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AUDE 5410 Aud-Vestib Disorders > Ear Canal Pathology > Flashcards

Ear Canal Pathology Flashcards

1
Q

Foreign bodies in the EAC are a frequently encountered problem and include

A

beads
insects
food
pebbles
small batteries

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2
Q

how to remove foreign bodies

A

hook or suction
with/without local anesthesia

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3
Q

what can PT complain about with insects in the canal

A

itching or tickling sensation or patients report that they can hear something “moving”

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4
Q

Small alkaline batteries that can cause ____ in canal

A

chemical burns

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5
Q

should you remove insects

A

NO
you may leave behind parts of it that will cause a reaction for the PT, refer them out to get remove

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6
Q

what is ear canal stenosis

A

When the ear canal fails to completely develop during the 7th month in utero, the result is a very narrow ear canal

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7
Q

how to fix stenosis

A

canalplasty - widening the canal

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8
Q

what can stenosis lead to

A

difficulty in examining the EAC
collection of wax and debris in EAC
possible CHL

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9
Q

what is congenital aural atresia

A

Failure of canalization of the EAC can result in aural atresia

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10
Q

is atresia bilateral and in females

A

no one sided and more common in males

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11
Q

Congenital Aural Atresia is often associated with

A

microtia & middle ear anomalies

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12
Q

peanut ear is an example of

A

microtia

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13
Q

Often sporadic, it may occur in association with a known syndrome including

A

Treacher-Collins, Trisomy 22, Crouzon’s syndrome, and hemifacial microsomia

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14
Q

trisomy 21 is usually associated with

A

stenotic ear canals

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15
Q

can establish cochlear function in children with unilateral and bilateral atresia

A

bone conducted ABR

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16
Q

why do you want to do bone conducted ABR?

A

establish cochlear function because changes the treatment plan knowing the cochlear fxn

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17
Q

Aural atresia occurs after inner ear development, therefore, most patients (› 80%) have _____ cochlear function but have a maximum_____ (~ 60 dB HL)

A

normal, CHL

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18
Q

Repair of ___ should take place after repair of a ____

A

aural atresia, coexisting microtia

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19
Q

when does surgical repair of aural atresia take place

A

around 6-8 yrs old because aural is close to full size by then

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20
Q

FDA has approved that children with bilateral or unilateral atresia can be fit with a surgically implanted bone-anchored hearing aid (BAHA) after _____

A

5 years of age

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21
Q

Children < 5 years can be fit a

A

bone-conducted hearing aid/BAHA coupled to a soft or hard headband

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22
Q

CI vs BAHA

A

CI stimulates auditory nerve

BAHA sends signal in nonfunctioning middle ear and sending it to the functioning inner ear

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23
Q

which populations are more adapt to having collapsing ear canals

A

children - cartilage not fully developed
adults - cartilage is deteriorating

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24
Q

what are collapsing ear canals

A

Ear canal walls can collapse when standard supraaural headphones are placed over the ears

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25
Q

an occluded ear canal can cause as much as a

A

50 dB HL hearing loss

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26
Q

what happens if you test for HL and close off the ear canal?

A

exaggerate their HL
result in mixed HL if they already had a HL

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27
Q

how can you figure out you have a collapsed ear canal

A

if they can converse with you and the thresholds dont match
high frequency conductive hl (abg)
unmasked bc will show huge ABG that you think has a snhl

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28
Q

audio findings in collapsing canals

A

Normal tympanogram

A “conductive” hearing loss, present only at or worse in the higher frequencies with supraaural headphones

Threshold improves when the headphone(s) are elevated slightly from the ear canal
Rarely, patients may complain that they cannot hear as well with headphones as without

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29
Q

best ways to manage collapsing ear canals

A

Use of insert phones (best option)

Placement of immittance probe tips in the ear canal

Use of stock ear mold(s) to keep the canal open

Pull the pinna upwards and backwards when placing the headphones

If suspecting collapsing canal, hold the headphone, if possible, against the ear rather than fixing it in place with the headband

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30
Q

what is epithelial migration

A

Cerumen and dead skin are carried out of the external auditory canal by an unusual lateral migratory property of the squamous epithelium (skin) lining the ear canal

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31
Q

why does cerumen get drier with age

A

reduced number and activity of ceruminous and sebaceous glands

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32
Q

why is impaction more common in males

A

due to thicker and coarser hairs found at the lateral end of the EAC

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33
Q

what are examples of what can lead to impaction

A

Narrow canals, over-zealous use of cotton coated tips, and a hearing aid/earmold can all impede the normal flow of cerumen to the periphery

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34
Q

if there is complete impaction what should you do

A

you do not know how far back it goes, do not try to remove it but refer for a medical cerumen management with a physician

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35
Q

what happens besides safety if you test with ceumen impaction?

A

a fake conductive loss or mixed loss

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36
Q

what are audiologic findings you would see with cerumen impaction

A

sensation of obstruction
on otoscopy, cerumen blocking the ear canal; ™ structures are not visualized
tympanogram volume </= .2ml
mild CHL
otalgia
vertigo/dizziness
coughing (Arnold’s nerve, branch of X nerve in EAC)

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37
Q

what level hl can you have with cerumen impaction

A

can have up to 30dB HL with impacted cerumen

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38
Q

otoscopy is not 100% accurate for everything we see
what else could be done to determine cerumen impaction

A

if the tymp shows volume of .2 ml you have a complete obstruction
flat tymp
if it is greater than .2, there is some opening and you may be ok to do a hearing test

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39
Q

what is management of the cerumen impaction

A

removal by medical personnel
Cerumen softening by cerumenolytic agents like olive oil, Murine, and Debrox prior to removal

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40
Q

what are inflammatory polyps

A

abnormal tissue growth

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41
Q

what is inflammatory polyps typically seen with

A

chronic otitis media with or without choesteatoma

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42
Q

what is a cholesteatoma

A

sudo tumors, eat into anything that gets in their way, can present as a polyp or have them associated with it

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43
Q

what can cause inflammatory polyps

A

Foreign bodies in the EAC or TM such as retained PE tubes, canal cholesteatoma, and benign or malignant tumors

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44
Q

how are inflammatory polyps treated

A

usually not painful
respond to topical therapy and steroid antibiotic drops

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45
Q

what happens if inflammatory polyp doesn’t heal with medication

A

biopsy

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46
Q

the single most common condition to affect the EAC

A

otitis externa

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47
Q

what is otitis externa

A

inflammatory condition of the skin lining the EAC

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48
Q

otitis externa aka

A

swimmers ear

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49
Q

what are the causes of OE

A

acute, chronic, diffuse (whole eac), or localized (part of eac)

50
Q

describe acute diffuse otitis externa

A

severe, sudden onset in whole eac
bacterial infection
can be caused by local trauma (q tips)
frequent swimming
spontaneously

51
Q

what are the audiologic findings with ADOE

A

severe pain
usually CHL (superimposed)
whitish, watery otorrhea
acute swelling (severe enough to close EAC)

52
Q

why is there pain associated with ADOE

A

swelling because there is fluid (edema) and causes pain because there is not a lot of room in the canal between the skin and cartilage/bone and the pressure there is what you are feeling

53
Q

What are the two forms of ADOE

A

furuncle (abscess)
bullous myringitis

54
Q

treatment for ADOE

A

Analgesics for pain
Topical antibiotics and steroids
Removal of infected debris by physician

55
Q

describe furuncle (abscess) form of ADOE

A

staphylococcus aureus infection of a hair follicle in the EAC
Extremely tender and painful, but self-remitting in a few days
Symptomatic treatment for pain if needed

56
Q

describe bullous myringitis form of ADOE

A

Localized viral (e.g., influenza or herpes zoster) or bacterial infection (e.g., Strep. pneumoniae) of TM and deep EAC
Results in blood blisters of various sizes
Extremely painful but again self-remitting in a few days

57
Q

treatment for bullous myringitis

A

Symptomatic for pain
Cleaning of debris in the EAC by a physician

58
Q

most common cause is seborrhic dermatitis believed to be caused by a yeast-like organism

A

chronic otitis externa

59
Q

describe chronic OE

A

generalized condition of EAC
skin appears red & scaly & lack of cerumen
itchy (rather than pain)
watery discharge
prone to frequent acute flare ups

60
Q

treatment for chronic OE

A

topical steroids

61
Q

what are complications of chronic OE

A

Stenosis of the EAC due to inflammation
Formation of a false membrane across the EAC that may obscure the TM and result in a conductive hearing loss

62
Q

fungal infection

A

otomycosis

63
Q

occurs spontaneously or a result of frequent use of topical antibiotics, in which case it may be secondary to chronic otitis externa

A

otomycosis

64
Q

describe otomycosis

A

range from blue-black, green, yellow, to white
produces debris in EAC
PT complain of HL or wetness in ear

65
Q

what can happen if otomycosis is untreated

A

can destroy sections of EAC
mastoid bone
can cause meningitis & death

66
Q

treatment for otomycosis

A

Topical anti-fungal medication
Removal of debris from the EAC by a physician

67
Q

what is the difference bw chronic and recurring?

A

recurrent - can come and go and come and go
chronic - continuously occurring

68
Q

dermatitis

A

any inflammation in the skin

69
Q

how does otomycosis cause meningitis?

A

starts in eac, can eat structures and cause mastitis and can go into the middle ear, the brain is above the bony plate in the middle ear and if it eats through the plate into the brain it reaches the meninges and causes this

70
Q

Historically called malignant otitis externa

A

necrotizing external otitis (NEO)

71
Q

Otitis externa can be a much more aggressive infection in the immunocompromised patient, such as

A

Poorly controlled diabetic patients (most common)
HIV and AIDs patients

72
Q

NEO can involve

A

temporal bone and skull base and then it is essentially osteomyelitis - skull-base osteomyelitis

73
Q

describe neo

A

episode begins as an acute otitis externa but because the host is immunocompromised, the infection spreads beyond soft tissue of the ear canal to the underlying temporal bone

chronic infection ensues with granulation and inflammatory tissue forming in the EAC replacing a significant portion of the bony EAC, which then mimics a malignant disease

74
Q

why does uncontrolled diabetes cause immunocompromised?

A

affects multi systems so it will also attach your immune system

75
Q

Intratemporal and intracranial complications with NEO occur through involvement of neurovascular pathways, including

A

Inferior extension of the disease into the mastoid portion of the temporal bone can produce facial weakness/paralysis
Medial extension into the petrous apex can affect CNs V & VI
Inferior-medial extension can involve the jugular foramen and cranial nerves IX, X, & XI resulting in

76
Q

what is inferior extension of the disease

A

astoid portion of the temporal bone can produce facial weakness/paralysis

77
Q

what is the medial extension of NEO

A

into the petrous apex can affect CNs V & VI

78
Q

what is the inferior-medial extension of NEO

A

can involve the jugular foramen and cranial nerves IX, X, & XI resulting in hoarseness, dysphonia, and aspiration

79
Q

Extension of NEO into the dura lining the temporal bone can result in

A

Vascular complications – e.g., sigmoid sinus thrombosis
Intracranial complications – e.g., otic hydrocephalus & meningitis

80
Q

what is aspiration pneumonia

A

liquids or food particles go into the lungs

81
Q

blood clot

A

thrombosis

82
Q

what is otic hydrocephalus

A

caused by a problem at the ears, excessive fluid caused from an external ear canal infection

83
Q

how do you diagnose NEO

A

Biopsy of granulation tissue in the EAC to rule out malignant disease and obtain cultures for bacterial and fungal organisms
CT scan and MRI to evaluate temporal bone, skull base, & soft tissue

84
Q

waht should be suspected in immunocompromized PT with ear pain

A

necrotizing external otitis

85
Q

what is the treatment of NEO

A

Parental and topical antibiotics (resolves the condition in ~ 80% of patients) but may require meds for up to 6 months
Treatment of underlying immunocompromising condition

86
Q

Common benign neoplasms are

A

exostosis & osteomas

87
Q

Bony growth and the most common benign tumor of the EAC

A

exostosis

88
Q

what is exostosis caused by

A

localized hyperplasia (abnormal cell increase) usually due to irritation or may be idiopathic
Single or multiple growths

89
Q

what is common to see in exostosis PT’s

A

bilateral but usually starts as a unilateral growth
Common in individuals with prolonged exposure to cold water
If large, may lead to a conductive hearing loss by obstructing EAC

90
Q

symptoms of exostosis (at a later stage)

A

pain/discomfort, tinnitus & associated OE

91
Q

what isthe treatment for exostosis

A

antibiotics analgesics & surgical excision of growth

92
Q

types of benign neoplasms

A

exostosis & osteoma

93
Q

what is an osteoma

A

true benign bony tumor
Less common and more laterally based than exostosis

94
Q

what is the difference bw osteomas & exostosis

A

exostosis are irregular and multiple, osteomas are smooth and usually singular

95
Q

symptoms of osteomas

A

similar to exostosis

96
Q

treatment for osteomas

A

cause obstruction faster so will need surgical excision
if you have infection need antibiotcs
if pain, pain meds etc.

97
Q

rare; with an incidence of 1 to 6 per 1,000,000

A

malignancies of the temporal bone

98
Q

25% of all temporal bone malignant tumors are

A

malignancies of EAC

99
Q

most common malignant temporal bone (neoplasm) in adults

A

squamous cell carcinoma

100
Q

rare form of adenocarcinoma found usually in head & neck

A

adenoid cystic carcinoma

101
Q

most common malignant neoplasm in children

A

sarcoma

102
Q

tumors of the temporal bone have varied presentation. Explain some ways it does

A

pain, drainage, and hearing loss, mimicking chronic otitis externa and delaying diagnosis

103
Q

All patients presenting with non-healing granulation tissue in the EAC should be

A

biopsied

104
Q

tumors are usually red due to

A

high vasculature

105
Q

what is osteoradionecrosis (ORN)

A

rare and most serious complication arising from radiation of the base of skull bones due to cancer, but idiopathic variants do occur
caused by radiation to the outer ear area (more for skull based cancers)

106
Q

can ORN occur years after original radiation?

A

yes

107
Q

ORN in EAC can be

A

localized or diffuse

108
Q

describe a localized EAC ORN

A

happens because EAC is portal of radiation like nasopharyngeal carcinoma

109
Q

describe diffuse EAC

A

more common in high dose radiation to the temporal bone

110
Q

why does radiated bone become susceptible to infection and healing compromised?

A

becaues you are killing off the tissue

111
Q

what bone is most commonly affected in ORN

A

mandible (jaw)

112
Q

to get radiation to the cancer in the back of the nose, they send the radiation into

A

the ear

113
Q

what are signs and symptoms of ORN

A

Ear fullness
Otalgia
Foul odor
Hearing loss (can be conductive or SNHL)
Discharge including bloody otorrhea
Tinnitus

114
Q

what will microscopy show with ORN

A

Debris in EAC and occasionally granulation tissue
Single or multiple areas of exposed devascularized bone that is yellowish in color and soft
Persistent granulation tissue in the area should be biopsied

115
Q

what is the treatment for localized ORN

A

less aggressive condition
in office debridement
topical antiobiotics

116
Q

treatment for diffuse ORN

A

more lethal condition
necrotic temporal bone at risk for intratemporal and intracranial neurovascular complications

surgical debridement
I/V antibiotics

117
Q

what is the differential diagnosis for ORN

A

chronic otitis media

118
Q

A 70-year-old man presents with a history of right-sided hearing loss, otalgia, and blockage
how many biopsies did it take to find his cancer

A

FOUR
3 showed benign

119
Q

what is the ICD 10 code for diseases of the ear and mastoid process

A

H60-H95 (overall code)

120
Q

would down syndrome use H61.319 acquired stenosis of EAC

A

NO becuase they were born with it

AUDE 5410 Aud-Vestib Disorders (18 decks)

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