Ear Flashcards
What is conductive hearing loss?
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)
Main causes of conductive hearing loss
- obstruction (cerumen impaction, foreign body)
- mass loading (middle ear effusions (OM), benign tumors of the middle ear, cholesteatoma)
- stiffness effect - bones don’t move (otosclerosis, Eustachian tube disorders)
- discontinuity (ossicular disruption)
What is sensorineural hearing loss?
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
Main causes of sensorineural hearing loss
- Sensory
- deterioration of the cochlea
- ototoxicity
- noise exposure (acoustic trauma)
- mammalian hair do not regenerate - Neural
- lesions involving CNVIII, auditory nuclei, ascending, tracts, or auditory cortex
What is presbycusis?
loss of hair cells from the organ of corti
most common of ARHL
hallmarks: bilateral, symmetric, high frequency sensorineural hearing loss
hearing loss screening
Birth to 4 months
Loud noise should startle infant
4 months to 2 years
Developmental delays
when to refer after a hearing loss test
- Any at risk child
- Any deficit or developmental delays
- Conditions that predispose child to hearing loss
acoustic trauma
- 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)
how do you diagnose acoustic trauma?
Diagnosed with audiogram
acoustic trauma treatment
Hearing aid may be beneficial or cochlear implants
PREVENTION
how does acoustic trauma develop
- Years of exposure to chronic industrial or non-industrial noise will cause SNHL
- Starts at 85 db
- Nearly always bilateral and symmetric
T/F: acoustic trauma produces profound hearing loss
FALSE - no hearing loss
Maximum loss of acoustic trauma seen after _____ of exposure
10-15 years
T/F: Continuous noise more damaging than intermittent noise
TRUE
weber test in conductive hearing loss
Sound will lateralize and be louder in the affected ear – bone cond. louder bc air conduction is blocked
rhinne test in conductive hearing loss
In the affected ear, sound will be louder on mastoid than beside ear (BC>AC)
sensorineural hearing loss in weber test
Sound will lateralize and be louder in the unaffected ear – bone/nerve is damaged in bad ear so BC louder good ear
sensorineural hearing loss in rhinne test
In the affected ear, sound will be louder beside the ear than on the mastoid (AC>BC) bc bone/nerve damaged
functions of pinna
acts as a funnel, amplifies the sound and directs it to the ear canal
function of tragus
Collects sound from behind and directs it into the ear canal
accessory auricle
skin tag
benign skin growth, may necessitate excision
microtia/anotia
abnormal development of auricle creating EAC stenosis; congenital, requires surgical/cosmetic correction
preauricular pit
- cystic tract unclosed from embryologic development
- May develop infection and require drainage and antibiotic therapy
- Can excise if recurrent or abnormally enlarged
types of external ear trauma
- Simple (skin +/- cartilage)
- Blunt/crush
- Avulsion (tear or separation)
treatment of external ear trauma
- Deep cleaning
- Debridement
- Surgical repair
- Pressure Dressing
- Antibiotics
hematoma treatment
- I&D
- Through & through suture
- Pressure Dressing
- Antibiotics
- Repeat aspiration
complications of hematoma treatment
- Fibrosis
- Cauliflower ear
what is cerumen
substance produced in the ear canal to protect from infection, trauma, water damage, etc
treatment of cerumen impaction
Detergent drops to soften
Colace to soften
Mechanical removal
Suction
Irrigation
what is the most common cause of conductive hearing loss
cerumen impaction
symptoms of cerumen impaction
hearing loss, otalgia, drainage, dizziness, tinnitus (ringing in the ear)
management of cerumen impact
- In-office debridement
- Debrox (H202 and warm water)
- Vosol-Hc: wet EAC
- Derm-otic: eczematous EACs
- Mineral oil or baby oil for mildly eczematous
foreign body
- 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
what is Acute Otitis Externa (AOE) also called
Swimmer’s Ear
what is Acute Otitis Externa (AOE)
Bacterial infection of external auditory canal
P. aeruginosa 38%, S. aureus 8%, Strep Pneumo 6%
signs and symptoms of otitis externa
- 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
risk factors for otitis externa
- Swimming
- Trauma
- Diabetes
- Immunocompromised Conditions
management of otitis externa
- 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
otitis externa treatment
- topical!
- Fluoroquinolone gtts is safest (no ototoxicity)
Polymyxin B with Neomycin gtts
Most also have a corticosteroid component
- Fluoroquinolone gtts is safest (no ototoxicity)
- 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
malignant otitis externa
Infection of the external auditory canal that progresses to osteomyelitis of the temporal bone
what is malignant otitis externa caused by
pseudomonas
common population malignant otitis externa affects
elderly with diabetes
HIV
does malignant otitis extern improve with topical ABO
NO!
treatment malignant otitis externa
fluoroquinolone ABO
location of malignancy
May arise within EAC or extend from pinna, post-auricular sulcus, or parotid
radiographic appearance of malignancy
Involvement or invasion of soft tissue with destruction of bony cortex
T/F: low mortality rate of malignant ear infection
FALSE - high because of early invasion of lymphatics, skull, brain
treatment for malignant ear
surgery and radiation
functions of eustachian tube
- Equalization of pressure across the TM
- Protect middle ear from reflux from nasopharynx
- Clearance of middle ear secretions
eustachian tube dysfunction
Failure of any of the functions of the ET caused by the functional valve not opening or closing properly.
what is ET common associated with
URI
causes of ETD
virus
attitude makes it worse
symptoms of ETD
Fullness
Muffled sounds
Popping sound
Pain
Tinnitus
Vertigo
treatment of ED
Swallow/yawn/chew-”pop”
Decongestants
Antihistamine
Surgery – Tubes? / Adenoids?
exam findings of ED
- Retracted TM if a Chronic Cause
- If an acute cause, such as associated with a virus, the TM might be erythematous and bulging.
barotrauma
difference in pressure between the external environment and the internal parts of the ear
symptoms of barotrauma
- “clogging” of the ear
- ear pain
- hearing loss
- Dizziness
- ringing of the ear (tinnitus)
- hemorrhage from the ear
- Vertigo
risk of barotrauma
TM rupture - damage to the middle and inner ear