Ear Flashcards
CONDUCTIVE HEARING LOSS
(Outer Ear and Middle Ear)
Any type of obstruction of sound waves will cause conductive hearing loss
Outer Ear
-Cerumen
-Otitis Externa
Middle Ear (fluid inside)
-Otitis Media
-Serous Otitis Media -Fluid filled
SENSORINEURAL HEARING LOSS
Inner Ear
Damage or aging of the cochlea/vestibule
-Presbycusis, Meniere’s disease
Damage to the nerve pathways (CNVIII or Acoustic Nerve) Otoxic drugs (oral aminoglycosides, erythromycin, tetracycline, high-dose aspirin
Weber test
Place the tuning fork for midline on the forehead.
Normal finding is NO lateralization
Tinne test
Place the tuning fork first on mastoid process, then at front of ear.
Normal finding : Air conduction (AC) lasts longer than bone conduction
Hearing test tip
The Weber and Rinne test are complete opposites of each other.
In sensorineural hearing loss, Weber finds lateralization to “good” ear; Rinne test finds AC > BC
In conductive hearing loss, Weber finds lateralization to “bad” ear; Rinne test finds BC > AC
Otitis Externa
Painful inflammation of the external auditory canal and auricle
Commonly known as “swimmer’s ear”
Does occur in the elderly, but more common in younger persons
Otitis Media
Infectious or inflammatory process within the middle ear
May be acute or chronic, suppurative or serous in nature
Caused by bacteria or viruses
Otitis Serous
Fluid trapped behind the tympanic membrane without an ear infection.
Often caused by URI or allergies
OM etiology
Eustachian tubes dysfunction or congestion that prevents effective drainage of the middle ear
Infectious causative agents (typically respiratory bacteria):
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
OM sub and obj findings
Throbbing pain
Conductive hearing loss
Vertigo and nausea
Severe ear pain with sudden relief usually indicates tympanic membrane rupture with immediate release of fluid into the middle ear cavity
Otorrhea
Red, dull, bulging tympanic membrane with serous or amber fluid in color
A fine black line (fluid meniscus) indicates a partially-filled cavity
Air bubbles may be visible beyond the tympanic membrane
Bony landmarks are obscured
Hole in the tympanic membrane in serous cases if rupture occurs
Tympanic membrane retracted, opaque and dull with decreased movement (often in Otitis Media with effusion)
mgmt OM
Antibiotics (oral course for 10 days)
Amoxicillin (Amoxil) 500 po q12 hrs. or 250 mg q8 hrs. for mild to moderate AOM, 875 mg po q 12hrs or 500 mg q8hrs for severe AOM
Cefdinir (Omnicef)
Cefuroxime
If TM Perforation has occurred: Cortisporin Otic 4 ear drops topically, 3x/day for 7 days
Analgesics PRN for pain : OTC acetaminophen or NSAIDS
Refer to ENT
for recurrent Acute Otitis Media (3-4 infections in 6 months)
for Chronic Otitis Media ( 3 months or more bilaterally or 6 months or more unilaterally)
Perforation of TM
Hearing loss of 20 dB
Bell’s palsy
Sudden onset of unilateral facial paralysis or weakness
Generally self-limiting, with restoration of health in a matter of weeks
Etiology/ Incidence / Predisposing factors
BP Etiology/ Incidence / Predisposing factors
Idiopathic
Probably involves inflammation of CN VII
Affects individuals across the life span without gender preference
Clinical appearance often correlates with periods of stress, viral infection, or fatigue
Familial tendency
Increased incidence in hypertension, diabetes, viral infection such as Herpes Simplex, Herpes Zoster, Epstein-Barr virus, CMV, coxsackievirus, adenovirus, and influenza B
Lyme disease
BO obj and sub findings
Unilateral paralysis of face
Taste impairment
Ipsilateral pain in ear, cheek, and face
Weakness of upper and lower face
Inability to close the eyelids
Abnormal corneal reflex on the affected side
Hyperacusis (increased hearing sensitivity)
Normal facial sensation or may have pain in or behind the ear
Taste disturbance
Herpetic lesions around ear/face
The corneal reflex (blink test) is abnormal in 100% of cases
Excessive tearing or dry eye
Bp lab and dx
Diagnostic testing is non-specific
Diagnosis is one of exclusion
A Lumbar puncture typically is not needed but may reveal levels of CSF protein and cells
Consider test to confirm other diagnoses such as:
CT, MRI, to rule out tumor
Lyme titer (if history of tick exposure is reported
Audiogram to rule out CNVIII involvement (not associated with Bell’s Palsy)
BP mgmt
Eye Care - Artificial Tears PRN
Eyelids may have to be taped closed to prevent external trauma
Consider referral to Physical therapy for evaluation, exercise, stimulation
Use of Steroids is indicated to decrease inflammation around CN VII
In the early stages of illness (before day 10 of onset)
Tapered regimen of Medrol Dosepak
Explain to pt. this disorder is self-limiting; most resolve in 4-6 weeks with complete resolution in 6 months
Cholesteatoma
“Cauliflower-like” growth accompanied by foul-smelling ear discharge
Hearing loss on affected ear
On exam, the tympanic membrane is NOT visible because of destruction by the tumor
History of Chronic Otitis Media infection
The mass is not cancerous, but can erode into the bones of the face and damage the facial nerve (CN VII)
Treated with antibiotics and surgical debridement
Refer to Otolaryngologist
Vertigo
False sensation of movement, usually associated with disequilibrium
Disequilibrium is a sense of light-headedness or of being off-balance without movement
Severe vertigo is also associated with nausea and vomiting, in addition to trouble standing or walking
Vertigo Etiology / Incidence / Predisposing Factors
Viral syndromes
Labyrinthitis
Meniere’s disease
Vascular disease/spasm
Damage to cranial nerve VIII – Meningitis, trauma, tumors
Damage to brain stem nuclei – Encephalitis, Brain abscess, Hemorrhage, Multiple Sclerosis
Other conditions – Tertiary syphilis, alcohol intoxication, drugs, cardiac arrythmia, hypoglycemia
Cerebellar (vertebrobasilar) - Transient ischemic attack, Cerebrovascular accident
Vertigo sub and ob finding
Sensation of movement/rotation
Light-headedness/ “faint feeling”
Sense of floating or swimming
Tinnitus
Hearing impairment
Nausea, vomiting
“Full” sensation in ear
Nystagmus
Carotid bruits
Positional hypotension
Conductive hearing loss
Positive Romberg sign
Vertigo mgmt
Treat symptomatically
Medication reconciliation and stopping unnecessary medications
Bedrest during acute attacks
Vestibular exercises to facilitate CNS compensation
Vestibular suppressants
Meclizine (Antivert) 25-100 mg PO divided every 6 hours
Diazepam (Valium) 2.5-5 mg POS at bedtime
Scopolamine (Transderm Scope patch) apply 1 patch every 3 days
Low salt diet with diuretics if Meniere disease is suspected
Antiemetics
Ondansetron (Zofran) 4-8 mg PO every 12 hrs
Metoclopramide (Reglan) 10 mg every 6 hour
Promethazine (Phenergan) 12.5-25 mg PO or per rectum (Suppository) q4hr-caution for falls
An older man is diagnosed with conductive hearing loss in the left ear by the NP. Which of the following is expected when performing a Rinne test?
BC>AC
Rationale:
The normal result in the Rinne test is air conduction (AC) greater than bone conduction (BC). When there is conductive hearing loss (i.e. Ceruminosis, Otitis media) the result will be BC greater than AC. The reason is that the sound waves are blocked (i.e. Cerumen, fluid in middle ear). Therefore, the patient cannot hear them as well as through bone conduction.
Which of the following is Not considered an objective finding n patients who have a case of suppurative otitis media?
Visualize mobility of the tympanic membrane as measured by tympanogram
Rationale:
Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system.
Suppurative stage: the tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present. Diagnosis is usually made simply by looking at the eardrum through an otoscope. The eardrum will appear red and swollen and may appear either abnormally drawn inward or bulging outward. Using the tympanogram with the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum, this movement may be decreased or absent.
