Ear Flashcards
Pt presents with dysfunctional ext and middle ear when she was cleaning her ear aggressively.
Test: Rinne test results show that pt was able to feel better than hear (placed 2” away from the mastoid).
Cerum Impaction (Conductive Hearing Loss) Tx: Irrigate, ear drops
Pt presents with loss of hearing bilaterally. Pt is old and has been taking abx w/ototoxiy (aminoglycosides, loop diuretics).
Test: Pt can hear better than feel.
Sensory/Sensorineural hearing Loss
Tx: hearing aid, audiology consult
Pt went to a concert (high noise exposure). Idiopathic.
Sensorineural Sudden Hearing Loss
Tx: oral steroids w/in 24 hrs
Pt presents with one sided hearing loss with tinnitus and vertigo.
Labs: a non-malignant tumor on CN 8 (arising from the Schwann cells on the inferior vestibular nerves) from MRI and ENT
Acoustic Neuroma/ Vestibular Schwannomas
Tx: hold off surgery as much possible, referral to ENT
Pt presents with ringing in the ears.
Pt has taking a lot of NSAIDs w/ a recent head and neck injury, and taking ototoxic drug (aminoglycosides)
Tinnits
Tx: treat underlying dx (chronic rhinitis, allergic rhinitis) before tx with drugs
Pt was playing BB when he was struck with a ball on the ear - a lot of bleeding.
Traumatic Auricular Hematoma
Tx: Drained to prevent cauliflower ear (cosmetic deformation).
RTC 24hrs for 3-5 days.
Pt presents with FB in ear and an insect.
Loop instrument was used after immobilizing insect with lidocaine.
DO NOT USE:
Aqueous Irrigation
Foreign Bodies
Tragus and Conchal Cartilage
Hair Follicles and Isthmus
Cerumen
Keratinizing squamous epithelium lining of the canal
Prevents FB from entering
Prevents contamination
Acidic to prevent bacterial growth, Hydrophobic to prevent water, Sticky to trap contaminates
Cleans the ear canal
Pt presents with mild (mod, severe, malignant) infection of the ear. She was excessively cleaning her ear after she swam.
Pain with pressure on the tragus, pulling on the auricle, and there is debris (brown, gray, yellow).
Otitis externa
Tx: Remove debris; abx (fluoroquinolones-Cipro drops) and fluconazole (fungal)
Lab: Bacterial: S. aurues, S. epidermidis, pseudomanas
Fungal: Candida
Pt presents with inflamed ear after wearing a nickel earring.
Contact dermitis
Tx: dry: mineral oil; inflammation: CS
Pt presents with bloody otorrhea, pain, hearing loss, and facial paralysis.
External auditory canal carcinoma
Tx: surgery and radiation
Pt presents with bony structures in her ear. She is an avid surfer. She is not bothered but is concerned.
Exostoses and Osteomas
Tx: Single: does not bother - don’t do anything. Multiple: surgically remove
Pt is a child*. Presents with URI, allergy, and exposure to tobacco.
Upon examination, the TM is retracted.
Eustachian (auditory) tube dysfunction
Children have straight ET compared to adults who have curved ET causing them to be at higher risk of infections.
ET is suppose to ventilate and equalize pressure.
Tx: URI: oral and nasal decongestants; allergy: CS
Patient has family history of middle ear infection with dx of the auditory tube. Hearing loss. Middle ear has effusion but no signs of infection.
Upon examination TM is retracted, dull with bubbles appreciated.
Serous otitis media/ otits media w/ effusion
Tx: URI: oral and nasal decongestants - pseudophedrine; allergy: CS
Pt went on a diving trip to Hawaii.
Upon examination, the TM is retracted and signs of hematoma*.
The air in the middle ear is slowly replaced when one yawns or swallows.
Barotraumas are from pressure gradients.
Problem: the TM is forced and stretched medially.
Tx: Decongestants
