Ear Flashcards
External Otitis: etiology
Gram negatives S. epidermidis (26%) S. aureus (11%) P. aeruginosa (11%) Anaerobes (2%)
External Otitis: modifying factors
No aminoglycosides if TM is not intact (due to ototoxicity)
i.e. neomycin
External Otitis: tx
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
Fungal Otitis Externa: etiology
Candida (white, fuzzy)
Aspergillus (black, fuzzy)
Fungal Otitis Externa: modifying factors
consider undiagnosed DM
Fungal Otitis Externa: tx
Fluconazole PO
Chronic External Otitis: etiology
Usually due to seborrhea—but should be evaluated by ENT (r/o malignant process)
Chronic External Otitis: tx
Polymixin+Neomycin+Hydrocortisone (must have intact TM bc neomycin is ototoxic);
Selenium sulfide shampoo
Malignant Otitis Externa: etiology
P. aeruginosa
Malignant Otitis Externa: modifying factors
Most common in immunosuppressed (ie. AIDS, diabetes, chemotherapy, elderly)
Malignant Otitis Externa: tx
Ciprofloxacin IV (long term tx)
BCC on the ear: tx
refer to Derm for excision and Otolaryngologist for further mgmt
SCC on the ear: tx
surgical resection of ear, neck dissection (removal of neck lymph nodes), radiotherapy
Cerumen impaction: etiology
self-induced: ill-advised attempts at cleaning ear
Cerumen impaction: tx
- Debrox drops (hydrogen peroxide or carbamide peroxide)
- mechanical removal using curette
- irrigation w/ room temp water (only if TM intact)
torn ear lobe: tx
- repair by plastic surgeons using local anesthetic
- clean ear, tetanus shot (if needed), oral BS abx: cefdinir, clindamycin
hematoma of external ear: tx
drain & place bolster (reattach perichondrium and cartilage): prevents re-accumulation of blood and cosmetic deformity (cauliflower ear)
Microtia: tx
bone anchor prosthesis
Ramsay-Hunt Syndrome: etiology
latent varicella herpes zoster virus (Herpes zoster oticus)
Ramsay-Hunt Syndrome: tx
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
Otitis Media: etiology
S. pneumococcus
H. influenza
M. catarhallis
(may be viral)
Acute Otitis Media: modifying factors
abx in last month, concomitant purulent conjunctivitis, recurrent OM, penicillin allergy, tx failure after 3 days of amoxicillin
Acute Otitis Media: tx (if no abx in last month, no concomitant purulent conjunctivitis, and no recurrent OM)
high dose amoxicillin:
<2 y/o: 10 days
= or > 2 y/o: 5-7 days
Acute Otitis Media: tx (if abx in last month, concomitant purulent conjunctivitis, and recurrent OM)
amoxicillin-clavulanic acid (10 days)
Acute Otitis Media: tx (penicillin allergy)
if anaphylaxis: macrolides
-if high s. penumo resistance to macrolides: TMP-SMX (trimethoprim/sulfamethoxazole)
if not anaphylactic rxn: cefinidir, cefpodoxime, cefprozil, cefuroxime
Acute Otitis Media: tx (tx failure after 3 days of amoxicillin, no abx in last month)
amoxicillin clavulanic acid, cefinidir, or cefpoxodime
Acute Otitis Media: tx (tx failure after 3 days amoxicillin, abx in last month prior to current tx)
- IM ceftriaxone
- clindamycin
Chronic Otitis Media: tx
- 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)
Chronic Suppurative Otitis Media: modifying factors
usually presence of tubes of perforation of TM
Mastoiditis: etiology
S. pneumococcus
H. influenza
M. catarhallis
(may be viral)
Mastoiditis: modifying factors
recurrent OM, recent abx, severe hypersensitivity rxn to penicillin, nonanaphylactic rxn to penicliins
Mastoiditis: tx (if no recurrent OM or recent abx)
vancomycin alone
Mastoiditis: tx (if recurrent OM or recent abx)
need 2 agents:
- ceftazidime OR
- cefepime OR
- pipercillin-tazobactam
- plus*
- vancomycin
Mastoiditis: tx (if severe hypersensitivity rxn to penicillin)
need 2 agents:
aztreonam & vancomycin
Mastoiditis: tx (if nonanaphylactic rxn to penicillins)
need 2 agents: -ceftazidime OR -cefepime *plus* vancomycin
Serous Otitis Media with Effusion: tx
if asymptomatic: observe for 3 mos if symptomatic/sx still present after 3 mos: -prednisone PO -amoxicillin PO -myringotomy + tubes -decongestants
Eustachian Tube Dysfunction (ETD): tx
- valsalva maneuver
- decongestant (dries fluid in ET)
- antihistamine (stops mucus production)
- nasal steroid (opens up ET)
- balloon dilation (controversial)
- pacifier for infant
Bullous Myringitis: etiology
mycoplasma pneumoniae, strep pneumoniae
Bullous Myringitis: tx
- topical abx: macrolide»_space;> erythromycin
- sometimes fluoroquinolone: ciprofloxacin
- if needed, I&D + culture
Barotrauma: tx
- valsalva
- decongestant PO (Sudofed) before travel
- topical decongestant: phenylaffrin or affrin
- myringotomy tubes if severe/chronic
Cholesteatoma: tx
surgical marsupialization of sac or complete removal
Otosclerosis: tx
hearing aid or stapedectomy (surgical replacement of stapes w/ prosthesis)
Meningitis: tx
IV abx: vancomycin and cephalosporin
Conductive HL: mechanisms
- obstruction (cerulean impaction)
- mass loading (middle ear effusion/URI)
- stiffness effect (otosclerosis)
- discontinuity (ossicular disruption t bone fracture, chronic OM, cholesteatoma)
Sensory HL: causes
deterioration of cochlea, usually due to loss of hair cells from Organ of Corti:
- presbycusis*
- noise trauma
- physical trauma
Neural HL: causes
lesions involving CN VIII, auditory nuclei, ascending tracts or auditory cortex:
- acoustic neuroma (vestibular schwannoma)
- herpes zoster
HL: tx
- bone anchored hearing aid (BAHA): stimulates ipsilateral cochlea (CHL) or contralateral cochlea (SNHL)
- cochlear impant: stimulates auditory nerve (SNHL)
- traditional hearing aid
Tinnitus: tx
avoid exposure to excessive noise/ototoxic agents, mask with noisemaker/fan, antidepressant: nortriptyline
Tinnitus: offending drugs
hydrochlorothiazide (HCTX), methotrexate, benzos, wellbutrin, prozac, NSAIDS, BB, prednisone
Benign Positional Vertigo (BPV): dx
Dix-Hallpike test
Benign Positional Vertigo (BPV): tx
Epley maneuver
Meniere’s Disease aka “Endolymphatic Hydrops:” tx
- 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
Meniere’s Disease aka “Endolymphatic Hydrops:” dx
hx, caloric testing
Labyrinthritis: tx
if febrile: abx;
meclizine/dramamine during acute phases of attack
Foreign body in ear canal - tx
- 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.
