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PHA 521 > EAR 1 > Flashcards

EAR 1 Flashcards

1
Q

Conductive Loss (weber and rinne)

A

Weber: lateralizes to bad ear

Rinne: BC>AC

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2
Q

Sensorineuronal Loss (weber and rinne)

A

Weber: lateralizes to good ear

Rinne: AC>BC (normal)

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3
Q

Cone of Light always points

A

anteriorly

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4
Q

Disorders of External Ear

A

Cerumen impaction
Foreign body
Otitis externa
Hematoma of external ear

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5
Q

Cerumen Impaction: clinical presentation

A

often asymptomatic

hearing loss
earache or fullness

itchiness
reflex cough
dizziness
tinnitus

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6
Q

Cerumen Impaction: treatment

A

Most common: irrigation

  • detergent ear drops (debrox/carbamide peroxide)
  • mechanical removal
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7
Q

Irrigation

A

body temperature water
only when TM is intact
dry canal after

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8
Q

Foreign Body: clinical presentation

A

often asymptomatic

decreased hearing
pain
drainage
chronic cough/hiccups

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9
Q

Foreign Body: treatment (urgent)

A

button batteries
live insects
penetrating fb

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10
Q

Foreign Body: treatment (firm object)

A

Remove with loop/hook or irrigation

Avoid pushing closer to TM

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11
Q

Foreign Body: treatment (organic object)

A

ex: beans, insects

DO NOT IRRIGATE

immobilize living insects w/ lidocaine

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12
Q

Hematoma of External Ear

A

traumatic auricular hematoma

recognize promptly

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13
Q

Hematoma of External Ear: treatment and complications

A

Treatment: drainage

Complications: cauliflower ear

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14
Q

Otitis Externa

A

aka swimmers ear

inflammation of external auditory canal

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15
Q

Otitis Externa: etiology

A

most common: infection

  • gram negative rods (pseudomonas)
  • fungi

allergic
dermatologic

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16
Q

Otitis Externa: risk factors

A
  • warmer climates with high humidity
  • inc water exposure
  • debris from dermatologic conditions
  • trauma
  • occlusive devices
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17
Q

Otitis Externa: clinical presentation

A
  • otalgia
  • pruritus
  • purulent discharge (black in fungal)
  • hearing loss
  • fullness
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18
Q

Otitis Externa: physical exam

A
  • erythema and edema of ear canal
  • purulent exudate
  • tenderness with palpation
  • erythematous TM
  • normal movement with pneumatic otoscopy
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19
Q

Otitis Externa: differential diagnosis

A
  • middle ear disease
  • contact dermatitis
  • psoriasis
  • chronic suppurative otitis media
  • squamous cell carcinoma of external ear
  • herpes simplex virus
  • radiation therapy
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20
Q

Ramsay Hunt Syndrome

A

aka herpes zoster oticus

herpes simplex virus

ipsilateral facial paralysis + pain + vesicles in ear canal

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21
Q

Otitis Externa: treatment

A

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

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22
Q

Otitis Externa: complications

A

periauricular cellulitis
contact dermatitis
malignant otitis externa

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23
Q

Malignant Otitis Externa

A

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

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24
Q

Disorders of the Middle Ear

A 
Acute otitis media
Chronic otitis media
Otitis media with effusion
Cholesteatoma
TM perforation
Otic barotrauma
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25
Q

Acute Otitis Media

A

bacterial infx of middle ear

usually precipitated by URI

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26
Q

Acute Otitis Media: etiology

A

Most common bacterial causes:

  1. streptococcus pneumoniae
  2. haemophilus influenza
  3. moraxella pyogenes

Recurrent cases associated with allergies or 2ndhand smoke

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27
Q

Acute Otitis Media: epidemiology

A

most common in children 4-24 months

inc in call and winter

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28
Q

Acute Otitis Media: risk factors

A 
family hx
day care
lack of breastfeeding
tobacco smoke/air pollution
pacifier use
29
Q

Acute Otitis Media: clinical presentation

A

otalgia, pressure
hearing loss
fever (more common in children)
URI symptoms

30
Q

Acute Otitis Media: physical examination

A

TM

  • immobile
  • erythematous
  • bulging
  • may rupture

bullae associated with mycoplasma infx

retraction can occur

31
Q

Acute Otitis Media: differential diagnosis

A
  • otitis media w/ effusion
  • otitis externa
  • eustachian tube dysfunction
  • herpes zoster
  • head/neck infx
32
Q

Acute Otitis Media: treatment

A

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

33
Q

Acute Otitis Media: treatment w/ perforated TM

A

include topical antibiotic with low ototoxicity (ofloxacin)

34
Q

Acute Otitis Media: prevention

A

pneumovax

35
Q

Acute Otitis Media: observation

A

6 mo-2 yr: unilateral, mild

> 2yr: unilateral or bilateral, not severe

antibiotics if

  • worsening
  • no improvement in 48-72 hrs
36
Q

Acute Otitis Media: immediate antibiotics

A

< 6 months

<24 months if severe

  • mod-severe pain
  • pain > 48 hrs
  • T > 102.2 F
  • bilateral
37
Q

Acute Otitis Media: complications

A
  • labyrinthitis
  • hearing loss
  • mastoiditis
  • non response to meds
  • recurrent infection
38
Q

Mastoiditis

A

spiking fevers
postauricular pain
erythema

Tx: antibiotics or mastoidectomy

39
Q

Chronic Otitis Media: etiology

A

recurrent AOM

40
Q

Chronic Otitis Media: presentation

A

chronic otorrhea

41
Q

Chronic Otitis Media: physical exam

A

perforated TM

conductive hearing loss

42
Q

Chronic Otitis Media: treatment

A
  • removal of infected debris
  • earplug use
  • antibiotics (topical, oral)
  • surgery (TM repair)
43
Q

Serous Otitis Media

A

otitis media with effusion

44
Q

Serous Otitis Media: pathophysiology

A

eustachian tube stays blocked for a prolonged time

neg pressure –> transudation of fluid into middle ear

45
Q

Serous Otitis Media: epidemiology

A

More common in children (eustachian tubes are narrower, more horizontal)

Less common in adults (after URI, barotrauma, chronic allergies)

46
Q

Serous Otitis Media: clinical presentation

A

no acute signs
conductive hearing loss
fullness

47
Q

Serous Otitis Media: physical exam

A

TM

  • dull
  • hypermobile

bubbles
conductive hearing loss

48
Q

Serous Otitis Media: treatment

A

? decongestants, antihistamines

if underlying allergies: nasal steroids

if resistant: ventilating tubes

49
Q

Cholesteatoma

A

specific type of chronic otitis media

50
Q

Cholesteatoma: etiology

A

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)

51
Q

Cholesteatoma: presentation

A

asymptomatic or hearing loss

chronic: ear drainage

52
Q

Cholesteatoma: physical exam

A

TM pocket

TM perforation exuding debris

53
Q

Cholesteatoma: treatment

A 
antibiotic drops
surgical removal (mostly this)
54
Q

Cholesteatoma: complications

A

erosion into inner ear, facial nerve, brain

abscess

55
Q

Eustachian Tube

A

connects middle ear and nasopharynx

provides ventilation and drainage to middle ear

normally closed
-open during yawning, swallowing

56
Q

Eustachian Tube Dysfunction: etiology

A

edema of tubal lining

air trapped in middle ear causing negative pressure

  • viral URI
  • allergies
57
Q

Eustachian Tube Dysfunction: presentation

A

fullness
fluctuating hearing
pain with pressure change
popping/crackling sensation

58
Q

Eustachian Tube Dysfunction: physical exam

A

TM

  • retraction
  • dec mobility
59
Q

Eustachian Tube Dysfunction: management

A

AVOID
air travel
altitude change
underwater diving

60
Q

Eustachian Tube Dysfunction: treatment

A 
decongestants
autoinflation
desensitization therapy (allergies)
intranasal corticosteroids
surgical
61
Q

Eustachian Tube Dysfunction: complications

A

inc risk for

  • serous otitis media
  • cholesteatoma
62
Q

Otic Barotrauma

A

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)

63
Q

Otic Barotrauma: presentation

A

otalgia

DESCENT > ascent

64
Q

Otic Barotrauma: treatment

A

enhance eustachian tube function

  • systemic decongestants before travel
  • topical nasal decongestant 1 hr before descent
65
Q

Otic Barotrauma: patient education

A

swallow, yawn, autoinflate during descent

66
Q

Otic Barotrauma: diving without equilibrating

A

can experience

  • hemotympanum
  • perilymphatic fistula
67
Q

Perilymphatic Fistula

A

rupture of oval window
sensory hearing loss
acute vertigo
vomiting

68
Q

Otic Barotrauma: complications

A

TM rupture

persistant pressure

69
Q

Tympanic Membrane Perforation

A

small ruptures (<25%) will close on their own

larger require tympanoplasty

PHA 521 (12 decks)

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