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Ear Flashcards

1
Q

What is conductive hearing loss?

A

anything that blocks sound from access to inner ear

occurs when sound is inadequately conducted through the external or middle ear to the sensorineural apparatus of the inner ear (through round window)

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2
Q

Main causes of conductive hearing loss

A
  1. obstruction (cerumen impaction, foreign body)
  2. mass loading (middle ear effusions (OM), benign tumors of the middle ear, cholesteatoma)
  3. stiffness effect - bones don’t move (otosclerosis, Eustachian tube disorders)
  4. discontinuity (ossicular disruption)
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3
Q

What is sensorineural hearing loss?

A

Occurs when sound is carried normally through the external and middle ear, but there is a defect in the inner ear – nerve impulses from the cochlea to the auditory cortex are impaired

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4
Q

Main causes of sensorineural hearing loss

A
  1. Sensory
    - deterioration of the cochlea
    - ototoxicity
    - noise exposure (acoustic trauma)
    - mammalian hair do not regenerate
  2. Neural
    - lesions involving CNVIII, auditory nuclei, ascending, tracts, or auditory cortex
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5
Q

What is presbycusis?

A

loss of hair cells from the organ of corti

most common of ARHL

hallmarks: bilateral, symmetric, high frequency sensorineural hearing loss

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6
Q

hearing loss screening

A

Birth to 4 months
Loud noise should startle infant
4 months to 2 years
Developmental delays

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7
Q

when to refer after a hearing loss test

A
  • Any at risk child
  • Any deficit or developmental delays
  • Conditions that predispose child to hearing loss
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8
Q

acoustic trauma

A
  • Single exposure to an intense sound (damage to cochlear hair cells) will cause (SNHL)
  • Hearing loss is permanent (b/c hair cells do not regenerate)
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9
Q

how do you diagnose acoustic trauma?

A

Diagnosed with audiogram

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10
Q

acoustic trauma treatment

A

Hearing aid may be beneficial or cochlear implants

PREVENTION

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11
Q

how does acoustic trauma develop

A
  • Years of exposure to chronic industrial or non-industrial noise will cause SNHL
  • Starts at 85 db
  • Nearly always bilateral and symmetric
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12
Q

T/F: acoustic trauma produces profound hearing loss

A

FALSE - no hearing loss

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13
Q

Maximum loss of acoustic trauma seen after _____ of exposure

A

10-15 years

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14
Q

T/F: Continuous noise more damaging than intermittent noise

A

TRUE

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15
Q

weber test in conductive hearing loss

A

Sound will lateralize and be louder in the affected ear – bone cond. louder bc air conduction is blocked

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16
Q

rhinne test in conductive hearing loss

A

In the affected ear, sound will be louder on mastoid than beside ear (BC>AC)

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17
Q

sensorineural hearing loss in weber test

A

Sound will lateralize and be louder in the unaffected ear – bone/nerve is damaged in bad ear so BC louder good ear

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18
Q

sensorineural hearing loss in rhinne test

A

In the affected ear, sound will be louder beside the ear than on the mastoid (AC>BC) bc bone/nerve damaged

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19
Q

functions of pinna

A

acts as a funnel, amplifies the sound and directs it to the ear canal

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20
Q

function of tragus

A

Collects sound from behind and directs it into the ear canal

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21
Q

accessory auricle

A

skin tag

benign skin growth, may necessitate excision

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22
Q

microtia/anotia

A

abnormal development of auricle creating EAC stenosis; congenital, requires surgical/cosmetic correction

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23
Q

preauricular pit

A
  • cystic tract unclosed from embryologic development
  • May develop infection and require drainage and antibiotic therapy
  • Can excise if recurrent or abnormally enlarged
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24
Q

types of external ear trauma

A
  • Simple (skin +/- cartilage)
  • Blunt/crush
  • Avulsion (tear or separation)
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25
Q

treatment of external ear trauma

A
  • Deep cleaning
  • Debridement
  • Surgical repair
  • Pressure Dressing
  • Antibiotics
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26
Q

hematoma treatment

A
  • I&D
  • Through & through suture
  • Pressure Dressing
  • Antibiotics
  • Repeat aspiration
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27
Q

complications of hematoma treatment

A
  • Fibrosis
  • Cauliflower ear
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28
Q

what is cerumen

A

substance produced in the ear canal to protect from infection, trauma, water damage, etc

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29
Q

treatment of cerumen impaction

A

Detergent drops to soften
Colace to soften
Mechanical removal
Suction
Irrigation

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30
Q

what is the most common cause of conductive hearing loss

A

cerumen impaction

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31
Q

symptoms of cerumen impaction

A

hearing loss, otalgia, drainage, dizziness, tinnitus (ringing in the ear)

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32
Q

management of cerumen impact

A
  • In-office debridement
  • Debrox (H202 and warm water)
  • Vosol-Hc: wet EAC
  • Derm-otic: eczematous EACs
  • Mineral oil or baby oil for mildly eczematous
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33
Q

foreign body

A
  • BEST PERFORMED UNDER A MICROSCOPE WITH TWO HANDS
  • Alligator forceps
  • Small suction
  • Curette
  • Otoscope
  • Suction
  • Mineral Oil / Viscous Lidocaine to kill the bug
  • Irrigation / Angiocath
  • REPEAT EXAM

Risk – TM Perf

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34
Q

what is Acute Otitis Externa (AOE) also called

A

Swimmer’s Ear

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35
Q

what is Acute Otitis Externa (AOE)

A

Bacterial infection of external auditory canal

P. aeruginosa 38%, S. aureus 8%, Strep Pneumo 6%

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36
Q

signs and symptoms of otitis externa

A
  • Pain, worse with auricle or tragus
    movement
  • Pruritus of canal
  • EAC edema/swelling
  • Otorrhea
  • Involvement of periauricular soft tissue
  • Erythema and edema of the canal
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37
Q

risk factors for otitis externa

A
  • Swimming
  • Trauma
  • Diabetes
  • Immunocompromised Conditions
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38
Q

management of otitis externa

A
  • Serial removal of debris (may need referral)
  • Antibiotic otic drops (i.e. Ciprodex-bacterial; Clotrimazole-fungal)
  • Oral antibiotics helpful in severe cases or in the immunocompromised patient
  • For those with allergic or eczematous otitis, may need regular debridement and preventive management with DermOtic or other emollient-based drops
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39
Q

otitis externa treatment

A
  • topical!
    • Fluoroquinolone gtts is safest (no ototoxicity)
      Polymyxin B with Neomycin gtts
      Most also have a corticosteroid component
  • clean canal +/- wick placement
  • if invasive infection → culture drainage, oral MRSA/pseudomonas ABO and topical
  • Pain control → OTC
  • prevention!
    • no moisture for 4-6 weeks
    • 2-3 drops of vinegar/alcohol after water exposure
    • ear plugs for swimming
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40
Q

malignant otitis externa

A

Infection of the external auditory canal that progresses to osteomyelitis of the temporal bone

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41
Q

what is malignant otitis externa caused by

A

pseudomonas

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42
Q

common population malignant otitis externa affects

A

elderly with diabetes

HIV

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43
Q

does malignant otitis extern improve with topical ABO

A

NO!

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44
Q

treatment malignant otitis externa

A

fluoroquinolone ABO

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45
Q

location of malignancy

A

May arise within EAC or extend from pinna, post-auricular sulcus, or parotid

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46
Q

radiographic appearance of malignancy

A

Involvement or invasion of soft tissue with destruction of bony cortex

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47
Q

T/F: low mortality rate of malignant ear infection

A

FALSE - high because of early invasion of lymphatics, skull, brain

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48
Q

treatment for malignant ear

A

surgery and radiation

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49
Q

functions of eustachian tube

A
  • Equalization of pressure across the TM
  • Protect middle ear from reflux from nasopharynx
  • Clearance of middle ear secretions
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50
Q

eustachian tube dysfunction

A

Failure of any of the functions of the ET caused by the functional valve not opening or closing properly.

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51
Q

what is ET common associated with

A

URI

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52
Q

causes of ETD

A

virus

attitude makes it worse

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53
Q

symptoms of ETD

A

Fullness
Muffled sounds
Popping sound
Pain
Tinnitus
Vertigo

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54
Q

treatment of ED

A

Swallow/yawn/chew-”pop”
Decongestants
Antihistamine
Surgery – Tubes? / Adenoids?

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55
Q

exam findings of ED

A
  • Retracted TM if a Chronic Cause
  • If an acute cause, such as associated with a virus, the TM might be erythematous and bulging.
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56
Q

barotrauma

A

difference in pressure between the external environment and the internal parts of the ear

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57
Q

symptoms of barotrauma

A
  • “clogging” of the ear
  • ear pain
  • hearing loss
  • Dizziness
  • ringing of the ear (tinnitus)
  • hemorrhage from the ear
  • Vertigo
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58
Q

risk of barotrauma

A

TM rupture - damage to the middle and inner ear

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59
Q

treatment of barotrauma

A

prevention/surgery

60
Q

otitis media types

A
  1. Serous otitis media
  2. Acute otitis media
  3. Chronic otitis media
61
Q

O_____ M____ preceded by a ____ URI

A

otitis media; viral

62
Q

otitis media

A

Inflammation of the middle ear and mucosal lined air-spaces of the temporal bone

This causes inflammation of Eustachian tube and decreased drainage of middle ear

63
Q

predisposing medical conditions to otitis media

A

genetic

immune

obstruction

64
Q

acute serous otitis media

A
  • NON-Infectious fluid accumulation in middle ear space
  • Usually from Eustachian tube obstruction from upper respiratory infection (URI) of nasopharynx
65
Q

who is acute serous otitis media more common in

66
Q

T/F: acute serous otitis media is painful

A

FALSE. painless hearing loss after URI

67
Q

physical exam of acute serous otitis media

A

TM is dull and hypomobile

may see air bubbles

68
Q

color of TM in acute serous otitis media

A

amber or blue NOT white or pale yellow hue

69
Q

__________ is commonly misdiagnosed as acute serous otitis media

A

otitis media WITH effusion

70
Q

treatment of acute serous otitis media

A

antibiotics if meets standard

Amoxicillin is gold standard

71
Q

children and acute otitis media

A

For children younger than two years, follow-up of AOM can typically occur at the next scheduled wellness visit or three months after completing treatment to ensure resolution of middle ear fluid.

For children two years and older without an upcoming visit or children with recurrent AOM, reevaluation within three months of completing treatment should be considered to ensure resolution of middle ear effusion.

72
Q

signs and symptoms of acute otitis media

A
  • Otalgia
  • aural pressure
  • hearing loss
  • fever
73
Q

signs and symptoms of acute otitis media

A
  • Otalgia
  • aural pressure
  • hearing loss
  • fever
74
Q

do you treat pain in acute otitis media

A

YES with ibuprofen or acetaminophen

75
Q

what happens in refractory cases of acute otitis media

A

Tympanocentesis or myringotomy

76
Q

treatment for adults acute otitis media

A

considering adding decongestant and/or steroid

77
Q

how long does the fluid in ASOM last?

A
  • Usually self-limiting
  • Fluid can last 4-6 weeks.
  • Bulb suction nose, saline spray to nose, steam
  • Nasal decongestant (Afrin) and/or steroids for adults
  • If greater than 3 months, myringotomy and tube insertion should be done to prevent long-standing trauma and hearing loss.
78
Q

child with AOM findings

A

Tugging at ears
Fussy
Fever
Decreased appetite, not eating well
Hearing loss.
Capillary injection and Erythema of TM
Bulging TM
Possible purulent fluid
Immobility on bulb insufflation
May see micro-perforation with drainage

79
Q

guidelines for acute otitis media

A
  • Bulging of the Tympanic Membrane – Moderate to Severe
  • Signs of Acute Inflammation AND middle Ear Effusion
    • TM Erythema, Fever, Ear Pain
    • Bulging TM, decreased TM mobility, air-fluid level behind TM, otorrhea from perforation
  • Acute Perforation of the TM w/ Acute purulent otorrhea (assuming Acute otitis externa has been excluded as the cause for the otorrhea)
  • Must have at least one!
80
Q

tools to use to diagnose AOM

A

pneumatic otoscopy

tympanometry

81
Q

T/F: Antibiotic treatment of AOM in children decreases early pain (before 24 hours), hearing loss at three months, or recurrence within 30 days

A

FALSE: does NOT

82
Q

T/F: Antibiotic treatment has some beneficial effect on pain after 24 hours (up to 12 days), number of tympanic membrane perforations, and contralateral otitis media

83
Q

T/F: Adults with bilateral otitis media or otitis media with otorrhea benefit most from antibiotics

A

FALSE - Children younger than two years

84
Q

Initial antibiotic treatment for AOM

A
  • infants <6 months,
  • children 6 months to 2 years with unilateral or bilateral AOM of any severity, and
  • children ≥2 years who appear toxic, have persistent ear pain for >48 hours, had temperature ≥102.2°F (39°C) in the past 48 hours, have bilateral AOM or otorrhea, or
  • have uncertain access to follow-up
85
Q

chronic otitis media

A

Chronic (usually longer than 3 months) inflammation of the middle ear and/or mastoid cavity, which presents with recurrent ear discharges or otorrhea through a tympanic perforation

86
Q

what do you consider in nasopharyngeal mass obstructing the Eustachian tube for adults

A

Unilateral OM

87
Q

when does chronic otitis media occur

A

as a result of recurrent AOM

88
Q

what is common COM

A

perforations

89
Q

pathogens of COM

A

P. aeruginosa

90
Q

signs and symptoms of COM

A

Purulent aural discharge +/- otalgia

Conductive hearing loss is present

91
Q

treatment for COM

A
  • Surgical repair of perforation
  • Ciprofloxacin
92
Q

indications of tympanostomy tube placement

A
  • number/episodes
  • age of diagnosis
  • persistence
  • documented hearing loss
93
Q

Tympanostomy Tube Complications

A

Otorrhea
Occlusion
Premature displacement
Persistent perforation

94
Q

water precautions of otitis media

A

lake vs pool vs tub

ear plugs

95
Q

complications of OM

A
  • TM perforation
  • Mastoiditis
  • Cholesteatoma
  • Facial Nerve Palsy
  • Meningitis
96
Q

TM perforations

A
  • Infection
    Bacteria, Mycobacterium, Viruses
  • Trauma
    Penetrating trauma – NO Q-TIPS!
  • Blunt trauma
    Temporal bone fractures, Slap injury
  • Explosion Injury
  • Thermal injury
    Welders, steelworkers, lightning
97
Q

TM evaluation

A
  • Facial nerve
  • External ear
  • Otoscopy
    • Ear canal
    • TM Perforation
  • Audiometry
  • +/- CT of maxillary/facial bones
98
Q

what is Tympanic Membrane Perforation

A

Negative pressure within middle ear causes the tympanic membrane to perforate- will see a hole in the TM on exam

99
Q

TMP may be a _____ sequalae

100
Q

symptoms of TMP

A

otalgia, hearing loss, otorrhea, possible secondary otitis externa

101
Q

management of TMP

A

Otic drops susp. twice with oral antibiotics

102
Q

when to refer for TMP

A

present for more than 6 weeks

103
Q

what is mastoiditis

A

Spectrum of disease that ranges from inflammation of the mastoid periosteum to bony destruction of the mastoid air system and abscess development

Rare complication due to antibiotic vigilance

104
Q

mastoiditis is most common in ___ years of age

A

children <2

105
Q

acute mastoiditis signs and symptoms

A

Retroauricular pain/tenderness
Fever
Ear protrusion
Conductive hearing loss
Leukocytosis

106
Q

what exam to confirm acute mastoiditis

107
Q

treatment of acute mastoiditis

A
  • Antibiotics to cover Staph Aureus, Pseudomonas, and H. Influenza x 14 days
    • Cephalosporins
  • Myringotomy for C&S
  • Mastoidectomy if:
    • Medical failure
      Abscess
      Intracranial complications
108
Q

Cholesteatoma

A

Epidermal inclusion cyst of squamous epithelium containing desquamated keratin debris

Caused by chronic negative pressure in middle ear from eustachian tube dysfunction or direct growth from TM rupture and trapped flap of the TM

109
Q

what is the result of cholesteatoma

A

conductive hearing loss

110
Q

cholesteatoma morphology

A

Greasy-looking, white mass behind TM

+/- malodorous discharge

111
Q

treatment of cholesteatoma

A

antibiotics, surgical drainage & removal

If untreated the erosion can lead thrombosis, sepsis, brain abscess and even death

112
Q

otosclerosis

A
  • Genetic disease characterized by abnormal spongy and sclerotic bone formation in the temporal bone around the footplate of the stapes – covers oval window.
    Prevents normal ossicle movement of the stapes
113
Q

T/F: otosclerosis is autosomal recessive

A

Autosomal dominant with incomplete penetrance and variable expression

⅔ positive family history

114
Q

T/F: otosclerosis can have conductive hearing loss, but may have have sensorineural component

115
Q

population impacted by ostosclerosis

A

CHL in 15-50 age group

More common in women

116
Q

otosclerosis is _____ progressive

117
Q

T/F: otosclerosis is unilateral but asymmetric hearing loss

A

FALSE, bilateral with asymmetric hearing loss

118
Q

otosclerosis may experience

A

experience disequilibrium with occasional attacks of vertigo & rotatory nystagmus

119
Q

____ sign in otosclerosis

A

Schwatze’s signs - erythema around stapes from hypervascularity of new bone formation

120
Q

do we use a tuning fork for otosclerosis

A

yes, progressive HL from low to high 256-512-1021 Hz TF

121
Q

treatment of otosclerosis

A

Medical –Sodium fluoride
Helps reduce ossification of ossicles

Surgery- Stapedectomy

122
Q

when does sensorineural hearing loss occur

A

Occurs when sound is carried normally through the external and middle ear, but there is a defect in the inner ear – nerve impulses from the cochlea to the auditory cortex are impaired

123
Q

causes of SNHL

A

sensory (deterioration of cochlea, ototoxicity, noise exposure)

neural (CN VIII)

124
Q

can infections occur with viruses?

A

obviously, CMV, mumps, rubella, rubeola, influenza, varicella-zoster, EBV, poliovirus, RSV, adenovirus, parainfluenza, HSV, HIV

may occur with. meningitis and encephalitis infection including syphilis

125
Q

what is ototoxicity?

A

Damage to the cochlea or vestibular apparatus from chemical exposure

varying levels of SNHL

May be associated with tinnitus, dizziness

Ototoxic medications:

  • Antibiotics
    Vancomycin, Aminoglycosides
  • Diuretics
    Furosemide
  • Chemotherapeutic agents
    Aspirin
126
Q

ototoxicity increases incidence with….

A

exposure greater than 10 days

preexisting hearing loss

concurrent exposure to noise

other ototoxic agents

127
Q

treat ototoxicity

A

with serial audiometric evaluation and removal of offending drug

128
Q

can hearing loss occur with ototoxicity

A

may be permanent or return with discontinuing drug

129
Q

Acute Labyrinthitis / Vestibular Neuritis

A

Acute inflammation of vestibular nerve and labyrinth
Unknown etiology, presumed to be viral
COMMONLY OCCURS AFTER A VIRAL URI

130
Q

signs and symptoms of Acute Labyrinthitis / Vestibular Neuritis

A

Single, acute onset of vertigo, lasting days to weeks
Associated with N&V, nystagmus, gait instability
+/- Hearing loss

131
Q

why do may we need a CT/MRI for Acute Labyrinthitis / Vestibular Neuritis

A

cerebellar infarction may mimic it

132
Q

treatment of Acute Labyrinthitis / Vestibular Neuritis

A

Bed rest, meclizine, antiemetics, +/- corticosteroids

133
Q

Acoustic Neuroma

A

Vestibular Schwannomas
Benign tumor of 8th CN
Most common intracranial tumor
Usually unilateral

134
Q

how does acoustic neuroma present

A

with progressive dizziness, disequilibrium, unilateral tinnitus, SNHL

135
Q

T/F: acoustic neuroma is common with neurofibromatosis type 1

A

false, type 2

136
Q

treatment of acoustic neuroma

A

Surgery
Radiotherapy
Chemotherapy

137
Q

how to diagnose acoustic neuroma

138
Q

what is meniere syndrome

A

Endolymphatic Hydrops
Disturbance of salt and water balance in endolymphatic space & degeneration of vestibular hair cells in one ear so ears are getting different inputs

139
Q

signs and symptoms of meniere syndrome

A

Intermittent, sudden onset of vertigo
Episodic
Aural fullness
Tinnitus
SNHL – low frequency
N&V lasting 1-2 hours.

140
Q

classic triad

A

recurrent vertigo

fluctuating SNHL

tinnitus

141
Q

meniere and neurosyphilis

A

Otosyphilis - inner ear communicates with spinal fluid via the cochlear aqueduct
Tullio’s Phenomenon – Induction of vertigo by loud noise

142
Q

Tullio’s Phenomenon

A

Induction of vertigo by loud noise

143
Q

treatment of meniere

A
  • Bed rest, antiemetics, dietary salt restriction & diuretics
  • For disabling vertigo or failure of medical therapy, can treat with:
    • Labyrinthectomy: 80% success, destroys all residual hearing
    • Intratympanic gentamicin or corticosteroids
144
Q

Meniere’s Pearls

A

SNHL

Tinnitus

Intermittent vertigo

145
Q

Labrinthitis Pearls

A

+/- hearing loss

vertigo

preceding URI

146
Q

acoustic neuroma

A

presents with progressive dizziness

disequilibrium

unilateral tinnitus

SNHL

EENT (5 decks)

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