Ear Flashcards
What is Conductive Hearing Loss?
disruption of the external or middle ear, impairing sound conduction to the inner ear; sound wave conduction is obstructed by canal obstruction, fluid in the middle ear, or ossicular disease such as otosclerosis
What are four causes of Conductive Hearing Loss?
obstruction (foreign body, cerumen impaction) stiffness effect (otosclerosis) mass loading (middle ear effusion) discontinuity (ossicular disruption or fixation)
What might a patient’s tympanic membrane look like if they have Conductive Hearing Loss?
tympanic membrane may disclose bulging, perforation, scarring, inflammation, fluid levels, or hemotympanum
How will a patient with Conductive Hearing Loss react to Weber and Rinne tests?
Weber Test – sound lateralizes towards affected ear
Rinne Test – bone conduction is great than or equal to air conduction (negative Rinne)
How is Conductive Hearing Loss treated?
resolved with medical or surgical measures (remove cerumen or foreign body, topical antibiotics for otitis externa)
routine audiograms
amplification with hearing aids
What is Sensorineural Hearing Loss?
impaired nerve impulse transmission to the brain; inner ear or cochlear nerve disorder losses of both air and bone thresholds are diminished; seen as damage or dysfunction to cochlea/hair cells and eighth cranial nerve disease/trauma, tumors such as acoustic neuroma or CNS disease
What can cause Sensorineural Hearing Loss?
natural aging (presbycusis) drugs head trauma excessive noise exposure acoustic neuroma systemic causes such as diabetes mellitus
What is the primary, common symptom of Sensorineural Hearing Loss?
upper tones/high frequencies are lost
Is Sensorineural Hearing Loss sudden or gradual?
It can be both, but a patient has a sudden onset, refer to ENT immediately.
What are common histories of patients who experience Sensorineural Hearing Loss?
may have history of excessive noise exposure, inner ear infection, trauma, and certain medications
How will a patient with Sensorineural Hearing Loss react to Weber and Rinne tests?
Weber Test – sound lateralizes into good ear
Rinne – air conduction is greater than bone conduction
How is Sensorineural Hearing Loss treated?
refer to ENT – especially if sudden onset
routine audiograms
amplification with hearing aids
usually not correctable, but may be stabilized or prevented
What other tests can be ordered for patients with Conductive or Sensorineural Hearing Loss?
audiogram – establishes pattern of hearing loss (normal 0-20dB; severe loss 60-80 dB)
MRI – used to rule out multiple sclerosis or acoustic neuroma
CT scans – used in middle-ear and mastoid problems
What is a Neoplasia? How does it relate to the ear?
abnormal growth of cells, usually a sign of cancer. Neoplasia commonly appears on the auricle of the ear as a result of excessive sun exposure.
What is the most common type of cancer that affects the ear?
Squamous Cell Carcinoma
What other disease of the ear might Neoplasia of the auricle be confused with?
Otitis Media; if otitis media persists in a patient, have a biopsy done.
Why is it crucial to catch Neoplasia early on?
Skin cancer on the ear can quickly spread to the base of the skull. I has an extremely high 5-year mortality rate.
How might skin cancer of the ear affect hearing?
may cause conductive hearing loss from buildup of debris and exudates
How is Neoplasia of the ear treated?
refer to an ENT!
wide surgical resection
radiation therapy
What is a Hematoma?
A build-up of clotting blood in the tissues
How do Hematomas most often develop on the ear?
trauma
How will a Hematoma look on the ear?
A purplish swelling of the upper part of the ear; blood clots between the cartilage and perichondrium
How are Hematomas on the ear treated?
refer to an ENT; must be recognized and drained to prevent cauliflower ear or canal blockage, resulting from dissolution of supporting cartilage
Why is Cellulitis of the ear important to catch and treat?
Cellulitis of the ear must be treated to prevent perichondritis and its resultant deformity.
What is Polychondritis?
a rheumatologic disorder that attacks cartilage
What are symptoms of Polychondritis?
recurrent, frequently bilateral, and painful erythema and edema
How is Polychondritis treated?
corticosteroids may forestall cartilage dissolution
How would you differentiate between Cellulitis of the ear and Chondritis or Perichondritis?
chondritis and perichondritis attack only cartilage and won’t affect the lobule (no cartilage); cellulitis of the auricle will affect the lobule
What is cerumen?
ear wax; a protective secretion produced by the outer portion of the ear canal; the ear is self-cleaning
How do Cerumen Impactions usually occur?
self-induced by pushing the earwax further into the ear canal (often with q-tips)
How are Cerumen Impactions treated?
detergent eardrops
mechanical removal
suction
irrigation (water at room temperature; only when the tympanic membrane is known to be intact, dry thoroughly)
In what group are Foreign Bodies in the ear most commonly found?
more common in children than adults
What symptoms might occur as a result of a foreign body in the ear?
may cause conductive hearing loss
may get secondary infection
bleeding if the foreign body is sharp
How is a foreign body in the ear treated?
if firm, can be removed with a hook or a loop
do not use aqueous irrigation with organic foreign bodies
living insects should be immobilized (lidocaine) before removal
otic topical antibiotics can be prescribed to prevent a secondary infection
What is External Otitis?
a bacterial or fungal infection of the external auditory canal that usually results from excesss fluid int he ear canal
What are essentials of diagnosis in regard to External Otitis?
Painful erythema and edema of the ear canal skin
Often with purulent exudate
May evolve into malignant external otitis
What causes External Otitis?
gram-negative rods (Pseudomonas, Proteus)
Fungi (Aspergillus)
What are common symptoms of External Otitis?
pain upon moving the auricle
occurs frequently with pruritis and pussy discharge
erythema and edema of the ear canal
tympanic membrane moves normally (unlike Otitis Media)
hearing may not be affected or minor
if sever, cellulitis
What are common histories of patients with external otitis?
recent water exposure (swimmer’s ear)
mechanical damage (q-tips or scratching)
trauma
What illnesses predispose patients to persistent External Otitis?
diatbetes mellitus and immunologic disordes
What might persistent External Otitis evolve into?
Malignant External Otitis
What other tests might you order for patients with External Otitis?
cultures if treatment fails
How is External Otitis treated?
protect ear from additional moisture and avoid scratching
acidification with a drying agent (50/50 isopropyl alcohol/white vinegar)
if infected, acidic otic antibiotics drops (contain aminoglycoside or fluoroquinolone, with or without corticosteroids, use abundantly to make it to the inner canal)
oral fluorquinolones for Pseudomonas
When would you refer External Otitis?
Refer to ENT if persistent
What is Malignant External Otitis?
osteomyelitis of the skull base that begins at the floor of the ear canal and may extend into the middle fossa floor, the clivus, and the contralateral skull base
What causes Malignant External Otitis?
Pseudomonas aeruginosa
What illnesses often precede Malignant External Otitis
External Otitis
more often in patients with immunologic disorders and diabetes mellitus
What are symptoms of Malignant External Otitis?
foul aural discharge granulations in the ear canal deep otalgia (ear pain) cranial palsies in advanced cases
What tests might help in diagnosing Malignant External Otitis?
CT or radionuclide scanning will show osseous erosion
How is Malignant External Otitis treated?
prolonged antipseudomonal antibiotic - often several months
ciprofloxacin is usually required (intravenously or orally)
surgical debridement may be necessary
What is Pruritis, and how is it related to the ear?
severe itching of the external ear, particularly at the meatus; usually due to absence of cerumen
What causes Pruritis of the ear?
most cases are self-induced (excoriation (pathological skin picking) or overly zealous ear cleaning
may be associated with external otitis or seborrheic dermatitis and psoriasis
How is Pruritis of the ear often treated?
avoid use of soap and water, cotton swabs, and scratching (allows cerumen to come back)
mineral oil relieves dryness and irritaion
if inflamed, topical corticosteroids
What are Exostoses and Osteomas?
bony overgrowths of the ear; seen often in patients who have had repeated exposure to cold water (surfer’s ear)
How do Exostoses and Osteomas appear upon examination?
skin-covered bony mounds in the medial ear canal, obscuring the tympanic membrane
How are Exostoses and Osteomas treated?
They are not treated unless there are multiple growths, and/or they obstruct the middle ear or cause infection
What is the eustachian tube?
the tube that connects the middle ear to the nasopharynx; provides ventilation and drainage to the middle ear cleft; normally closed, but opens during swallowing and yawning
What are essential components of diagnosing Eustachian Tube Dysfunction?
aural fullness
fluctuating hearing
discomfort with barometric pressure change
at risk for serous otitis media
What is Eustachian Tube Dysfunction?
when the eustachian tube is compromised, air becomes trapped within the middle ear and results in negative pressure
What is generally the cause of Eustachian Tube Dysfunction?
commonly caused by edema resulting from a viral upper respiratory infection or allergies
How will the tympanic membrane react upon examination if the patient has Eustachian Tube Dysfunction?
the tympanic membrane will be retracted
decreased mobility upon pneumatic otoscopy
How is Eustachian Tube Dysfunction treated?
lasts days to weeks following a viral illness
systemic and intranasal decongestants (autoflation will help)
desensitizaiton or intranasal corticosteroids for patients with allergies
avoid air travel, rapid altitudinal change, and underwater diving
What does Patent Eustachian Tube mean?
the eustachian tube does not open
What can cause a Patent Eustachian Tube?
rapid weight loss; may become worse after exertion and may diminish during an upper respiratory infection
What are common symptoms of a Patent Eustachian Tube?
fullness of the ear
autophony (hearing your own voice unusually loudly)
How is a Patent Eustachian Tube treated?
avoid decongestants
insertion of a ventilation tube may reduce the outward stretch of the eardrum during phonation
surgical procedures on a rare occasion
What is Serous Otitis Media?
the prolonged blockage of the eustachian tube; negative pressure in the middle ear results in transudation of fluid
What causes Serous Otitis Media?
persistent Eustachian Tube Dysfunction; serous or mucoid secretions fill the middle ear and interfere with tympanic membrane movement and ossicular chain function
In what group is Serous Otitis Media most common and why?
Serous Otits Media is more common in children because their eustachian tubes are narrower and more horizontal than adults.
What is the most common cause of Serous Otitis Media in adults and what disease needs to be excluded in diagnosis?
If adults get Serous Otitis Media, it usually follows an upper respiratory infection. Nasopharyngeal Carcinoma needs to be checked on and ruled out as the cause for the symptoms.
What symptoms occur as a result of Serous Otitis Media?
the tympanic membrane is dull and hypomobile
ear bubbles form in the middle ear
conductive hearing loss
How is Serous Otits Media treated?
short course of oral corticosteroids (prednisone)
oral antibiotics (amoxicillin)
maybe both
ventilating tube is placed if it persists for several months
laser expansion of the nasopharyngeal orifice of the eustachian tube in recalcitrant cases
What is Otic Barotrauma?
poor eustachian tube funciton results in inability to equalize barometric stress exerted on the middle ear; worsens during during air travel, with rapid altitude changes, and during underwater diving
How does Otic Barotraua relate to air travel?
most acute during airplane decent, since the negative middle ear pressure tends to collapse and block the eustachian tube
advice to swallow, yawn, or autinflate frequently during descent
oral decongestants (pseudoephedrine) should be taken several hours before anticipated arrival time
topical decongestants such as phenylephrine nasal spray 1 hour before arrival
myringotomy (creation of small eardrum perforation) in the event of severe otalgia and hearing loss
ventilating tubes for people who fry frequently
How does Otic Barotrauma relate to Underwater Diving?
worse during decent
advice to descend slowly
may result in hemotympanum (hemorrhage of the tympanic membrane)
may result in perilymphatic fistula: oval window ruptures, resulting in sensory hearing loss and acute vertigo
tympanic membrane perforation may occur as well
avoid diving during an upper respiratory infection or if nasal allergies are present
What is Acute Otitis Media?
commonly a bacterial infection of the mucosal lined air-containing spaces of the temporal bone (viral in 25% of cases); accumulation of fluid and mucus due to eustachian tube obstruction results in secondary infection by bacteria
What causes Acute Otitis Media?
S pneumoniae, H influezae, and Strep pyrogenes
What group does Acute Otitis Media most commonly affect and why?
infants and children (90%) due to narrow and horizontal eustachian tubes (incidence decreases with age); at greater risk for upper respiratory tract infections if they attend daycare, have allergies, or do not eat in an upright position
What time of year does Acute Otitis Media most often peek?
winter and spring
What predisposes adults to Acute Otitis Media, and what do they need to be checked for?
more common in adults who had recurrent Acute Otitis Media as children; must be checked for nasopharyngeal tumors, especially if unilateral
What are symptoms of Acute Otitis Media?
otalgia
aural pressure
decreased hearing/conductive hearing loss
fever
tenderness of the mastoid due to presence of pus within the mastoid air cells
rupture is accompanied by sudden decreased in pain followed by otorrhea (discharge draining from the ear)
may be systematic and accompanied by vomiting and diarrhea
How will Acute Otitis Media present in the ear?
erythema decreased mobility of tympanic membrane bubbles in the tympanic membrane purulent material tympanic membrane can bulge when ear empyema is severe
What is the first-line treatment for Acute Otitis Media?
amoxacillin (oral antibiotic) plus sulfonamide
What are alternative treatments for Acute Otitis Media?
if resistant cefaclor or amoxacillin-clavulanate
ruptured tympanic membranes should heal on their own (if not could lead to Chronic Otitis Media)
surgical drainage for patients with severe otalgia or when complications of otitis have occured
What is Chronic Otitis Media?
chronic infection of the middle ear and mastoid that generally develops as a result of recurrent acute otitis media
What is causes Chronic Otitis Media?
commonly caused by P aeruginosa, Proteus, Staph aureus, and mixed anaerobic infections
What predisposes patients to Chronic Otitis Media?
recurrent Otitis Media
may follow diseases or trauma
What is the hallmark symptom of Chronic Otitis Media?
purulent aural discharge
pain is uncommon
conductive hearing loss
How will a patient’s ear look under examination if they have Chronic Otitis Media?
perforation of the tympanic membrane is common
may be accompanied by polypoid degeneration and granulation tissue
may be accompanied by osseous changes such as osteitis and sclerosis
How is Chronic Otitis Media treated?
regular removal of infected debris
use of earplugs during water exposure
topical antibiotic drops (ofaxacin or ciprofloxacin)
tympanic membrane repair in most cases
What is Cholesteoatoma?
a chronically infected sac (created by the inward migration of the upper portion of the tympanic membrane) lined with squamous epithelium that can erode into bone and damage the ossicular chain
How will Cholesteoatoma appear during an exam?
epitympanic retraction pocket or marginal tympanic membrane perforation
keratin debris or granulation tissue
How is Cholesteoatoma treated?
surgical marsupialization of the sac or its complete removal
What is Mastoiditis?
inflammation of the mastoid; follows several weeks of inadequately treated acute otitis media
What causes Mastoiditis?
S pneumoniae, H influezae, S pyrogenes
In what group does Mastoiditis most commonly occur?
children under 2
What are symptoms of Mastoiditis?
inflammation of the mastoid
postauricular pain
erythema
spiking fever
What tests can be ordered in diagnosing Mastoiditis?
CT reveals coalescence of the mastoid air cells due to destruction of their bony septa
myringotomy for culture
How is Mastoiditis treated?
intravenous antibiotics
myringotomy for drainage
surgical drainage if medical therapy fails
