ear Flashcards
vestibular schwannoma and how to dx
CN?
neoplastic cause of hearing loss(acoustic neuroma).
This is a slow growing benign tumor of the vestibulocochlear nerve, CN VIII.
Occurs in males and females equally and is most often found in those between the ages of 50 and 60. These are the most common intracranial tumor.
CN VIII
dx with MRI with contrast.
steptomycin, kanamycin, neomycin, ethacryic acid and chloramphenicol can cause what
drug induced hearing loss. tinnitus 1st symptom.
why is ceruman good
acidic pH is bacteriostatic and fungistatic
can ceruman affect hearing
conductive hearing loss
vestibular symptoms suggest what
stapes dislocation. 90% spontaneously heal
what is cholesteotoma
skin cells behind eardrum
how to further evaluate chr ear inf or cholesteotoma
with a CT of temporal bones. may be assoc with mastoiditis or erosion of middle ear bones. tx with antibx drops or surgical repair
symptoms of mastoiditis
can occur with what
order what test
spiking fever, post auricular pain/redness/swelling, erythema, fluctuant painful mass, hearing loss otalgia, malaise, may appear toxic
can occur with inadequate treatment of otitis media
CT
CT shows what in mastoiditis
coalescence, possible boney destruction
tx for mastoiditis
myringotomy(for culture as well as drainage) with IV antibiotics, cefazolin
mastoidectomy if needed
main sx in BPPV
vertigo always last seconds
dx of BPPV
dix-hallmark positional testing will reveal nystagmus to be rotary or delayed fatigable nystagmus. If the nystamus is nonfatiguable, a central cause is more likely
clockwise rotary nystagmus when the pathologic ear is in downward position
BPPV-hallpike positional testing
quickly turning the head 90 degrees while the pt is supine
BPPV tx
tx symptomatically. repositioning movements such as Epley
vestibular suppressants(diazepam or meclizine)
PT manuevers
labyrinthitis or vestibular neuronitis history
sudden onset of vertigo assoc with hearing loss, N/V and unsteadiness that lasts several days to weeks
labyrinthitis or vestibular neuronitis symptoms
last days to weeks with most severe sx present at the onset. no cochlear sx(sudden hearing loss and tinnitus), No history of neuro deficit; viral origin
hearing loss may or may not resolve
pH of ceruman
acidic
chr mastoiditis, what should u worry about?
assoc cranial complications: urgent referral!
tinnitus, HL, N/V, fullness/pressure in ear
vertigo
duration of BPPV
always short, lasts seconds
weber test
Tuning fork placed against the forehead equidistant from both ears. A patient without hearing loss will hear the tuning fork equally in both ears.
lateralization to affected ear indicates conductive hearing loss
Sensorineural- Louder in unaffected ear
rinne test
Place the tuning fork on the mastoid process and then remove it and place it next to the ear. Normal hearing or a positive test will be louder with air conduction rather than bone conduction
conductive loss result in bone conduction greater then air conduction on affected side
sensorineural: The sound will be louder off the mastoid with air conduction. This is referred to as a positive Rinne’s test
senorineural defect
impairment of both air and bone conduction. air conduction will always be greater
hallpike or nylen-baeany maneuver
test for vertigo, quickly turning the pts head 90 degrees while supine to reproduce vertigo. positive with peripheral causes
sensorineural hearing loss. think what location
behind eardrum
what kind of hearing loss is involved with ceruman
conductive
what goes first in the elderly hearing loss
high frequencies
3 most common causes for hearing loss
ceruman impaction
eustachian tube dysfunction (secondary to URI)
increasing age (prebycusis)
Causes/Predisposing Factors
Not well understood
Syphilis
Head trauma
Distention of the inner ear(endolymphatic hydrops)
menieres d/s
I came in to see my physician assistant because of…
Episodic vertigo(lasting minutes to hours)
Low frequency hearing loss
Tinnitus
Unilateral ear pressure
what is dx and tx?
menieres
Treatment
initial: Low salt diet and Diuretics
Intratympanic steroid injection
Labyrinthectomy or ablation
Sudden unilateral hearing loss
Episodic or continuous vertigo
Tinnitus
what is dx?
gender?
ages?
Acoustic Neuroma (Vestibular Schwannoma)
This is a slow growing benign tumor of the vestibulocochlear nerve, CN VIII.
Occurs in males and females equally and is most often found in those between the ages of 50 and 60. These are the most common intracranial tumor.
These are the most common intracranial tumor.
Acoustic Neuroma (Vestibular Schwannoma)
tx of acoustic neuroma
Treatment
Observation with annual MRI
Surgical excision
Radiotherapy
caloric testing, nystagmus is lost on the impaired side
menieres
raised endolymphatic pressure in inner ear
menieres(episodic fluid imbalance of inner ear)
menieres main sx
unilateral; lasts hrs;followed by fatigue
sx worse at the beginning
labyrinthitis or vestibular neuronitis
is menieres unilateral or bilateral
unilateral
duration of meniere’s
hours then fatigue follows
ototoxic drugs(name 3)
aminoglycosides
loops
anticancer
3 congenital causes of childhood hearing loss
asphyxia, erythroblastosis, maternal rubella
measles, mumps, pertussis, meningitis, influenza, labyrinthitis
acquired causes childhood hearing loss
otoscope exam for otitis media
immobile, eryathematous, buldging eardrum. bullae suggest mycoplasmic infection
inadequate tx of otitis media can cause what? sx, tx.
mastoiditis. spiking fevers, pain, eryathema, post auricular pain. tx with IV antibx
otitis media tx
amox, augment, bactrim, emycin/sulfa.
organisms for otitis externa
pseudomonas, enterobacteria, proteus, fungi
I came in to see my physician assistant because of…
Ear pain
Fever
Irritability
Decrease in hearing
What test to order?
Acute Otitis media
Labs, Studies and Physical Exam Findings
An exam of the tympanic membrane may show erythema
Decreased mobility with a pneumatic otoscope
Tenderness over the mastoid
otorrhea and abruptly decreased ear pain
bulging and eventual rupture of tympanic membrane in otitis media
acute otitis media tx
Treatment
watchful waiting for older children withous severe pain or fever
Antibiotics
Amoxicillin x 10 days is first line
Erythromycin x 10 days, cephalosporin, bactrim, azithromycin
resistant cases: cefaclor or augmentin
recurring cases: Tympanocentesis, tympanostomy, myringotomy
Acute Otitis Media
Causes and organisms
Acute Otitis Media (Middle ear infection)
Causes: Typically occur in children secondary to an upper respiratory infection. The eustachian tubes become clogged and then bacteria settle in. The most common pathogens include
Strep pneumoniae
Strep pyogenes
Haemophilus Influenzae
Moraxella
what can occur with inadequate treatment of otitis media
mastoiditis
I came in to see my physician assistant because of…
Redness and swelling behind the ear
High fever
Ear pain
Drainage from the ear
Loss of hearing
mastoiditits
order CT
chronic otitis media organisms
pseudomonas, st aureus, proteus, anaerobes
main findings in a chronic otitis media
what kind of hearing loss
perforated TM and chronic ear discharge with or without pain
TM or ossicular damage can result in conductive hearing loss
dx and tx!
<strong>I came in to see my physician assistant because of…</strong>
My ear hurts
My ear itches
There is a yucky discharge coming out of my ear
My ear is red and swollen and gross
<strong>Labs, Studies and Physical Exam Findings</strong>
Pain with movement of the auricle
Tympanic membrane moves with a pneumatic otoscope
Eardrum is intact
otitis externa
Don’t put things in the ear canal at home!
Careful use of earplugs
A drying agent after swimming may be helpful. Fifty percent alcohol or white vinegar work well.
Antibiotic drops several times a day for about seven days or 3-5 days past the end of symptoms
Fluoroquinolones or Aminoglycosides
Steroid drops are optional
what otitis can occur in diabetic or immunocompromised pts
malignant otitis externa
necrotizing infection extending to the blood vessels, bone, cartilage- need hospitalization and perenteral antibiotics
what is malignant otitis externa
occurs in diabetic or immunocompromised pts
necrotizing infection extending to the blood vessels, bone, cartilage- need hospitalization and perenteral antibiotics
I came in to see my physician assistant because of…
There is a high pitched ringing in my ears driving me nuts!
I can hear my heartbeat in my ears
I hear a clicking in my ears
This is pulsatile tinnitus usually caused by conductive hearing loss
Think about getting an MRI
I came in to see my physician assistant because of…
Sensation of moving or spinning while not moving
Nausea and vomiting
Labs, Studies and Physical Exam Findings
Usually a clinical diagnosis
MRI may be helpful for a further workup
Complete audiologic evaluation
vertigo
sensation of movement in the absence of any actual movement or an over response to movement
vertigo
which nystagmus has no auditory component?
central
labyrinthitis, menieres, positional vertigo BPPV, vestibular neuronitis, head injury, migrainous vertigo, obstructing anatomic abnormalities
what is the cause of peripheral vertigo
brain stem vascular disease, av malformations, tumors of brain stem or cerebellum, MS, vertebrobasilar migraine syndrome
what is the cause of central vertigo
Vertigo PE
- peripheral
- central
which has no auditory component?
accelerated with movement, nystagmus.
peripheral(sudden onset, N/V, tinnitus, HL),
central(slower onset, motor, cerebellar, and sensory deficits; no auditory component)
which vertigo has nystagmus with a horizontal rotary component
peripheral vertigo
which vertigo has nystagmus with a vertical plane
central vertigo
acute tx of vertigo
diazepam, injection
tx of mild vertigo
meclizine, cyclizine, dimenhydrinate
tx of severe vertigo
scopolamine
what is labyrinthitis
phenonmenon of severe acute vertigo, hearing loss, and tinnitus. cause unknown. tx with meclinzine, promethazine, and dimenhydrinate
what is barotrauma
inability to equalize barometric stress on middle ear, resulting in pain
what causes barotrauma
auditory tube dysfunction. can result from congenital narrowing or acquired mucosal edema
Causes/Predisposing Factors
Fatigue, Alcohol consumption, Allergies, Upper respiratory infection, Smoking,Stress, Drugs
I came in to see my physician assistant because of…
Acute onset of vertigo, involuntary eye movements, unilateral hearing loss, nausea and vomiting, Tinnitus
Labs, Studies and Physical Exam Findings
History and physical
labyrinthitis
Treatment
If patient has signs of bacterial infection treat with antibiotics
Diazepam for the acute vertigo
I came in to see my physician assistant because of…
Conductive hearing loss
Tinnitus
Earache
Discharge of fluids
Treatment of TM perforation
A patient with an open ear drum should be very careful of water.
Most are will heal within weeks
Surgical repair may be necessary – Tympanoplasty
barotrauma tx
Prevention by opening the eustachian tube, exhale while the mouth is closed and holding the nostrils – autoinflation
Chew gum, Yawn, Hard candy – swallowing
Decongestants
Myringotomy
Insertion of tubes if this is a frequent problem
tx of NARROW eustachian tube dysfunction
Treatment
Decongestants
pseudoephedrine orally
oxymetazoline spray
Intranasal steroids
Surgical insertion of a tympanostomy tube
I came in to see my physician assistant because of…
Mild hearing impairment
Exaggerated ability to hear yourself breathe and speak
Feels better during a URI
*avoid what in tx
eustachian tube dysfunction
overly patent
decongestants
Typically the ear canal is filled with debri
Discharge from a defect in the tympanic membrane
Posterior and superior parts of the membrane are most commonly affected
cholestoma
