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ear Flashcards

1
Q

inflame of the middle ear, usually assoc w buildup of fluid and related to viral/bacterial infx

A

acute otitis media

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2
Q

fluid in middle ear wout infx

A

otitis media w effusion

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3
Q

drainage from middle ear for at least 2w usually assoc tympanic membrane perf

A

chronic supperative otitis media

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4
Q

what systems are involved with otitis media

A

nares, eustation tube, mastoid air cells

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5
Q

path of acute otitis media

A
  • inflam response obstructs gustation tube causing neg pressure/accum of secretions
  • vir/bac enter middle ear via aspiration/reflux
  • organisms mult=supprative infx
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6
Q

bacterial organisms of otitis media

A

strep pneumo*
h flu
m cat

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7
Q

viral organisms of otitis media

A

rsv, rhinovirus, coronavirus, influenza

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8
Q

path of ome

A

chronic inflame response to residual bacterial componetns

allergic rhinitis, myringotomy

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9
Q

rf for otitis media

A

daycare, bottles, smoking, male, fam hx

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10
Q

presentation aom and ome

A

aom- earache, +/- fever, +/- uri symp, dec hearing

ome- asymp, dec hearing

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11
Q

pt presents with earache and fever. upon further exam so inflamed tm

A

otitis media

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12
Q

proper dx ome

A

pneumatic otoscopy, typanometry

GS= myringotomy

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13
Q

syndromes of aom

A

otitis conjunctivitis

bullous myringitis

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14
Q

combination of otitis media and purulent conjunctivitis caused by H flu and seen in pt

A

otitis conjunctivitis

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15
Q

inflammation of TM w bullae, painful caused by same organism as AOM

A

bullous myringitis

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16
Q

what does it mean if pt has otalgia then pain suddenly goes away and followed by purulent discharge

A

aom w perforation of tm

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17
Q

when will you see purulent drainage from the ear

A

aom w tm rupture

otitis externa

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18
Q

causes of perforation

A

excess fluid and pressure
extreme pressure changes
trauma

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19
Q

pt presents w bloody drainage, pain, and tinnitis

A

perforation of tm

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20
Q

what 3 findings are needed to call it aom

A

bulging tm, middle ear effusion, inflammation

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21
Q

tx aom pain relief

A

motrin/tylenol

topical benzocaine/antipyrine (auralgan) >2yo= numb

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22
Q

tx aom kids

A

abx

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23
Q

tx aim kids 6m-2y

A

abx if dx certain (bulging,effusion,inflam)

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24
Q

tx aom >2y

A

dx certain- abx amoxil

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25
Q

if tx aom in kid with analgesics and no abx what do you do

A

48-72hr then reexamine

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26
Q

abx of choice tx peds for aom

A

amoxicillin
10d if severe
5-7d >6y

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27
Q

abx of choice tx peds for aim w resistance to amoxicillin

A

high dose augmentin

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28
Q

abx choice tx peds for aom w pcn allergy

A

mild 3rd gen- cefdinir, cefpodoxime, cefuroxime

anaphylaxis- azithryomycin or clarithromycin

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29
Q

what is recommended for kids unable to take oral abx for tx aom

A

ceftriaxone 50mg/kg

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30
Q

tx aom adults

A 
1st line amoxicillin
may use augmenting if severe pain/fever
mild allergy-cefdinir, cefuroxime
anaphylaxis- zithromax 
maybe bactrim
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31
Q

tx peds and adults aom w perforation

A

peds- oral abx

adults- oral and otic abx

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32
Q

tx otitis media w effusion in adults

A

resolve spont but attempt to correct gustation tube dysfunction- antihistamines, decongestants, nasal steroids

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33
Q

tx otitis media w effusin in kids

A

watchful waiting, sympt past 3 months= chromic refer to ent

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34
Q

when are tympanostomy tubes in kids indicated

A

> 3 confirmed cases aom in 6m

>4 confirmed cases aom in 12 m

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35
Q

pt presents w ear pain, postauricular tenderness, erythma, swelling and displacement of auricle

A

mastoiditis

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36
Q

primary rf for mastoiditis

A

aom

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37
Q

bacteria causes mastoiditis

A

strep pneumo, strep pyogene, staph aureus

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38
Q

complications of mastoiditis

A 
facial nerve palsy
subperiosteal abscess
hearing loss
labryrinthitis (tinnitis, vertigo, n/v, nystagmus)
osteomyelitis
bezold abscess
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39
Q

when should you get ct w iv contrast for mastoiditis

A

extracranial complications (mass/abscess)
intracranial complications (neuro deficits)
severe illness/toxic appearance
aom not responding to abx

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40
Q

should cx be obtained for mastoiditis? if so when

A

blood if >102.2 temp
fluid strongly considered
tympanocentesis or myrinotomy
already drainage from ear

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41
Q

tx mastoiditis

A

ent for aspiration/drainage/mastoidectomy
admit + iv abx (vanco)
may need to add gram neg coverage

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42
Q

another name for otitis externa

A

swimmers ear

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43
Q

inflammation or infx of external auditory canal

A

otitis externa

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44
Q

origins/causes of otitis externa

A

infx
allergic
dermatologic

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45
Q

what ages does otitis externa most commonly occur

A

5-14

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46
Q

path of otitis externa

A

breakdown skin-cerumen barrier leads to inflam and edema of skin that causes pruritus and obstruction
the inflam changes alter cerumen prod and creates environment for breeding organisms

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47
Q

rf otitis externa

A

swimming/excess moisture
trauma to canal
devices- hearing aids, earphones
allergic contact dermatitis-shampoos,earrings
dermatologic issues-psoriasis, atopic dermatitis
prior radiation to ear area

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48
Q

bacteria that causes otitis externa

A

usually gram pos- staph aureus, staph epidermidis
**pseudomonas
candidal- check sugar

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49
Q

pt presents with pain when move tragus, pruritus, and hearing loss

A

otitis externa

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50
Q

on otoscopy exam what will otitis externa look like

A

canal erythematous, edematous
debris yellow, brown, white, gray
tm might be erythematous
no signs aom or tm rupture

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51
Q

complication of OE

A

malignant external otitis (necrotizing external otits)

  • severe, potentially fatal
  • elder diabetics and immunocompromised
  • spreads from skin to bone to marrow of skull
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52
Q

pt presents with pain out of proportion, granulation tissue at bony cartilaginous junction of ear canal floor, and erythema

A

malignant external otitis

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53
Q

tx malignant external otitis

A

admit and consult ENT
IV cipro 1st line consider levofloxacin
control bs

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54
Q

tx otitis externa

A
  1. clean debris- remove cerum/ debris
  2. topical abx- fluoroquinolones (ofloxacin, cipro), polymyxin B/neomycin mix, aminoglycosides (tobramycin, gentamycin)
  3. antiseptics- bacterial static agent
  4. glucocorticoids to dec swelling
  5. wick placement for severe/bad
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55
Q

when should you tx OE w systemic abx and what are they

A

severe infx and immunocomp

cipro or ofloxacin

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56
Q

in tx oe with amino glycosides-tobramycin and gentamycin what can se be

A

ototoxicity

iatrogenic hearing loss, balance dysfunction

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57
Q

follow up OE and when to refer

A

improve by 36-48hr

refer not better 48-72hr

58
Q

anatomy of eustation tube

A

runs from anterior wall of middle ear cavity and opens into nasopharynx

59
Q

3 functions of eustation tube

A
  1. equalization of pressure across tm
  2. protecting middle ear from infx/ reflux of nasopharyngeal contents
  3. clearance of middle ear secretions
    all mediated by opening/closing eustation tube
    -yawning opens=pop
60
Q

3 pathologic process of eustation tube

A
  1. pressure dysregulation
  2. impaired protective function
  3. diminished clearance
61
Q

path of pressure dysregulation of eustation tube

A

failure to open and allow adequate ventilation leading to mucosal inflam and obstructed nose

62
Q

functional obstruction w pressure dysregulation of eustation tube

A

neg pressures make opening of tube difficult

ex barometric pressure changes, airplanes

63
Q

path of impaired protective function of eustation tube

A

reflux of nasophar pathogens, allergy inducing proteins, and gastric secretions into tube

64
Q

what causes impaired protective function of eustation tube

A
  • congenital
  • short/floppy tubes (craniofacial anomalies)
  • abn pos pressure nasopharynx (blowing nose, crying)
  • loss immune protection in tube due to secretions
  • loss mucosal protection from gastric enzymes
65
Q

path of impaired clearance of eustation tube

A
  • inability to clear viscous material/pathogens from middle ear
  • loss of mucociliary function due to bacterial toxins, viruses, smoking, allergic ds, inflam
66
Q

pt presents w ear pain/fullness, tinnitus and popping sounds

A

eustation tube dysfx

67
Q

what will otoscopy exam look like for ETD

A
  • dull bluish gray/ yellow tm (fluid behind)
  • bony structures behind tm distorted
  • retracted tm
  • nasal mucosal swelling/inflam/polyps
68
Q

tx ETD

A
  • tx underlying issue is key: rhino sinusitis, allergic rhinitis, laryngopharyngeal reflux
  • decong: pseudoephedrine/phenylephrine
69
Q

when should refer for ETD

A
  • severe ear complaints
  • no improvement
  • cholestetomma, recurrent aom, tm rupture
70
Q

abnormal growth of squamous epithelium in middle ear and mastoid

A

cholesteatoma

71
Q

what 2 ways can cholesteatoma lead to hearing loss

A
  • destroy ossicles

- obstructs ET orifice leading to effusion

72
Q

predisposing factors of cholesteatoma

A
  • hx recurrent aom/middle ear effusions
  • older age tympanostomy tube placement
  • cleft palate
  • craniofacial abn
  • turner syndrome
  • down syndrome
  • fam hx of chronic middle ear ds/cholesteatoma
73
Q

path of congenital cholesteatoma

A

squamous cysts arise from epithelium of middle ear, fail to dissipate, dev into cholesteatoma

74
Q

path of acquired cholesteatoma

A
  • arise form retraction pocket of TM
  • invaginations of TM that form in pts w chronic ETD, neg middle ear pressure, and focal collapse of tm
  • retraction poclet pulled into middle ear space creating pouch that collects desquamating cells and forms cholesteatoma
75
Q

complications fo cholesteatoma

A

late stage can destroy bone and lead to deafness and paralysis of facial nerve
secondary infx- pseudomonas, proteus

76
Q

where is acquired cholesteatoma found

A

posterosuperior quadrant tm

77
Q

where is congenital cholesteatoma found

A

anterosuperior quadrant of tm

78
Q

pt presents with white mass behind intact tm and focal granulation on surface of tm

A

cholesteatoma

79
Q

tx cholesteatoma

A

refer and surgery
complete excision (tympanoplasty) and reconstruction of ossicles
exteriorization forming a skin lined cavity

80
Q

what is acoustic neuroma known as and why

A

vestibular schwannomas- schwan cell derived tumors that commonly arise from vestibular portion of 8th cranial nerve
avg age 50

81
Q

path of acoustic neuroma

A

genetically linked assoc w neurofibromatosis type 2- gene located on chromosome 22

82
Q

rf of acoustic neuroma

A

exposure to loud noise
childhood exposure low dose radiation head/neck
hx parathyroid adema

83
Q

pt presents with hearing loss and tinnitus, unsteadiness while walking, and taste disturbance

A

acoustic neuroma
cochlear nerve- hearing loss/tinnitus
vestibular nerve- unsteadiness
facial nerve- taste disturbance

84
Q

pt presents with tinnitus, feel like tilting, and hypesthesea

A

acoustic neuroma
cochlear- tinnitus
vestibular- tilting
trigeminal- hypesthesea

85
Q

pt presents hearing loss, facial numbness, facial paresis

A

acoustic neuroma
cochlear-hearing loss
trigeminal-numbness
facial- paresis

86
Q

cochlear nerve invol of acoustic neuroma

A

hearing loss and tinnitus

87
Q

vestibular nerve invol of acoustic neuroma

A

unsteadiness while walking, feeling of tilting or veering

88
Q

trigeminal nerve invol of acoustic neuroma

A

facial numbness, hypesthesea, pain

89
Q

facial nerve involve of acoustic neuroma

A

facial paresis, taste disturbance

90
Q

tumor progression in acoustic neuroma is a sign of

A

cerebellar or brainstem compression

91
Q

best initial test for dx acoustic neuroma

A

audiometry

92
Q

tx options of acoustic neuroma

A

surgery- good long term control
radiation- sterotactic radiosurgery/radiotherapy and proton beam therapy
observation- slow growing, MRI every 6-12m

93
Q

pt presents with episodic vertigo, sensorineural hearing loss, and tinnitus (age 20-40)

A

meniere ds

94
Q

path of meniere ds

A

endolymphatic hydrops cause distortion and distention of membrane/endolymph portions of labyrinthine system
not sure why excess fluid builds up

95
Q

how does episodic vertigo present in meniere ds

A
  • rotatory spinning or rocking sensation
  • +/- N/V
  • persists for 20m to 24h
  • disequilibrium sensation
96
Q

how does hearing loss present in meniere ds

A 
sensorineural
fluctuating
affect lower frequencies
progressive over time
permanent 8-10y
97
Q

how does tinnitus present in meniere ds

A

low pitch sound

auditory distortion

98
Q

definitive dx of meniere ds

A

postmortem

99
Q

guideline to dx meniere

A

2 separate episodes vertigo lasting at least 20m
audiometric confirmation of sensorineural hearing loss
tinnitus / perception aural fullness

100
Q

what diagnostic studies should be performed w meniere ds

A

audiometry- normal in mid freq, low/high loss
vestibular testing
labs- rpr rule out syphilis
imaging- mdi rule out cns lesions
vestibular evoked myogenic potential (VEMP)- detect hydrops

101
Q

lifestyle adjustments w menieres

A

salt restriction

caffeine/nicotine/alcohol restriction

102
Q

antihistamine tx menieres

A

meclizine (antivert)

dimenhydrinate (dramamine)

103
Q

anticholinergic tx menieres

A

scopolamine

104
Q

antiemetic tx menieres

A

promethazine (phenergan)

prochlorperazine (compagine)

105
Q

benzo tx menieres

A

lorazepam (ativan)

106
Q

types rehab menieres

A

hearing aids

vestibular rehab- exercises max balance

107
Q

what improves fluid exchange in inner ear for menieres

A

pos pressure pulse generator (meniett)

108
Q

perception of sound in absence of an external source within 1 or both eyes, within or around head or as outside distant noise

A

tinnitus- buzzing, ringing, hissing

109
Q

vascular disorders that can cause tinnitus

A

believed to be secondary to atherosclerotic narrowing of vessels

  • arterial bruits
  • av shunts (av fistula)
  • paranganglioma: near carotid bifurcation
  • venous hum: htn , inc ICP
110
Q

path of neuralgic disorders causing tinnitus

A

spasm of muscles in middle ear- pulsatile tinnitus- related to cn V/VII (MS)

111
Q

ETD path causing tinnitus

A

vents too much causes ocean sound; mc after sudden weight loss and improves when lie down

112
Q

causes of tinnitus from auditory system

A

ototoxic meds
presbycusis-hearling loss w age
otosclerosis-bony overgrowth of stapes
acoustic neuroma- tumor compressing cochlear nerve

113
Q

behavioral therapies for tinnitus

A

tinnitus retraining- suppress auditory neural connections
biofeedback/stress reduction- relaxation tech control autonomic functions
cognitive behaviroal- altering psychological response to tinnitus

114
Q

meds to tx tinnitus

A

prostaglandin analogue- misoprostol (limited benefit)

intratympanic dexamethasone

115
Q

illusion of movement, transient sensation of spinning and can be assoc with gait, N/V, nystagmus

A

vertigo

116
Q

vertigo is either 2 things in origin

A

central- cps issue

peripheral- vestibular system issure

117
Q

peripheral vestibular vertigo can sense 2 motions

A

semicircular canal- angular motion “spinning”

otolith organs- linear motion

118
Q

path of vertigo w 1 ear

A

dysfunction of 1 of vestibular labyrinths sends different messages to brain which doesn’t match with visual data
vestibular labyrinth dysfn=peripheral vertigo

119
Q

path of vertigo w both ears

A

sending appropriate msg to brain along w eyes so when brain malfunctions/misinterprets data causes vertigo
brain misinterpretation= central vertigo

120
Q

vestibular labyrinth dysfunction = ? vertigo

A

peripheral

121
Q

brain misinterpretation= ? vertigo

A

central

122
Q

mc vertigo caused by Ca debris within posterior semicircular canal

A

benign paroxysmal positional vertigo (BPPV)

123
Q

spinning sensation brought on when turning in bed or tilting head backward to look up

A

BPPV- peripheral

124
Q

dx BPPV

A

horizontal/vertical/torsional nystagmus

dix hallpike maneuver/epley maneuver

125
Q

rapid onset severe, persistent vertigo, N/V, and gait

A

vestibular neuritis (labyrinthitis)- peripheral

126
Q

acute vertigo, +/- hearing loss, facial paralysis, ear pain and vesicles in auditory canal

A

herpes zoster oticus “ramsay hunt syndrome”
peripheral
steroids/acyclovir

127
Q

vertigo, n/v, gait w traumatic peripheral vestibular injury following direct concussion

A

labyrinthine concussion
hemotympanum/hearing loss noted
weeks- months

128
Q

types of central vertigo

A

migrainous
brainstem ischemia
cerebellar infarct/bleed- sudden,intense, limb ataxia
MS-lesions near vestibular nuclei

129
Q

recurrent vertigo lasting under 1 min

A

bppv

130
Q

single episode vertigo lasting several min to hrs

A

migraine or transient ischemia

131
Q

recurrent episodes w meniere ds can last how long

A

hrs

132
Q

prolonges and severe episodes vertigo

A

vestibular neuritis

133
Q

presentation of nystagmus w peripheral vertigo

A

horizontal, fast and away from affected side

134
Q

presentation nystagmus w central vertigo

A

can have any trajectory

135
Q

gait presentation w vertigo

A

unilateral/peripheral lean/fall to affected side

cerebellar stroke-unable to walk without falling

136
Q

dx testing vertigo

A

acute setting- ct scan, mri/mra

ent referral- electronystagmography and video nystagmography, vestibular evoked myogenic potentials (vemp), audiometry

137
Q

acute sump relief vertigo

A

iv fluids
antiemetics- zofran, reglan, phenergan
antihist- antivert, dramamine, benadryl
benzos- valium, ativan

138
Q

vestibular neuritis (labyrinthitis) vertigo tx

A 
oral steroidsantiemetics- zofran, reglan, phenergan
antihist- antivert, dramamine, benadryl
benzos- valium, ativan
anticholinergics- scopolamine
vestibular rehab
139
Q

blunt trauma to outer ear

A

auricular hematoma

140
Q

path of auricular hematoma

A

blood accumulates in subperichondrial space creating barrier and cuts off blood supply to cartilage leading to necrosis and maybe infx

141
Q

another name for auricular hematoma

A

cauliflower ear

142
Q

tx auricular hematoma

A

needle drainage

I&D

ear (1 decks)

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