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Clinical Medicine I > Ear > Flashcards

Ear Flashcards

1
Q

What type of hearing is associated with the middle ear?

A

Conductive hearing

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2
Q

What type of hearing is associated with the inner ear?

A

Sensorineural hearing

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3
Q

What are the five cardinal signs of infection?

A 
Rubor
Callor
Tumor
Dolor
Functio Laesa
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4
Q

What is Otorrhea?

A

discharge from the ear that can originate from:

External auditory canal

Middle ear

Mastoid

Inner ear

Intracranial cavity

May be no symptoms associated with this

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5
Q

What is otitis externa?

A

an infection of the external auditory canal

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6
Q

What is tympanometry?

A

measures acoustic immittance (transfer of acoustic energy) of the ear as a function of ear canal air pressure

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7
Q

What is tympanosclerosis?

A

healed perforation of tympanic membrane that loks white/sclerotic when examining the tympanic membrane

This occurs for life and patient wont have any symptoms

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8
Q

What is Otitis media with effusion also known as?

A

Chronic otitis media

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9
Q

What is the gold standard for diagnosing otitis media?

A

Pneumatic Otoscopy

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10
Q

What is the normal finding of pneumatic otoscopy?

A

tympanic membrane will move

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11
Q

What four things typically cause otitis media?

A

Allergy

Eustachian Tube Dysfunction

Bacterial Infection

Viral Infection

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12
Q

What is the clinical presentation of Acute otitis media (AOM)?

A

Rapid onset < 48 hours

Signs and symptoms of inflammation of the middle ear

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13
Q

What is the clinical presentation of Severe AOM?

A

Rapid onset < 48 hours

Signs and symptoms of inflammation of the middle ear

Moderate to severe otalgia (pain) or fever > 39C (102.2F)

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14
Q

What is the clinical presentation of otitis media with effusion (OME)?

A

Inflammation of the middle ear with liquid collected in the middle ear

Signs and symptoms of acute infection are absent

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15
Q

What is the clinical presentation of middle ear effusion (MEE)?

A

liquid in the middle ear without reference to etiology, pathogenesis, pathology, or duration

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16
Q

How is AOM diagnosed?

A

Tympanic membrane will have severe to moderate bulging or otorrhea may be present

OR

Mild bulging of tympanic membrane AND recent ear pain OR intense redness

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17
Q

How is OME diagnosed?

A

MEE without signs or symptoms of acute ear infection

Tympanocentesis

Pneumatic otoscopy

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18
Q

What is AOM caused by?

A 
Strep pneumoniae*
H. influenzae*
M. Catarrhais*
Viruses
Ostiomeatal complex dysfunction
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19
Q

What is OME caused by?

A 
Ostiomeatal complex dysfunction
Sequelae of AOM
Viral
Unknown
Bacterial Antigens
Biofilm
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20
Q

What is Sequelae of AOM?

A

AOM that is treated properly will turn into OME overtime

Acute signs and symptoms are lost

Fluid just needs to drain and will take time

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21
Q

How do we treat OME?

A

Watchful waiting*

Tubes

Surgery

Prednisone oral or topical or antihistamines/decongestants

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22
Q

When is watchful waiting for OME not appropriate treatment?

A

If a child is at an increased risk for speech, language, or learning problem (kids about 1 or older)

If it has been three months from the date of effusion onset or diagnosis

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23
Q

What is the follow up treatment for kids with OME that have no evidence of hearing loss or non suspected structural abnormalities of the TM or middle ear?

A

every 3-6 months until fluid is gone

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24
Q

How do we treat Severe AOM in kids?

A

Antibiotics if > 6 months; not sure on < 6 months but most often give antibiotics

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25
Q

How do we treat Non-severe AOM in kids?

A

Anitbiotics or observe in 6-23 moths if unilateral and if you have good follow up

Antibiotics if < 24 months and bilateral

Antibiotics or observe if > 24 months

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26
Q

What antibiotic is First line for AOM?

A

Amoxicillin 80-90mg/kg/twice a day to max dose of 1000mg/dose

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27
Q

What is the alternate first line medication for AOM if child is allergic to amoxicillin or there is a perforation?

A

Quinolone drops

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28
Q

What is the second line medication for kids with AOM?

A

Augmentin ES 80-90mg/kg/twice a day

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29
Q

Why do we give Extended spectrum augmentin?

A

to decrease the diarrhea side effects

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30
Q

What are other choices of medications for kids with AOM?

A

Bactrim > 2months

2nd or 3rd gen ceph

Azithromycin or clindamycin if allergic to PCN

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31
Q

If a child is vomiting or can’t keep the amoxicillin down, what can medication can you give them?

A

50mg/kg/day dose of Ceftriazone IM

Often give one dose in office and then send child home with prescription for amoxicillin

Can do this even if patient is allergic to PCN but you should be prepared for potential allergic reaction

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32
Q

What is the treatment for AOM in adults?

A

Same as for kids but you must worry about secondary causes like tumors

FOLLOW UP IS MANDATORY

pt. education

More antibiotic choices

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33
Q

How do we generally manage AOM?

A

Pain relief with APAP, ibuprofen, or antipyrine/benzocaine drops

Topical decongestants for adults

Cold meds in kids older than 4

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34
Q

What is the follow up for AOM?

A

Improvement is expected within 24-48 hours, so you must follow up with patient within this timeframe even if it is just a phone call

Re-evalute in 2 weeks

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35
Q

How long can it take for MEE after Otitis Media to resolve?

A

Greater than 3 months

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36
Q

What prophylaxis can be given to prevent otitis media?

A

Vaccines

Breastfeeding

Smoke-free environment

No bottles in bed

Antibiotic prophylaxis isn’t recommended

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37
Q

What should a normal tympanic membrane look like?

A

Pearly gray with membrane and landmarks intact

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38
Q

What is pathognomonic for Otitis Externa?

A

tragus tug pain

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39
Q

What are the causes of Otitis externa?

A 
Bacterial:
Pseudomonas aeruginosa*
P. vulagris
S. aureus
E. coli

Fungal:
Aspergillus
Candida albicans

Furuncles:
S. aureas and maybe MRSA

Inadvertent injury

Allergies

Psoriasis

Eczema

Seborrheic dermatitis

Decreased canal acidity

Irritants like hairspray and hair dye

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40
Q

What is the clinical presentation of Otitis externa?

A

Drainage that may be foul-smelling

Otoscopy exam is painful and difficult to conduct

Red, swollen ear canal littered with moist, purple, tissue debris and desquamated epithelium

Pruritis often with fungal cases

Furuncles

Exquisite tenderness accompanies traction of teh pinnacle or pressure over the tragus

Hearing loss

Crusting outside of the ear

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41
Q

What is the treatment for otitis externa?

A

Debridement

Topicals:
May use wick
Acetic acid
Corticosteroids
Antibiotics --> CiproDex, quinolone drops, nystatin or clotrimazole if fungal

Oral Quinolones, cephs, or antifungals if patient is immunocompromised

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42
Q

How do we prevent swimmers ear?

A

1:1 mixture of rubbing alcohol and white vinegar (if TM is intact) immediately after swimming

NO COTTON SWABS

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43
Q

How do we treat FB in the ear?

A

Wash it out

Suck it out

Alligator forceps

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44
Q

What are the causes of tympanic membrane perforation?

A

Infection

Trauma --> usually barotrauma
Blow to the ear
Severe atmospheric pressure
Exposure to excessive water pressure
Improper attempts at wax removal or ear cleaning
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45
Q

What is the treatment for tympanic membrane perforation?

A

Most heal on their own and treatment isn’t needed

Systemic antibiotics if otorrhea occurs

Paper patch method, Gelfoam, fibrin glue, or similar in office and is only done if perforation is bothersome

Surgical –> tympanoplasty

Ear drops

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46
Q

What ear drops should be avoided in tympanic membrane perforation?

A

Those containing:

Gentamycin

Neomycin

Sulfate

tobramycin

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47
Q

When should a tympanic membrane perforation be referred?

A

If the perforation lasts longer than 2 months

If there is significant hearing loss

If there is ossicles trauma

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48
Q

What is the follow up for tympanic membrane perforation?

A

1-2 months

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49
Q

What is auricular hematoma caused by?

A

Direct trauma

Shearing forces –> causes separation of the anterior auricular perichondrium from the cartilage

Rugby

Boxers

Wrestling

MMA

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50
Q

How does auricular hematoma present?

A

hematoma formation on ear

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51
Q

How do we treat auricular hematomas?

A

Early identification

Drainage with needle or I & D

Splints

Compression

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52
Q

What is mastoiditis?

A

infection of mastoid air cells

53
Q

How does mastoiditis present?

A

welling behind ear

54
Q

How is mastoiditis treated?

A

Consult

Medical

Surgical

55
Q

Which semicircular canal detects yes motion?

A

Anterior

56
Q

Which semicircular canal detects no motion?

A

Posterior

57
Q

Which semicircular canal detects shoulder to ear motion?

A

Lateral

58
Q

What tells us where we are in a plane?

A

macule

59
Q

What are two symptoms of vertigo?

A

Tinnitus

Nystagmus

60
Q

What is tinnitus?

A

Perception of sound when no actual external noise is present

Referred to as “ringing in ears” or can be a buzzing, hissing, whistling, swooshing, or clicking

61
Q

Who does tinnitus most commonly occur in?

A

Smokers

Men

62
Q

What is tinnitus caused by?

A

Ototoxic medications
Hearing loss –> sensorineural with aging or acquired high-frequency
Otosclerosis
Chairi malformations
Wax buildup or FB in outer ear
Infection, fluid, diseases of the ear bones or eardrum in middle ear
Noise exposure, drugs, or meniere’s disease in inner ear
Tumors and other problems affecting brain or nerves in retrocochlear area

63
Q

What type of tinnitus is most common?

A

Subjective

64
Q

What is subjective tinnitus?

A

head or ear oises that are perceivable only to the patient
Traceable to auditory or neurological reactions to hearing loss
Perceived noise by the patient and often occurs when patient has a URI

65
Q

What is objective tinnitus?

A

More severe and rare
Head or noises are audible to others
Usually produced by the internal functions in the bodies circulatory (blood flow) and somatic (MSK movement)

66
Q

What physical exams should be performed if patient comes in complaining of tinnitus?

A

Complete HEENT exam
Cranial nerve exam
Evaluate tympanic membrance
Asucultate the neck, periauricular area, temple, orbit, and mastoid

67
Q

IF tinnitus is UNILATERAL, what must we do in order to diagnose tinnitus and why?

A

An MRI to rule out retrocochlear lesions such as vestibular schwannoma

68
Q

How do we treat tinnitus?

A

NO cure
Avoid excessive noise, ototoxic drugs, and other drugs that might damage the cochlea
Correct identified comorbidities and mitigate their effect of tinnitus
Hearing aids to offset the hearing loss
Sound therapy
Behavioural therapy to decrease anxiety caused by tinnitus
TMJ treatment
Cochlear implants in severe sensorineural hearing loss

69
Q

What is nystagmus?

A

Vision condition in which the eyes make repetitive, uncontrolled movements that will reduce vision and depth perception and can affect balance and coordination

Symptom usually of another eye or medical problem

70
Q

What can make nystagmus worse?

A

Fatigue and stress

71
Q

What is nystagmus caused by?

A

Neurological problems that are present at birth or develop in early adulthood
Aquired will be caused by symptoms of another condition or disease
Lack of development of normal eye movement in early life
Very high refractory error that is seen in nearsightedness or astigmatism
Congenital cataracts
Inflammation of inner ear
Medications like anti-epileptic drugs
CNS diseases

72
Q

What are the types of nystagmus?

A

Infantile
Spasmus nutans
Acquired

73
Q

What is infantile nystagmus?

A

Occurs at 2-3 months of age
Eyes will move in horizontal swinging fashion
Congential condition normally like the absence of iris, underdeveloped optic nerve, and congenital cataract

74
Q

What is spasmus nutans nystagmus?

A

Occurs bewteen 6 months to 3 years of age
Improves on its own between 2 to 8 years of age
Often the child will nod and tilt their head
Eyes may move in ANY direction
Usually no treatment required

75
Q

What is aquired nystagmus?

A

Develops later in childhood or adulthood
UNknown cause
Alcohol, drug toxicity, and CNS and metabolic disorders can cause it

76
Q

How do we treat nystagmus?

A

Eye glasses or contact lenses
Improves with time typically
treat underlying causes
Surgery is rarely performed

77
Q

What medication most commonly causes vertigo?

A

Aminoglycosides

78
Q

What other medications may cause veritgo?

A 
Antidepressants
Anxiolytics
Aminoglycosides
Furosemide
Amiodarone
ASA
79
Q

What are the central causes of vertigo?

A 
Migraines
Cerebral tumors of CN VIII
Chairi malformations
Brain ischemia --> cerebellar infarct/hemorrhage-stroke
TIA
MS
80
Q

What are some other causes of vertigo?

A

Alcohol
Drugs like cocaine
Brain injury
Migraine

81
Q

What type of vertigo does hypo function cause?

A

vestibular neuritis

82
Q

What type of vertigo does hyperfunction cause?

A

Benign Paroxysmal Positional vertigo

83
Q

What does central vertigo involve?

A

cerebellum and brainstem

84
Q

What are the features of central vertigo?

A 
ONSET IS GRADUAL
Disproportionate gait --> walking drunk
Visual field defects
Hemisensory loss
Limb weakness
Diplopia
Slurred speech
Difficult swallowing
Frequency and intensity will start to change over time
85
Q

What does peripheral vertigo involve?

A

Semicircular canals and otolith organs

86
Q

What are the features of peripheral vertigo?

A 
Onset is SUDDEN
Tinnitus
Hearing loss
Aural fullness
Vestibular neuritis
Labyrinthitis
87
Q

What are the clinical manifestations of vertigo?

A

Nausea
Vomiting
Sweating
Pallor

88
Q

What is the most common cause of severe spontaneous vertigo?

A

Vestibular neuritis and labyrinthitis

89
Q

What is vestibular neuritis and labyrinthitis result from?

A

Infection that inflames inner ear or the nerves connecting the inner ear to the brain

Infection disrupts the sensory information from the ear to the brain which is when patient will develop vertigo, difficulties with balance, and hearing and/or vision loss

90
Q

What is vestibular neuritis and labyrinthitis typically causes by 99% of the time?

A

virus

91
Q

What is inflamed in labyrinthitis?

A

membranous labyrinth

92
Q

What is inflamed in vestibular neuritis?

A

vestibular Nerve

93
Q

What are the clinical manifestations of vestibular neuritis?

A

NO HEARING LOSS

balance is imparied resulting in dizziness or vertigo

94
Q

What are the clinical manifestations of labyrinthitis?

A

HEARING LOSS
Infection will effect both vestibule-cochlear nerve which results in hearing changes and dizziness
Patients describe hearing as muffled

95
Q

What are common clinical manifestations of both vestibular neuritis and labyrinthitis?

A 
Rapid onset of severe, persistent vertigo
N/V
Gait instability
\+/- horizontal nystagmus
\+/- hearing loss
96
Q

How is vestibular neuritis and labyrinthitis diagnosed?

A

By excursion

97
Q

How is labyrinthitis and vestibular neuritis treated?

A

Steroids to reduce inflammation –> PREDNISONE
Antivert –> MECLIZINE
Antiemetic –> zofran
Antivirals –> Acyclovir
Antibiotics –> amoxicillin
Usually self-limiting and will resolve in a few days to a week

98
Q

What is Benign Paroxysmal Positional Vertigo?

A

When crystalline deposits are displaced from utrical matrix and lodge in the semicircular canals

Short in duration and usually only lasting seconds to minutes

99
Q

What is BPPV caused by?

A

excessive response to head movement and crystalline deposits in matricx

100
Q

Who most commonly gets BPPV?

A

older than 60

Women

101
Q

What are the clinical manifestations of BPPV?

A

Rapid onset of dizziness or spinning that may last second to hours
Clockwise, rotary nystagmus
Sensation of motion precipitated by sudden head movement or moving the head in a certain direction
Ear pain, hearing loss, and tinnitus are typically absent

102
Q

What do we use to detect BPPV?

A

Dix-Hallpike maneuver

103
Q

If you see rotary nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?

A

posterior canal

104
Q

If you see vertical nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?

A

Superior canal

105
Q

If you see horizontal nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?

A

Lateral canal

106
Q

How do we treat posterior canal otolith BPPV?

A

Eply maneuver

107
Q

How do we treat superior canal otolith BPPV?

A

Deep head hanging maneuver

108
Q

How do we treat lateral canal otolith BPPV?

A

Lamperet (BBQ) maneuver

109
Q

If vertical nystagmus is not corrected with deep handing head maneuver, what should we do?

A

SEND PATIENT TO ER because the cause of this vertigo is NOT BPPV

110
Q

What are other treatments for BPPV?

A 
Electronystagmography done by ENT
MRI/CT to rule out other causes like a CVA
Syptomatic treatment --> 
Antihistamines
Antiemetics
Benzos
Scopolamine

Neurology referral needed
Physical therapy
If patient has had for > 6 months, surgery is recommended

111
Q

What are the dix-hallpike findings for periipheral nystagmus?

A 
2 to 20 second latent period
Less than one minute in duration
Fatiguing with repetition
One type of direction that may change direction with gaze
Severe
112
Q

What are dix-hallpike findings for central nystagmus?

A 
No latent period
> 1 min, in duration
Nonfatiguing
Direction may change with given head position
Less sever
113
Q

What is Meniere’s disease?

A

Vertigo
Tinnitus
Fullness or congestion of ear

Patient may have drop attacks from severe vertigo
UNILATERAL
Suddenly occurs and typically after episode of tinnitus
Single attack of dizziness separated by long period fo time or lots of attacks over a number of days then nothing for a few days, then more attacks –> NOT CONTINUOUS or worsening

114
Q

What causes Meniere’s disease?

A

Buildup of fluid in the compartments of the inner ear = labyrinths

115
Q

Who are more likely to get Meniere’s disease?

A

women

116
Q

What are risk factors/associations with Meniere’s disease?

A

Allergies
stress
Viral

117
Q

What are the clinical manifestations of Meniere’s disesae?

A

TWO OR MORE EPISODES OF VERTIGO LASTING AT LEAST 20 MINUTES EACH
TINNITUS
TEMPORARY HEARING LOSS
FEELING OF FULLNESS IN THE EAR

118
Q

If you suspect a patient has meniere’s what should you first go?

A

send to ENT

119
Q

What may cause similar symptoms of Meniere’s disease?

A

Syphilis

High Na content

120
Q

How do we treat Meniere’s disease?

A

Dizziness medications –>
Meclizine
Diazepam
Lorazepam

Salt restrictions and diuretics

Dietary and behavior changes including decreasing caffeine, chocolate, and alcohol intake

Cognitive therapy to help cope with the unexpected nature of attacks and reduce anxiety about future attacks

Injected Gentamicin –> careful because this can raise risk of hearing loss

injections of steroids to reduce inflammation

Pressure pulse treatment

121
Q

When does the eustachian tube fully develop?

A

by age 7/8

122
Q

What causes eustachian tube dysfunction?

A 
Blockage
Swelling of lining of tubes
Colds and other nasal, sinus, or throat infections
Allergies
Air travel
123
Q

What are the clinical manifestations of dilatory eustachian tube dysfunction?

A

Tube will not dilate
Accompanying symptoms of hearing loss
Otoscope exam will show effusions, scarring, and thickening of TM
Treat the underlying condition

124
Q

What are the clinical manifestations of Patulous eustachian tube dysfunction?

A

Valve incompetency
patient will hear their own voice amplified
Otoscope exam will show movement of TM
ONly need to treat if symptoms last longer than 6 weeks

125
Q

What are the clinical manifestations of general eustachian tube dysfunction?

A

Patients report ear fullness
Mild to moderate hearing loss
Sometimes hear a “popping” sound during yawning or swallowing
Occasionally will complain of ear pain

126
Q

How do we diagnose eustachian tube dysfunction?

A

Retracted TM on the affected side

Decrease in TM mobility

127
Q

How do we treat eustachian tube dysfunction?

A

Swallow, yawn, or chew to increase air flow in and out of eustachian tube
Valsalva maneuver will gently push air into Eustachian tube

Medications --> 
Decongestant to decrease fluid:
Sudafed
Mucinex
Afrin - no more than 3 days

Antihistamines if allergies are cause:
Zyrtec
Claritin
Allegra

Steroid nasal spray to reduce inflammation in the nose:
FLONASE

128
Q

If symptoms of eustachian tube dysfunction persist due to treatment failure, what are your next steps?

A

Refer to ENT for nasal endoscopy, CT or MRI with contrast if > 3 months, or tube surgery

Clinical Medicine I (15 decks)

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