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CLIN MED 3 - HEENT > Disorders of the Ear - Waldron > Flashcards

Disorders of the Ear - Waldron Flashcards

1
Q

What is the most common cause of hearing impairment in the elderly

A

cerumen impaction (ear wax)

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2
Q

what is within the middle ear

A

incus, stapes and malleus

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3
Q

what is the inner ear

A

the bone structure itself
semicircular canals
cochlea
oval window
nerves

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4
Q

what is the placement of the Weber test

A

top of the head

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5
Q

what is the placement of the Rinne test

A

mastoid bone behind the ear

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6
Q

What is another name for swimmers ear

A

otitis externa

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7
Q

what are the potential organisms with swimmers ear

A

Bacterial: p.aeroginosa, s. aureus, proetus, klebsiella, e.coli
Fungal: aspergillus niger, candida albicans

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8
Q

What is another name for Ramsay-Hunt syndrome

A

Zoster oticus

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9
Q

what is Ramsay-Hunt syndrome

A

herpes zoster infection
presents with severe pain with facial paralysis
vesicular eruption (ear, face, or palate)
hearing loss/vertigo

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10
Q

what is a otomycosis

A

fungal ear infection

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11
Q

what type of otitis externas require ASAP EENT referrals

A

malignant otitis externa and granulation tissue

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12
Q

what is the treatment of otitis externa

A

clear ear canal (debris/pus can prevent medications from reaching infection)
acidify ear canal
keep water out of the ear

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13
Q

what is another major concern with Ramsy-Hunt

A

eyes - need eye care

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14
Q

what are the antibacterial ototopical medications

A

Cortisporin and Fluoroquinolones

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15
Q

What are the anti-inflammatory ototopical medication

A

abx combo with steroid to reduce inflammation
-VoSol HC
-Ciprodex
-Cipro HC
-Corticosporin

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16
Q

what antibacterial ototopical medication is not ototoxic

A

fluorqinolones

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17
Q

what are the antifungal ototopicals

A

clotrimazole and Nystatin (candida)
voraconizole (aspiergillus)

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18
Q

What is a pope sponge

A

ear wick
keeps ear canal patent
keeps meds in contact with ear canal

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19
Q

what is auricular hematoma

A

a blunt/sheer trauma injury that causes a hematoma between the cartilage/perichondrium

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20
Q

what is the treatment for auricular hematoma

A

I&D - recommended with EENT
compressive dressing
anti-staph antibiotics

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21
Q

What are complications of auricular hematomas

A

infection/abscess
“cauliflower” ear

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22
Q

what are the three important functions of the eustachian tube

A

equalizes pressure in middle ear
drains thin mucus produced in middle ear
prevents reflux of fluid into middle ear

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23
Q

what are dangerous foreign objects in the ear canal

A

beans and button batteries

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24
Q

What is the treatment of ETD

A

treat underling nasal problems
nasal steroid sprays
for air travel: gum chewing, decongestant spray

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25
Q

what is the treatment of patulous eustachian tube (PET)

A

estrogen nasal drops (females)
weight stabilization
surgery?

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26
Q

what can cause TM performations

A

infection
ETD
penetrating trauma (q-tip)
base of skull fracture
barotrauma

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27
Q

what tests are used for TM perforations

A

Pneumotoscopy
tuning fork examination
audiogram

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28
Q

how do you treat a traumatic TM Perforations

A

most close with time
keep water out of the ear
otic abx drops?
surgical evaluation if non-healing after 6 weeks

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29
Q

what are the different classification types of otitis media

A

types: serous and suppurative
durations: acute and chronic
Designations: with perforation and without perforations

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30
Q

what is OME

A

otitis media with effusion
presence of fluid in the middle ear WITHOUT signs or symptoms of acute ear infection

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31
Q

What is RAOM

A

Recurrent acute otitis media
multiple episodes of AOM
symptom free periods

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32
Q

What is COME

A

Chronic otitis media with Effusion
persistent fluid. in the middle ear
no signs of inflammation (fever, otalgia)

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33
Q

What is AOM

A

acute otitis media
infectious, inflammatory condition of the middle ear
effusion behind intact tympanic memebrane

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34
Q

what are contributing factors for AOM

A

URI
ETD

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35
Q

What are risk factors for AOM

A

Male
large # of siblings
Daycare

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36
Q

what groups are at high risk of AOM

A

Trisomy 21 (downs)
immune deficiency
Native American

37
Q

Whaat are the causes of AOM

A

viral URI
bacterial URI
allergic rhinitis
ETD

38
Q

what are symptoms of AOM

A

ear pain
hearing loss
fever?
drainage?

39
Q

What is the treatment of acute serious otitis media

A

treat underlying illness (symptomatic/supportive)
TIME
surgical drainage if needed
NOT A BACTERIAL INFECTION - ABX NOT NEEDED

40
Q

what is the medical management of uncomplicated ASOM

A

amoxicillin (90mg/kg/day divided Q12h for 10d)
if PCN allergy: Erythromycin or clindamycin with Bactrim
cephalosporins
fluoroquinolones (only adults)

41
Q

when should ABX be changed for ASOM

A

if worsening of not improving after 48-72 hours

42
Q

What is the management of ASOM with performation

A

oral abx
aural abx (fluoroquinolones)
water precautions
f/u to assure closure

43
Q

What are complications of otitis media

A

facial paralysis
mastoiditis
subperiosteal abscess
meningitis
brain abscess

44
Q

What is the concern with unilateral Otitis Media

A

should raise suspicion of nasopharyngeal mass blocking ET orifice

45
Q

What are the pediatric AOM abx treatments

A

amoxicillin
add beta-lactamase coverage (augmentin)
or
Azithromycin (single dose)

46
Q

what are the indications for tubes

A

recurrent AOM: > 3 separate episodes in 6 months OR > 4 episodes in 12 months
*should have effusion at time of consult

47
Q

What is the most common reason for tubes

A

chronic non-suppurative otitis media

48
Q

What is the medical management of chronic otitis media

A

autoinsufflation; +/- steroids; recheck 6-8 weeks; consider allergy evaluation, NO abx unless other sites of bacterial infection

49
Q

when do you refer for chronic otitis media

A

severe TM retraction
failure to improve in 2-3 months
persistent UNILATERAL effusion
significant hearing loss - especially in children

50
Q

What is cholesteatoma

A

keratoma or skin where it does not belong
congenital or primary
secondary or acquires
SURGICAL disease

51
Q

what is the presentation of Acute Mastoiditis

A

> 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

52
Q

What is the treatment of Acute mastoiditis

A

surgery - mastoidectomy

53
Q

what is vertigo

A

abnormal sense of motion characterized by a spinning sensation

54
Q

what are the types of vertigo

A

central (neurology/cardiology)
peripheral (otolaryngology)
systemic

55
Q

what is Oscillopsia

A

jumping images

56
Q

what areas are responsible for maintaining equilbrium

A

eyes
labyrinth
CNS

57
Q

how is vertigo diagnosed/worked up

A

audiology: assess peripheral vestibular system
imaging: assess CNS
Blood tests: assess Systemic

58
Q

What is the gold standard test for vertigo

A

MRI with Gadolinium contrast

59
Q

what is the most important test with vertigo

A

audiogram

60
Q

What is the most common cause of vertigo

A

BPPV (benign paroxysmal positional vertigo)

61
Q

what is BPPV

A

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)

62
Q

What is Meniere’s syndrome

A

condition of excess pressure accumulation in inner ear

63
Q

what are the four main features of menieres syndrome

A

atttacks of vertigo
fluctuating hearing loss (usu. low frequency)
tinnitus
aural fullness (pressure sensation in the ears)

64
Q

how do you diagnose/work up menieres syndrome

A

inner ear inflammation, infection or trauma (autoimmune, syphilis, allergy)
Metabolic/endocrine (high cholesterol/triglycerides, thyroid disease, diabeses)
idiopathic

65
Q

What is vestibular neuritis / neuronitis labrynthitis

A

viral infection / inflammation of nerve / labyrinth
think along the lines of Bell’s palsy
watch out for Ramsey Hunt Syndrome

66
Q

What is Pathognomonic for BPPV

A

positive Dix Hallpike maneuver

67
Q

what are the management steps for acute prostrating vertigo

A

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

68
Q

What is the treatment of vertigo

A

tx should be directed towards a specific cause if identified
BPPV: Epleys

69
Q

how do you treat menieres disease

A

low salt diet
diuretics
vasodilators
avoidance of caffeine and alcohol
intratympatic gentimycin
surgery for worse cases

70
Q

What causes conductive hearing loss

A

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

71
Q

What are the causes of sensorineural (SNHL)

A

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

72
Q

What is acoustic neuroma

A

unilateral SNHL
dizzy but not vertigo
“Great Masquerader”
RARE
aka Vestibular schwannoma

73
Q

What is the treatment of Acoustic Neuroma / Vestibular schwannoma

A

observation: if small and dose not cause symptoms
surgical removal
radiation: stop tumor from growing

74
Q

What is the cause of sudden sensorinuural hearing loss

A

Acustic neuroma / vestibular schwannoma

75
Q

What test assesses the tympanic membrane mobility

A

tympanometry testing

76
Q

what is air conduction testing

A

pure tone testing uses headphones in which tones are sounded off in each of the ears

77
Q

What is bone conduction testing

A

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

78
Q

What is the difference between air and bone conduction with SNHL

A

minimal to no difference between air and bone

79
Q

What is congenital hearing loss

A

can appear at birth or progress later in life - need to monitor speech development in infancts/toddlers
usually SNHL

80
Q

What is otosclerosis

A

gradual stiffening of the ossicles, causing progressive conductive hearing loss
can be unilateral or bilateral
more common in Females in the family

81
Q

what is Presbycusis

A

age related hearing loss - usually bilateral
usually greater for high pitched sounds

82
Q

what is the management/treatment of presbycusis

A

devices/mechanical aids: vibrating alarms, flashing phones/doorbells, TV listening systems, personal amplifiers
hearing aids

83
Q

what is the management of conductive hearing loss

A

medical treatment
hearing aids or hearing implants: bone conduction devices
surgery

84
Q

What is the management of SNHL

A

conventional hearing aids or an implantable hearing device, i.e. cochlear implant

85
Q

what is the workup for pediatric hearing loss

A

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

86
Q

What are the adjunctive input for pediatric hearing loss

A

ophthalmology, genetics, developmental pediatrics

87
Q

What is tinnitus

A

the perception of noise in the absence of acoustic stimulus outside of the body
symptom NOT a disease

88
Q

what is the most common identified cause of tinitus

A

SNHL

89
Q

What is the treatment of tinnitus

A

avoid dietary stimulants (cola, coffee, tea)
smoking cessation
avoid medications: ASA, NSAIDS, many others
reassurance
feedback training
White noise and other maskers

CLIN MED 3 - HEENT (8 decks)

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