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Clinical Medicine Jeff > Ear > Flashcards

Ear Flashcards

1
Q

External Otitis: etiology

A 
Gram negatives
S. epidermidis (26%)
S. aureus (11%)
P. aeruginosa (11%)
Anaerobes (2%)
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2
Q

External Otitis: modifying factors

A

No aminoglycosides if TM is not intact (due to ototoxicity)

i.e. neomycin

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3
Q

External Otitis: tx

A

Mild: acetic acid + propylene glycol
Moderate to Severe: Ofloxacin drops,
Ciprofloxacin/Hydrocortisone drops ($$$$) or neomycin/polymixin B (must have intact TM)

If cellulitis around ear: oral fluoroquinolone: ciprofloxacin PO

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4
Q

Fungal Otitis Externa: etiology

A

Candida (white, fuzzy)

Aspergillus (black, fuzzy)

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5
Q

Fungal Otitis Externa: modifying factors

A

consider undiagnosed DM

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6
Q

Fungal Otitis Externa: tx

A

Fluconazole PO

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7
Q

Chronic External Otitis: etiology

A

Usually due to seborrhea—but should be evaluated by ENT (r/o malignant process)

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8
Q

Chronic External Otitis: tx

A

Polymixin+Neomycin+Hydrocortisone (must have intact TM bc neomycin is ototoxic);
Selenium sulfide shampoo

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9
Q

Malignant Otitis Externa: etiology

A

P. aeruginosa

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10
Q

Malignant Otitis Externa: modifying factors

A

Most common in immunosuppressed (ie. AIDS, diabetes, chemotherapy, elderly)

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11
Q

Malignant Otitis Externa: tx

A

Ciprofloxacin IV (long term tx)

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12
Q

BCC on the ear: tx

A

refer to Derm for excision and Otolaryngologist for further mgmt

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13
Q

SCC on the ear: tx

A

surgical resection of ear, neck dissection (removal of neck lymph nodes), radiotherapy

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14
Q

Cerumen impaction: etiology

A

self-induced: ill-advised attempts at cleaning ear

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15
Q

Cerumen impaction: tx

A
  • Debrox drops (hydrogen peroxide or carbamide peroxide)
  • mechanical removal using curette
  • irrigation w/ room temp water (only if TM intact)
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16
Q

torn ear lobe: tx

A
  • repair by plastic surgeons using local anesthetic

- clean ear, tetanus shot (if needed), oral BS abx: cefdinir, clindamycin

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17
Q

hematoma of external ear: tx

A

drain & place bolster (reattach perichondrium and cartilage): prevents re-accumulation of blood and cosmetic deformity (cauliflower ear)

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18
Q

Microtia: tx

A

bone anchor prosthesis

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19
Q

Ramsay-Hunt Syndrome: etiology

A

latent varicella herpes zoster virus (Herpes zoster oticus)

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20
Q

Ramsay-Hunt Syndrome: tx

A

gabapentin (pain mgmt), antiviral within 72 hours of onset of symptoms, steroid to reduce swelling, educate pt to tape eyes shut at night if they have facial paralysis

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21
Q

Otitis Media: etiology

A

S. pneumococcus
H. influenza
M. catarhallis
(may be viral)

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22
Q

Acute Otitis Media: modifying factors

A

abx in last month, concomitant purulent conjunctivitis, recurrent OM, penicillin allergy, tx failure after 3 days of amoxicillin

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23
Q

Acute Otitis Media: tx (if no abx in last month, no concomitant purulent conjunctivitis, and no recurrent OM)

A

high dose amoxicillin:
<2 y/o: 10 days
= or > 2 y/o: 5-7 days

24
Q

Acute Otitis Media: tx (if abx in last month, concomitant purulent conjunctivitis, and recurrent OM)

A

amoxicillin-clavulanic acid (10 days)

25
Q

Acute Otitis Media: tx (penicillin allergy)

A

if anaphylaxis: macrolides
-if high s. penumo resistance to macrolides: TMP-SMX (trimethoprim/sulfamethoxazole)
if not anaphylactic rxn: cefinidir, cefpodoxime, cefprozil, cefuroxime

26
Q

Acute Otitis Media: tx (tx failure after 3 days of amoxicillin, no abx in last month)

A

amoxicillin clavulanic acid, cefinidir, or cefpoxodime

27
Q

Acute Otitis Media: tx (tx failure after 3 days amoxicillin, abx in last month prior to current tx)

A
  • IM ceftriaxone

- clindamycin

28
Q

Chronic Otitis Media: tx

A
  • earplugs (to protect against water exposure)
  • abx gtt: ofloxacin or ciprofloxacin +/- steroids (dexamethasone) if granulation tissue or tubes present
  • surgery: graft tissue taken from temporalis fascia (if perforated TM)
29
Q

Chronic Suppurative Otitis Media: modifying factors

A

usually presence of tubes of perforation of TM

30
Q

Mastoiditis: etiology

A

S. pneumococcus
H. influenza
M. catarhallis
(may be viral)

31
Q

Mastoiditis: modifying factors

A

recurrent OM, recent abx, severe hypersensitivity rxn to penicillin, nonanaphylactic rxn to penicliins

32
Q

Mastoiditis: tx (if no recurrent OM or recent abx)

A

vancomycin alone

33
Q

Mastoiditis: tx (if recurrent OM or recent abx)

A

need 2 agents:

  • ceftazidime OR
  • cefepime OR
  • pipercillin-tazobactam
  • plus*
  • vancomycin
34
Q

Mastoiditis: tx (if severe hypersensitivity rxn to penicillin)

A

need 2 agents:

aztreonam & vancomycin

35
Q

Mastoiditis: tx (if nonanaphylactic rxn to penicillins)

A 
need 2 agents:
-ceftazidime OR
-cefepime
*plus*
vancomycin
36
Q

Serous Otitis Media with Effusion: tx

A 
if asymptomatic: observe for 3 mos
if symptomatic/sx still present after 3 mos:
-prednisone PO
-amoxicillin PO
-myringotomy + tubes
-decongestants
37
Q

Eustachian Tube Dysfunction (ETD): tx

A
  • valsalva maneuver
  • decongestant (dries fluid in ET)
  • antihistamine (stops mucus production)
  • nasal steroid (opens up ET)
  • balloon dilation (controversial)
  • pacifier for infant
38
Q

Bullous Myringitis: etiology

A

mycoplasma pneumoniae, strep pneumoniae

39
Q

Bullous Myringitis: tx

A
  • topical abx: macrolide&raquo_space;> erythromycin
  • sometimes fluoroquinolone: ciprofloxacin
  • if needed, I&D + culture
40
Q

Barotrauma: tx

A
  • valsalva
  • decongestant PO (Sudofed) before travel
  • topical decongestant: phenylaffrin or affrin
  • myringotomy tubes if severe/chronic
41
Q

Cholesteatoma: tx

A

surgical marsupialization of sac or complete removal

42
Q

Otosclerosis: tx

A

hearing aid or stapedectomy (surgical replacement of stapes w/ prosthesis)

43
Q

Meningitis: tx

A

IV abx: vancomycin and cephalosporin

44
Q

Conductive HL: mechanisms

A
  • obstruction (cerulean impaction)
  • mass loading (middle ear effusion/URI)
  • stiffness effect (otosclerosis)
  • discontinuity (ossicular disruption t bone fracture, chronic OM, cholesteatoma)
45
Q

Sensory HL: causes

A

deterioration of cochlea, usually due to loss of hair cells from Organ of Corti:

  • presbycusis*
  • noise trauma
  • physical trauma
46
Q

Neural HL: causes

A

lesions involving CN VIII, auditory nuclei, ascending tracts or auditory cortex:

  • acoustic neuroma (vestibular schwannoma)
  • herpes zoster
47
Q

HL: tx

A
  • bone anchored hearing aid (BAHA): stimulates ipsilateral cochlea (CHL) or contralateral cochlea (SNHL)
  • cochlear impant: stimulates auditory nerve (SNHL)
  • traditional hearing aid
48
Q

Tinnitus: tx

A

avoid exposure to excessive noise/ototoxic agents, mask with noisemaker/fan, antidepressant: nortriptyline

49
Q

Tinnitus: offending drugs

A

hydrochlorothiazide (HCTX), methotrexate, benzos, wellbutrin, prozac, NSAIDS, BB, prednisone

50
Q

Benign Positional Vertigo (BPV): dx

A

Dix-Hallpike test

51
Q

Benign Positional Vertigo (BPV): tx

A

Epley maneuver

52
Q

Meniere’s Disease aka “Endolymphatic Hydrops:” tx

A
  • low sodium diet, diuretics: to address fluid retention in ears;
  • for acute attacks: PO Meclizine or Valium; –refractory: TM corticosteroid injections, endolymphatic sac decompression (??) vestibular ablation
53
Q

Meniere’s Disease aka “Endolymphatic Hydrops:” dx

A

hx, caloric testing

54
Q

Labyrinthritis: tx

A

if febrile: abx;

meclizine/dramamine during acute phases of attack

55
Q

Foreign body in ear canal - tx

A
  • Remove firm materials with loop or hook (curette), scopping out from posterior aspect.
  • Avoid aqeous irrigation with organic foreign body (insect). If insect involved fill ear with lidocaine before scooping out.

Clinical Medicine Jeff (7 decks)

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