis media
types: serous and suppurative
durations: acute and chronic
Designations: with perforation and without perforations
what is OME
otitis media with effusion
presence of fluid in the middle ear WITHOUT signs or symptoms of acute ear infection
What is RAOM
Recurrent acute otitis media
multiple episodes of AOM
symptom free periods
What is COME
Chronic otitis media with Effusion
persistent fluid. in the middle ear
no signs of inflammation (fever, otalgia)
What is AOM
acute otitis media
infectious, inflammatory condition of the middle ear
effusion behind intact tympanic memebrane
what are contributing factors for AOM
URI
ETD
What are risk factors for AOM
Male
large # of siblings
Daycare
what groups are at high risk of AOM
Trisomy 21 (downs)
immune deficiency
Native American
Whaat are the causes of AOM
viral URI
bacterial URI
allergic rhinitis
ETD
what are symptoms of AOM
ear pain
hearing loss
fever?
drainage?
What is the treatment of acute serious otitis media
treat underlying illness (symptomatic/supportive)
TIME
surgical drainage if needed
NOT A BACTERIAL INFECTION - ABX NOT NEEDED
what is the medical management of uncomplicated ASOM
amoxicillin (90mg/kg/day divided Q12h for 10d)
if PCN allergy: Erythromycin or clindamycin with Bactrim
cephalosporins
fluoroquinolones (only adults)
when should ABX be changed for ASOM
if worsening of not improving after 48-72 hours
What is the management of ASOM with performation
oral abx
aural abx (fluoroquinolones)
water precautions
f/u to assure closure
What are complications of otitis media
facial paralysis
mastoiditis
subperiosteal abscess
meningitis
brain abscess
What is the concern with unilateral Otitis Media
should raise suspicion of nasopharyngeal mass blocking ET orifice
What are the pediatric AOM abx treatments
amoxicillin
add beta-lactamase coverage (augmentin)
or
Azithromycin (single dose)
what are the indications for tubes
recurrent AOM: > 3 separate episodes in 6 months OR > 4 episodes in 12 months
*should have effusion at time of consult
What is the most common reason for tubes
chronic non-suppurative otitis media
What is the medical management of chronic otitis media
autoinsufflation; +/- steroids; recheck 6-8 weeks; consider allergy evaluation, NO abx unless other sites of bacterial infection
when do you refer for chronic otitis media
severe TM retraction
failure to improve in 2-3 months
persistent UNILATERAL effusion
significant hearing loss - especially in children
What is cholesteatoma
keratoma or skin where it does not belong
congenital or primary
secondary or acquires
SURGICAL disease
what is the presentation of Acute Mastoiditis
> 80% have no hx of recurrent OM
persistent otorrhea >3wks is most consistent sign of mastoid involvement
persistent fever despite abx
pain deep or behind the ear, worse at night
hearing loss is common
elevated WBC
What is the treatment of Acute mastoiditis
surgery - mastoidectomy
what is vertigo
abnormal sense of motion characterized by a spinning sensation
what are the types of vertigo
central (neurology/cardiology)
peripheral (otolaryngology)
systemic
what is Oscillopsia
jumping images
what areas are responsible for maintaining equilbrium
eyes
labyrinth
CNS
how is vertigo diagnosed/worked up
audiology: assess peripheral vestibular system
imaging: assess CNS
Blood tests: assess Systemic
What is the gold standard test for vertigo
MRI with Gadolinium contrast
what is the most important test with vertigo
audiogram
What is the most common cause of vertigo
BPPV (benign paroxysmal positional vertigo)
what is BPPV
benign paroxysmal positional vertigo
a phantom sensation of motion of elicited by specific changes in head position
caused by placing the affected ear downward
associated with characteristic eye movements (nystagmus)
What is Meniere’s syndrome
condition of excess pressure accumulation in inner ear
what are the four main features of menieres syndrome
atttacks of vertigo
fluctuating hearing loss (usu. low frequency)
tinnitus
aural fullness (pressure sensation in the ears)
how do you diagnose/work up menieres syndrome
inner ear inflammation, infection or trauma (autoimmune, syphilis, allergy)
Metabolic/endocrine (high cholesterol/triglycerides, thyroid disease, diabeses)
idiopathic
What is vestibular neuritis / neuronitis labrynthitis
viral infection / inflammation of nerve / labyrinth
think along the lines of Bell’s palsy
watch out for Ramsey Hunt Syndrome
What is Pathognomonic for BPPV
positive Dix Hallpike maneuver
what are the management steps for acute prostrating vertigo
pt presents to the ED
1. quick evaluation to r/o catastrophic event
2. establish IV - replaced fluids and electrolytes
3. stop vomiting and vertigo
4. re-evaluate
What is the treatment of vertigo
tx should be directed towards a specific cause if identified
BPPV: Epleys
how do you treat menieres disease
low salt diet
diuretics
vasodilators
avoidance of caffeine and alcohol
intratympatic gentimycin
surgery for worse cases
What causes conductive hearing loss
something that stops sound from getting through to the outer or middle ear
blockage of ear canal, perforated drum, problems with ossicles, or fluid in middle ear
most cases can be improved
What are the causes of sensorineural (SNHL)
most common type:
loss due to pathology (damage) of cochlea, auditory nerve or CNS
common causes: exposure to loud noises, genetic factors or natural aging process
What is acoustic neuroma
unilateral SNHL
dizzy but not vertigo
“Great Masquerader”
RARE
aka Vestibular schwannoma
What is the treatment of Acoustic Neuroma / Vestibular schwannoma
observation: if small and dose not cause symptoms
surgical removal
radiation: stop tumor from growing
What is the cause of sudden sensorinuural hearing loss
Acustic neuroma / vestibular schwannoma
What test assesses the tympanic membrane mobility
tympanometry testing
what is air conduction testing
pure tone testing uses headphones in which tones are sounded off in each of the ears
What is bone conduction testing
direct stimulation of inner ear, bypassing outer and middle ear
microphone is placed behind the ear and sound enters the skull through the mastoid bone
What is the difference between air and bone conduction with SNHL
minimal to no difference between air and bone
What is congenital hearing loss
can appear at birth or progress later in life - need to monitor speech development in infancts/toddlers
usually SNHL
What is otosclerosis
gradual stiffening of the ossicles, causing progressive conductive hearing loss
can be unilateral or bilateral
more common in Females in the family
what is Presbycusis
age related hearing loss - usually bilateral
usually greater for high pitched sounds
what is the management/treatment of presbycusis
devices/mechanical aids: vibrating alarms, flashing phones/doorbells, TV listening systems, personal amplifiers
hearing aids
what is the management of conductive hearing loss
medical treatment
hearing aids or hearing implants: bone conduction devices
surgery
What is the management of SNHL
conventional hearing aids or an implantable hearing device, i.e. cochlear implant
what is the workup for pediatric hearing loss
medical/family/birth history
physical exam - otoscopy
neonatal screen results
behavioral audiogram
tympanogram, OAE exam, ABR results
labs?
audiometric testing, serial audio testing
adjunctive input
What are the adjunctive input for pediatric hearing loss
ophthalmology, genetics, developmental pediatrics
What is tinnitus
the perception of noise in the absence of acoustic stimulus outside of the body
symptom NOT a disease
what is the most common identified cause of tinitus
SNHL
What is the treatment of tinnitus
avoid dietary stimulants (cola, coffee, tea)
smoking cessation
avoid medications: ASA, NSAIDS, many others
reassurance
feedback training
White noise and other maskers
