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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
How do we treat Non-severe AOM in kids?
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
26
What antibiotic is First line for AOM?
Amoxicillin 80-90mg/kg/twice a day to max dose of 1000mg/dose
27
What is the alternate first line medication for AOM if child is allergic to amoxicillin or there is a perforation?
Quinolone drops
28
What is the second line medication for kids with AOM?
Augmentin ES 80-90mg/kg/twice a day
29
Why do we give Extended spectrum augmentin?
to decrease the diarrhea side effects
30
What are other choices of medications for kids with AOM?
Bactrim > 2months 2nd or 3rd gen ceph Azithromycin or clindamycin if allergic to PCN
31
If a child is vomiting or can't keep the amoxicillin down, what can medication can you give them?
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
32
What is the treatment for AOM in adults?
Same as for kids but you must worry about secondary causes like tumors FOLLOW UP IS MANDATORY pt. education More antibiotic choices
33
How do we generally manage AOM?
Pain relief with APAP, ibuprofen, or antipyrine/benzocaine drops Topical decongestants for adults Cold meds in kids older than 4
34
What is the follow up for AOM?
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
35
How long can it take for MEE after Otitis Media to resolve?
Greater than 3 months
36
What prophylaxis can be given to prevent otitis media?
Vaccines Breastfeeding Smoke-free environment No bottles in bed Antibiotic prophylaxis isn't recommended
37
What should a normal tympanic membrane look like?
Pearly gray with membrane and landmarks intact
38
What is pathognomonic for Otitis Externa?
tragus tug pain
39
What are the causes of Otitis externa?
``` 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
40
What is the clinical presentation of Otitis externa?
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
41
What is the treatment for otitis externa?
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
42
How do we prevent swimmers ear?
1:1 mixture of rubbing alcohol and white vinegar (if TM is intact) immediately after swimming NO COTTON SWABS
43
How do we treat FB in the ear?
Wash it out Suck it out Alligator forceps
44
What are the causes of tympanic membrane perforation?
Infection ``` Trauma --> usually barotrauma Blow to the ear Severe atmospheric pressure Exposure to excessive water pressure Improper attempts at wax removal or ear cleaning ```
45
What is the treatment for tympanic membrane perforation?
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
46
What ear drops should be avoided in tympanic membrane perforation?
Those containing: Gentamycin Neomycin Sulfate tobramycin
47
When should a tympanic membrane perforation be referred?
If the perforation lasts longer than 2 months If there is significant hearing loss If there is ossicles trauma
48
What is the follow up for tympanic membrane perforation?
1-2 months
49
What is auricular hematoma caused by?
Direct trauma Shearing forces --> causes separation of the anterior auricular perichondrium from the cartilage Rugby Boxers Wrestling MMA
50
How does auricular hematoma present?
hematoma formation on ear
51
How do we treat auricular hematomas?
Early identification Drainage with needle or I & D Splints Compression
52
What is mastoiditis?
infection of mastoid air cells
53
How does mastoiditis present?
welling behind ear
54
How is mastoiditis treated?
Consult Medical Surgical
55
Which semicircular canal detects yes motion?
Anterior
56
Which semicircular canal detects no motion?
Posterior
57
Which semicircular canal detects shoulder to ear motion?
Lateral
58
What tells us where we are in a plane?
macule
59
What are two symptoms of vertigo?
Tinnitus | Nystagmus
60
What is tinnitus?
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
Who does tinnitus most commonly occur in?
Smokers | Men
62
What is tinnitus caused by?
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
What type of tinnitus is most common?
Subjective
64
What is subjective tinnitus?
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
What is objective tinnitus?
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
What physical exams should be performed if patient comes in complaining of tinnitus?
Complete HEENT exam Cranial nerve exam Evaluate tympanic membrance Asucultate the neck, periauricular area, temple, orbit, and mastoid
67
IF tinnitus is UNILATERAL, what must we do in order to diagnose tinnitus and why?
An MRI to rule out retrocochlear lesions such as vestibular schwannoma
68
How do we treat tinnitus?
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
What is nystagmus?
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
What can make nystagmus worse?
Fatigue and stress
71
What is nystagmus caused by?
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
What are the types of nystagmus?
Infantile Spasmus nutans Acquired
73
What is infantile nystagmus?
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
What is spasmus nutans nystagmus?
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
What is aquired nystagmus?
Develops later in childhood or adulthood UNknown cause Alcohol, drug toxicity, and CNS and metabolic disorders can cause it
76
How do we treat nystagmus?
Eye glasses or contact lenses Improves with time typically treat underlying causes Surgery is rarely performed
77
What medication most commonly causes vertigo?
Aminoglycosides
78
What other medications may cause veritgo?
``` Antidepressants Anxiolytics Aminoglycosides Furosemide Amiodarone ASA ```
79
What are the central causes of vertigo?
``` Migraines Cerebral tumors of CN VIII Chairi malformations Brain ischemia --> cerebellar infarct/hemorrhage-stroke TIA MS ```
80
What are some other causes of vertigo?
Alcohol Drugs like cocaine Brain injury Migraine
81
What type of vertigo does hypo function cause?
vestibular neuritis
82
What type of vertigo does hyperfunction cause?
Benign Paroxysmal Positional vertigo
83
What does central vertigo involve?
cerebellum and brainstem
84
What are the features of central vertigo?
``` 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
What does peripheral vertigo involve?
Semicircular canals and otolith organs
86
What are the features of peripheral vertigo?
``` Onset is SUDDEN Tinnitus Hearing loss Aural fullness Vestibular neuritis Labyrinthitis ```
87
What are the clinical manifestations of vertigo?
Nausea Vomiting Sweating Pallor
88
What is the most common cause of severe spontaneous vertigo?
Vestibular neuritis and labyrinthitis
89
What is vestibular neuritis and labyrinthitis result from?
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
What is vestibular neuritis and labyrinthitis typically causes by 99% of the time?
virus
91
What is inflamed in labyrinthitis?
membranous labyrinth
92
What is inflamed in vestibular neuritis?
vestibular Nerve
93
What are the clinical manifestations of vestibular neuritis?
NO HEARING LOSS | balance is imparied resulting in dizziness or vertigo
94
What are the clinical manifestations of labyrinthitis?
HEARING LOSS Infection will effect both vestibule-cochlear nerve which results in hearing changes and dizziness Patients describe hearing as muffled
95
What are common clinical manifestations of both vestibular neuritis and labyrinthitis?
``` Rapid onset of severe, persistent vertigo N/V Gait instability +/- horizontal nystagmus +/- hearing loss ```
96
How is vestibular neuritis and labyrinthitis diagnosed?
By excursion
97
How is labyrinthitis and vestibular neuritis treated?
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
What is Benign Paroxysmal Positional Vertigo?
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
What is BPPV caused by?
excessive response to head movement and crystalline deposits in matricx
100
Who most commonly gets BPPV?
older than 60 | Women
101
What are the clinical manifestations of BPPV?
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
What do we use to detect BPPV?
Dix-Hallpike maneuver
103
If you see rotary nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?
posterior canal
104
If you see vertical nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?
Superior canal
105
If you see horizontal nystagmus upon dix-hallpike maneuver, where is the otolith in BPPV located?
Lateral canal
106
How do we treat posterior canal otolith BPPV?
Eply maneuver
107
How do we treat superior canal otolith BPPV?
Deep head hanging maneuver
108
How do we treat lateral canal otolith BPPV?
Lamperet (BBQ) maneuver
109
If vertical nystagmus is not corrected with deep handing head maneuver, what should we do?
SEND PATIENT TO ER because the cause of this vertigo is NOT BPPV
110
What are other treatments for BPPV?
``` 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
What are the dix-hallpike findings for periipheral nystagmus?
``` 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
What are dix-hallpike findings for central nystagmus?
``` No latent period > 1 min, in duration Nonfatiguing Direction may change with given head position Less sever ```
113
What is Meniere's disease?
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
What causes Meniere's disease?
Buildup of fluid in the compartments of the inner ear = labyrinths
115
Who are more likely to get Meniere's disease?
women
116
What are risk factors/associations with Meniere's disease?
Allergies stress Viral
117
What are the clinical manifestations of Meniere's disesae?
TWO OR MORE EPISODES OF VERTIGO LASTING AT LEAST 20 MINUTES EACH TINNITUS TEMPORARY HEARING LOSS FEELING OF FULLNESS IN THE EAR
118
If you suspect a patient has meniere's what should you first go?
send to ENT
119
What may cause similar symptoms of Meniere's disease?
Syphilis | High Na content
120
How do we treat Meniere's disease?
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
When does the eustachian tube fully develop?
by age 7/8
122
What causes eustachian tube dysfunction?
``` Blockage Swelling of lining of tubes Colds and other nasal, sinus, or throat infections Allergies Air travel ```
123
What are the clinical manifestations of dilatory eustachian tube dysfunction?
Tube will not dilate Accompanying symptoms of hearing loss Otoscope exam will show effusions, scarring, and thickening of TM Treat the underlying condition
124
What are the clinical manifestations of Patulous eustachian tube dysfunction?
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
What are the clinical manifestations of general eustachian tube dysfunction?
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
How do we diagnose eustachian tube dysfunction?
Retracted TM on the affected side | Decrease in TM mobility
127
How do we treat eustachian tube dysfunction?
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
If symptoms of eustachian tube dysfunction persist due to treatment failure, what are your next steps?
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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