Disorders of the Ears Flashcards
Test used to determine conductive vs sensorineural loss in unilateral loss
Weber test
Test used to compare patient’s air and bone conduction
Rinne test
Conductive loss with Weber test
tone will be louder in poorer ear
Sensorineural loss with Weber test
tone will be louder in better ear
Classification of recurrent otitis media
3 or more AOM in 6 months or 4 or more AOM in 1 year
PE findings of otitis media
decreased TM mobility and bulging TM
When should a patient with otitis media be seen again?
14-21 days after initial presentation
The presence of middle ear effusion (MEE) in the absence of acute signs of infection
OM with effusion aka serous otitis media aka “glue ear”
Sx of hearing loss, fullness in ear, delayed speech development, unsteady gait
OM with effusion aka serous otitis media aka “glue ear”
PE of OM with effusion aka serous otitis media aka “glue ear”
TM is dull and retracted, No mobility of TM, Straw or tan color of ear drum or translucent gray
Diagnostic method of choice for OM with effusion aka serous otitis media aka “glue ear”
Pneumatic otoscopy
First line of tx of OM with effusion aka serous otitis media aka “glue ear”
watchful waiting. Test hearing after 3 months and re-examine until effusion is resolved, hearing loss is identified, or structural abnormalities of the tympanic membrane or middle ear are suspected
Tx of unresolved OM with effusion aka serous otitis media aka “glue ear”
tympanostomy and tube
A perforated tympanic membrane with persistent drainage from the middle ear or Chronic otorrhea (>6-12wks) through a perforated TM
chronic suppurative otitis
most common bacteria involved with chronic suppurative otitis
pseudomonas
Tx of chronic suppurative otitis
Removal of exudate from canal tissue with 50% peroxide with sterile water. Cipro PO reserved for failed cases
A skin growth that occurs in the middle ear behind the eardrum
cholesteoma
Sx include otorrhea, hearing loss, achy ear, dizziness, facial weakness
cholesteoma
Inflammation of the external auditory canal or auricle
otitis externa
Bacteria implicated in otitis externa
Staph aureus, Pseudomonas aeruginosa (swimmers ear), Proteus
Sx include otalgia, pain at tragus or auricle when pulled***, pruritis, discharge, hearling loss
otitis externa
Tx of otitis externa
Irrigate with 1:1 dilution of 3% hydrogen peroxide AT BODY TEMP. Tx infection with either cortisporin, cipro HC, tobradex put on wick so it doesn’t go thru membrane
An invasive infection of the external auditory canal and skull base.
malignant external otitis/necrotizing otitis externa
Bacteria primarily responsible for malignant external otitis/necrotizing otitis externa
pseudomonas
Illness characterized by exquisite otalgia and otorrehea, and granulatioin in the inferior portion of external auditory canal
malignant external otitis/necrotizing otitis externa
Complications of malignant external otitis/necrotizing otitis externa
osteomylitis of skull, mastoiditis, TMJ osteomyelitis
Tx for malignant external otitis/necrotizing otitis externa
Ciprofloxin 750mg PO BID for 6-8 weeks. No role for topical abx
Condition characterized by sudden decrease in ear pain followed by drainage from that ear, tinnitus, and pus/blood drainage
TM perforation
TM perforation tx
heal on their own, keep ear dry, maybe ear drum patch or tympanoplasty
Most common cause of barotrauma
flying
characterized by pressure in ear, pain due to stretching of TM, hearing loss, tinnitus
barotrauma to ear
Tx of ear barotrauma
valsalva, decongestants, myringotomy
characterized by Postauricular pain and erythema, Spiking fever, Tender mass
mastoiditis
Management of mastoiditis
admit for IV abx and ENT consult
benign lesions but grow to eventually compress the pons resulting in hydrocephalus
acoustic neuroma (vestibular schwannoma).
Sx of acoustic neuroma (vestibular schwannoma) associated with cochlear nerve involvement
Hearing loss and tinnitus
Sx of acoustic neuroma (vestibular schwannoma) associated with vestibular nerve involvement
Unsteadiness while walking
Sx of acoustic neuroma (vestibular schwannoma) associated with trigeminal nerve involvement
Facial numbness and Hypesthesia and pain
Sx of acoustic neuroma (vestibular schwannoma) associated with facial nerve involvement
Facial paresis and taste disturbances
difference between peripheral and central veritigo syndromes
peripheral has sudden onset with horizontal nystagmus that is inhibited by visual fixation whereas central has gradual onset with usually vertical nystagmus no inhibited by visual fixation
Maneuver to determine benign paroxysmal positional vertigo
Dix-Hallpike maneuver
Positive Dix-Hallpike maneuver
consists of a burst of nystagmus. The eyes jump upward as well as twist so that the top part of the eye jumps toward the down side.
Tx for benign paroxysmal positional vertigo
epley maneuver
Describe epley maneuver
movement of the head into four positions, staying in each position for roughly 30 seconds.
sensorineural hearing impairment in elderly individuals that involves bilateral high-frequency hearing loss associated with difficulty in speech discrimination and central auditory processing of information
presbycusis
epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti.
sensory presbycusis
atrophy of nerve cells in the cochlea and central neural pathways
nerual presbyscusis
atrophy of the stria vascularis represented by a flat hearing curve
metabolic presbycusis
thickening and secondary stiffening of the basilar membrane of the cochlea
mechanical presbyscusis
inflammation of inner ear that causes vertigo and is often triggered by URI
labyrinthitis
Results from distention of the endolymphatic compartment of the inner ear
Meniere’s (Endolymphatic Hydrops)
condition characterized by episodic vertigo lasting 1-8hrs, low frequency sensorineural hearing loss, tinnitus, sensation of aural pressure
Meniere’s (Endolymphatic Hydrops)
