EAR 1 Flashcards
Conductive Loss (weber and rinne)
Weber: lateralizes to bad ear
Rinne: BC>AC
Sensorineuronal Loss (weber and rinne)
Weber: lateralizes to good ear
Rinne: AC>BC (normal)
Cone of Light always points
anteriorly
Disorders of External Ear
Cerumen impaction
Foreign body
Otitis externa
Hematoma of external ear
Cerumen Impaction: clinical presentation
often asymptomatic
hearing loss
earache or fullness
itchiness
reflex cough
dizziness
tinnitus
Cerumen Impaction: treatment
Most common: irrigation
- detergent ear drops (debrox/carbamide peroxide)
- mechanical removal
Irrigation
body temperature water
only when TM is intact
dry canal after
Foreign Body: clinical presentation
often asymptomatic
decreased hearing
pain
drainage
chronic cough/hiccups
Foreign Body: treatment (urgent)
button batteries
live insects
penetrating fb
Foreign Body: treatment (firm object)
Remove with loop/hook or irrigation
Avoid pushing closer to TM
Foreign Body: treatment (organic object)
ex: beans, insects
DO NOT IRRIGATE
immobilize living insects w/ lidocaine
Hematoma of External Ear
traumatic auricular hematoma
recognize promptly
Hematoma of External Ear: treatment and complications
Treatment: drainage
Complications: cauliflower ear
Otitis Externa
aka swimmers ear
inflammation of external auditory canal
Otitis Externa: etiology
most common: infection
- gram negative rods (pseudomonas)
- fungi
allergic
dermatologic
Otitis Externa: risk factors
- warmer climates with high humidity
- inc water exposure
- debris from dermatologic conditions
- trauma
- occlusive devices
Otitis Externa: clinical presentation
- otalgia
- pruritus
- purulent discharge (black in fungal)
- hearing loss
- fullness
Otitis Externa: physical exam
- erythema and edema of ear canal
- purulent exudate
- tenderness with palpation
- erythematous TM
- normal movement with pneumatic otoscopy
Otitis Externa: differential diagnosis
- middle ear disease
- contact dermatitis
- psoriasis
- chronic suppurative otitis media
- squamous cell carcinoma of external ear
- herpes simplex virus
- radiation therapy
Ramsay Hunt Syndrome
aka herpes zoster oticus
herpes simplex virus
ipsilateral facial paralysis + pain + vesicles in ear canal
Otitis Externa: treatment
7-10 d of topical aminoglycoside or fluoroquinolone antibiotic w/ or w/out corticosteroids
(TM perforation = no aminoglycosides)
keep canal dry
avoid additional moisture, scratching
remove debris
place a wick
severe = oral antibiotics
refer to ENT if immunocompromised or DM
Otitis Externa: complications
periauricular cellulitis
contact dermatitis
malignant otitis externa
Malignant Otitis Externa
osteomyelitis of temporal bone/skull base
DM + immunocompromised at highest risk
- foul smelling discharge
- granulations in ear canal
- deep otalgia
- cranial nerve palsies
- HA
Dx: CT (osseous erosion)
Tx: IV antibiotics, surgery
Disorders of the Middle Ear
Acute otitis media Chronic otitis media Otitis media with effusion Cholesteatoma TM perforation Otic barotrauma
Acute Otitis Media
bacterial infx of middle ear
usually precipitated by URI
Acute Otitis Media: etiology
Most common bacterial causes:
- streptococcus pneumoniae
- haemophilus influenza
- moraxella pyogenes
Recurrent cases associated with allergies or 2ndhand smoke
Acute Otitis Media: epidemiology
most common in children 4-24 months
inc in call and winter
Acute Otitis Media: risk factors
family hx day care lack of breastfeeding tobacco smoke/air pollution pacifier use
Acute Otitis Media: clinical presentation
otalgia, pressure
hearing loss
fever (more common in children)
URI symptoms
Acute Otitis Media: physical examination
TM
- immobile
- erythematous
- bulging
- may rupture
bullae associated with mycoplasma infx
retraction can occur
Acute Otitis Media: differential diagnosis
- otitis media w/ effusion
- otitis externa
- eustachian tube dysfunction
- herpes zoster
- head/neck infx
Acute Otitis Media: treatment
1st line: high dose AMOX (80-90mg/kg/day divided twice daily)
2nd line: high dose AMOX-clavulanate or 2nd/3rd cephalosporin
improves in 48-72 hours
analgesics
Acute Otitis Media: treatment w/ perforated TM
include topical antibiotic with low ototoxicity (ofloxacin)
Acute Otitis Media: prevention
pneumovax
Acute Otitis Media: observation
6 mo-2 yr: unilateral, mild
> 2yr: unilateral or bilateral, not severe
antibiotics if
- worsening
- no improvement in 48-72 hrs
Acute Otitis Media: immediate antibiotics
< 6 months
<24 months if severe
- mod-severe pain
- pain > 48 hrs
- T > 102.2 F
- bilateral
Acute Otitis Media: complications
- labyrinthitis
- hearing loss
- mastoiditis
- non response to meds
- recurrent infection
Mastoiditis
spiking fevers
postauricular pain
erythema
Tx: antibiotics or mastoidectomy
Chronic Otitis Media: etiology
recurrent AOM
Chronic Otitis Media: presentation
chronic otorrhea
Chronic Otitis Media: physical exam
perforated TM
conductive hearing loss
Chronic Otitis Media: treatment
- removal of infected debris
- earplug use
- antibiotics (topical, oral)
- surgery (TM repair)
Serous Otitis Media
otitis media with effusion
Serous Otitis Media: pathophysiology
eustachian tube stays blocked for a prolonged time
neg pressure –> transudation of fluid into middle ear
Serous Otitis Media: epidemiology
More common in children (eustachian tubes are narrower, more horizontal)
Less common in adults (after URI, barotrauma, chronic allergies)
Serous Otitis Media: clinical presentation
no acute signs
conductive hearing loss
fullness
Serous Otitis Media: physical exam
TM
- dull
- hypermobile
bubbles
conductive hearing loss
Serous Otitis Media: treatment
? decongestants, antihistamines
if underlying allergies: nasal steroids
if resistant: ventilating tubes
Cholesteatoma
specific type of chronic otitis media
Cholesteatoma: etiology
most common: prolonged eustachian tube dysfunction
chronic negative middle ear pressure draws in part of TM
creates sac lined with squamous epithelium
can get secondarily infected (pseudomonas, proteus)
Cholesteatoma: presentation
asymptomatic or hearing loss
chronic: ear drainage
Cholesteatoma: physical exam
TM pocket
TM perforation exuding debris
Cholesteatoma: treatment
antibiotic drops surgical removal (mostly this)
Cholesteatoma: complications
erosion into inner ear, facial nerve, brain
abscess
Eustachian Tube
connects middle ear and nasopharynx
provides ventilation and drainage to middle ear
normally closed
-open during yawning, swallowing
Eustachian Tube Dysfunction: etiology
edema of tubal lining
air trapped in middle ear causing negative pressure
- viral URI
- allergies
Eustachian Tube Dysfunction: presentation
fullness
fluctuating hearing
pain with pressure change
popping/crackling sensation
Eustachian Tube Dysfunction: physical exam
TM
- retraction
- dec mobility
Eustachian Tube Dysfunction: management
AVOID
air travel
altitude change
underwater diving
Eustachian Tube Dysfunction: treatment
decongestants autoinflation desensitization therapy (allergies) intranasal corticosteroids surgical
Eustachian Tube Dysfunction: complications
inc risk for
- serous otitis media
- cholesteatoma
Otic Barotrauma
inability to equalize pressure exerted on middle ear during
- air travel
- rapid altitude change
- underwater diving
precursor: poor eustachian tube dysfunction
(mucosal edema, congenital narrowing)
Otic Barotrauma: presentation
otalgia
DESCENT > ascent
Otic Barotrauma: treatment
enhance eustachian tube function
- systemic decongestants before travel
- topical nasal decongestant 1 hr before descent
Otic Barotrauma: patient education
swallow, yawn, autoinflate during descent
Otic Barotrauma: diving without equilibrating
can experience
- hemotympanum
- perilymphatic fistula
Perilymphatic Fistula
rupture of oval window
sensory hearing loss
acute vertigo
vomiting
Otic Barotrauma: complications
TM rupture
persistant pressure
Tympanic Membrane Perforation
small ruptures (<25%) will close on their own
larger require tympanoplasty
