Ear

Question 1

outer ear =
middle ear =
inner ear =

Answer 1

derm
respiratory
neuro

Question 2

MC sensorineuronal HL

Answer 2

presbycusis (high freq lost 1st)

Question 3

sudden SNHL

Answer 3

• no prodrome, sudden HL (w/in 72 hrs), complains of fluid/wax in ear, PE nml (do Weber to help determine prob)
• unsure of eti: likely viral/autoimmune
• ref to ENT (emergency)
• when in doubt, tx w/ steroids (high taper)

Question 4

acoustic neuroma

Answer 4

• slow growing, non-CA tumor (vestibular schwannoma)
• asymmetric SNHL, tinnitus, imbalance
• dx via MRI internal audiory canals w/wo contrast
• tx w/ obs, stereotactation radiation, surgery

Question 5

SNHL ddx

Answer 5

presbycusis, noise-induced SNHL, idiopathic sudden SNHL, acoustic neuroma, ototoxicity, acute labyrinthitis, meniere’s dz

Question 6

conductive HL ddx

Answer 6

EAC swelling/stenosis/obstruction, TM perf, eustachian tube dysfxn, otits media, otosclerosis, chloesteatoma

Question 7

ENT for FB if

Answer 7

complete obstruction, TM perf, batteries

Question 8

Otitis externa

Answer 8

Bacterial: strept, staph, pseudomonas, MRSA

Fungal (otomycosis): aspergillus, candida

Question 9

OE tx

Answer 9

remove debris
wick if too narrow
topical abx (neo/poly/HC if TM intact - cipro/ofloxacin if perf’d)
cx otorrhea if abx fail (fungal/aerobic likely)

Question 10

fungal OE

Answer 10

refractory OE
very itchy/painful
topical tx (acetic acid, clotrimazole B/TID x 1wk)

Question 11

malignant OE

Answer 11

temporal bone involved/inj (aka temporal bone osteomyelitis)
DM, immunocomp’d
pseudomonas aeruginosa
dx: MR w/ con, CT temp bone
emergency, ref to ENT, potential for rapid fatality
tx: IV abx (cipro, ceftazidine, gentamicin), DM control

Question 12

middle ear d/o

Answer 12

ET dysfxn, OM, mastoiditis, cholesteatoma, TM perf, bullous myringtitis, otosclerosis, barotrauma

Question 13

ET dysfxn

Answer 13

• neg P buildup from nasal allergy, URI, nasopharynx mass
• TM retractions, prominent malleus, HL, ear fullness, popping/crackling, improvement w/ valsalva
• acute: monitor, nasal steroid spray
• chronic: bilateral myringotomy w/ tubes

Question 14

OM w/ effusion

Answer 14

• cz: chronic ETD, URI, chronic allergic rhinitis
• tx: nasal steroid spray x 3-4 mos
  myringotomy w/ tubes if no imp
• r/o nasopharyngeal mass/tumor

Question 15

AOM

Answer 15

• strept pneumo, H flu, M cat
• 1st line: amox +/- clavulanate
• 2nd: augmentin, ceftriaxone
• 3rd: levo/clinda
• if PCN allergy: azithro, doxy, clarithro, erythro, bactrim

Question 16

AOM comps

Answer 16

mastoiditis, meningitis/intracranial abscess, TM perf, HL, facial nerve paralysis, alt’d sense of taste

Question 17

mastoiditis

Answer 17

IV abx (vanc, ceftriaxone), ENT consult, admit for obs, mastoidectomy

Question 18

cholesteatoma

Answer 18

• non-CA, skin cyst from deep TM retraction pocket
• CHL
• destroys bone thru P and chronic inf
• surgical excision

Question 19

barotrauma

Answer 19

tx w/ nasal steroid spray, audiogram to assess HL

Question 20

bullous myringitis

Answer 20

• mycoplasma, H flu, strep pneumo
• VERY painful
• PO abx (macrolide, clarithro), topical abx if vesicles rupture, pain mgmt

Question 21

otosclerosis

Answer 21

• fusion of stapes footplate to oval window
• FHx, CHL
• Tx via surg (stapedectomy), hearing aids

Question 22

peripheral vertigo ddx

Answer 22

• BPPV
• meniere’s dz
• acute labyrinthitis/vestibular neuronitis

Question 23

central vertigo ddx

Answer 23

• MS
• Migraines
• b9 intracranial HTN

Question 24

BPPV

Answer 24

otoliths in semicircular canal

Question 25

meniere’s dz

Answer 25

• increased endolymphatic fluid pressure
• Triad: episodic SNHL, vertigo x hrs, roaring tinnitus
• LOW freq SNHL, ascending, usually unilateral
• tx: diuretics, lw Na diet, anti-vert meds, surg (ppx vert)

Question 26

labyrinthitis

Answer 26

• inf/flam of inner ear
• SEV vertigo x 24-72 hrs (disabling) then sev wks imbalance
• tx acute vertigo w/ meclizine or diastat
• tx chronic imbalance w/ PT
• high dose prednisone if sudden SNHL

Question 27

vertigo recap

Answer 27

• BPPV: lasts seconds, head movements, no HL
• Meniere’s: lasts several hrs, assoc w/ HL, tinnitus, ear fullness
• labyrinthitis: lasts 1-3 days, gradual recovery w/wo HL