Ear Clinical Correlates Flashcards
What is the most importnat part of an ear workup?
taking a good history
What tuning fork is usually used for rinne and weber?
512
What’s probably the most important scor eyou get out of an audiogram?
the speech discrimination score, since this is what patient’s really care about
What is considered a normal hearing threshold?
less than 25 DB
What are you measuring in tympanometry?
the impedence of the ear drum in comparison to the pressure behind the ear drum
What’s the most common cause of sensorineural hearing loss?
presbycusis - age-related sound induced progressive hearing loss (loss of the hair cells)
What happens in otosclerosis?
it’s an autosomal dominant disease where you get bony growth of the stapes, such that it stuffens and you get conductive hearing loss
What is a way to prevent otosclerosis? What is the treatment?
fluoride prevents
hearing aids to stapedectomy with proshtesis
What symptoms would a patient complaint of in an acoustic neuroma?
asymmetric hearing loss
vertigo
facial nerve paralysis
aural fullness
trigeminal numbness
diplopia
What is the difference between subjective and objective tinnitus?
subjective: perception of sound in the abscence of acoutstic, electrical or external stimulus
Objective: perception of sound caused by internal body sound or vibration
What type of hearing loss is associated with subjective tinnitus and which is associated with objective tinnitus?
subjective is associated with high frequency sensorineural hearing loss
objective tinnitus is exacerbated by conductive hearing loss - the “inner” sounds aren’t masked by normal external sounds anymore
Compare the following: vertigo, dysequilibrium, and imbalance
vertigo = illusion of movement
dysequilibrium = sense of poor coordination with erect posture or movement
imbalance = implies orthopedia or neuro problem
What are some tests to include in the vestibular work up?
H&P obviously
MRI or CT
Electronystagmography
Rotary chair
vestibular evoked myogenic potentials
What is hte most common cause of vertigo?
benign paroxysmal positional vertigo
What is thought to be the cause of benign paroxysmal positional vertigo
post-trauma or post-viral infection, the otoconia get dislodged and roll around in the semicircular canals
What does a presentation of benign paroxysmal positional vertigo look like?
positional vertigo that is latent after movement and brief
normal hearing
How do you diagnose benign paroxysmal positional vertigo
with the Dix-hallpike maneuver and history
What are the symptoms of meniere’s disease?
episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, aural fullness, progressive
often totally asymptomatic between spells
What’s tricky about the meniere’s disease diagnosis?
it’s really a diagnosis of exclusion
you need to rule out things that can mimic meniere’s, like stroke or tumor
What is vestibular neuronitis?
a viral infection of the vestibular nerve - it causes vertigo, but no hearing loss
How do you treat a bacterial labyrinthitis?
you have to use IV antibiotics because ear drops wont get to th einner ear
also vestibular suppressants
What is anotia? What is the treatment?
Developmental issue where there is NO ear
may or may not be a middle and inner ear
treat with a reconstruction or prosthesis. if middle ear is intact, use a bone anchored hearing aid
What is microtia?
developmental issue where the ear is not completely formed
this can range from almost unnoticeable (grade 1) to having only a few bits of cartilage sticking off (grade 3)
What is hte most common external anomaly?
lop ear (abscence of the anihelical fold, so ears kinda stick out)
What is a preauricular pit?
it’s an area that didn’t fuse completely and a fistula forms from the sinus to the front ot he ear. You can get drainage form the area and they often become infected
What is an auricular appendage?
it’s arrested development or fusion of the hillocks of his, resulting in a cartilage part of the ear located int he wrong spot
What is relapsing polychondritis and how does it affect the ear?
it’s an autoimmune diseases that causes inflammation affecting cartilginous areas like the ears, nose, joints, and airways
you get inflamed ear
How cna you tell the difference between a relapsing polychondritis and a cellulitis of the auricle?
polychondritis will have elevated ESR, CRP, and IgG, but normal CBC
whereas cellulitis will have normal IgG and abnormal CBC
What is nodularis chronicus helicus?
It’s a benign area of growth in the external ear, which is common in olde rpatients
it looks like a skin cance,r but it’s not - very painfult though
What is a keloid and how do you treat it>
it’s development of scar tissue after trauma, like piercing the ears
if early, inject iwth steroids
if too big, excise and then inject with steroids
What is an auricular hematoma and why do they need to be treated?
it’s a hematoma in the external ear that’s caused by trauma
you have to treat them with incision, drainage, and bolster
If you don’t trea thtme, the patient will end up with a cauliflower ear deformity
What are hte most common organisms that cause a cellulitis of the pinna?
staphylococcus
streptococcus
pseudomonas
What is an ear canal osteoma? Is it an issue?
It’s a benign bony projection intot he canal - often seen in orweigians and people who have been exposed to cold water (so minnesotans)
it’s really not an issue at all - surfical excision is rearely neeed
What is the treatment for carcinaoms of the ear canal?
excision and/or radiation
What will you see in herpes zoster oticus?
purulent ulcers in and around the ear - vesicles
it’s super painful, decreases hearing, facial nerve paralysis
What are some things that can cause otorrhea?
otorrhea = ear drainage
otitis media, externa, allergy, trauma, CSF leak
What is ear canal stenosis?
it’s when the ear canal is too small - can be congenital, post-trauma, or post-infeciton
often you’ll need surgery to widen it because small amoutns of wax will plug it
What is otomycosis?
fungal growht in the ear - it will look like modly bread pretty much
What is the risk factor for developing otomycosis?
- prior antibacterial drops for an ear infection
What is the treamtent for otomycosis?
debridement and antifungal drops
What method for cerumen removal do otologists prefer?
instrument techniques like suctioning, curetting, or grasping with alligators
they really don’t use irrigation
What symptoms will you see in a tympanic membrane perforation
ear pain, hearing loss, otorrhea, tinnitus
What is the management for a TM perf?
they don’t all require surgery - many will heal with time
if you’re not doing surgery, you need to keep the ear dry til it heals
What is bullous myringitis?
an inflammation of the TM with serous bullae formation - associated with virus or mycoplasma
What is tympanosclerosis?
white plaque formaiton on the TM (hyaline or calcium) after trauma like tubes for otitis media
benign if it only affects the TM, if it involves the middle ear you might have some conductive loss
What is a cholesteatoma?
a soft ball of keratin that ends up int he ear and causes bone erosion
What is the treatment for cholesteatoma?
all of them have to be surgically excised to prevent complete destruction of the ear
What are the 3 most common pathogens that cause acute otitis media?
S. pneumoniae, H influenza, Moraxella catarrhalis
What is a serous otitis media? WHat is the management?
if’s when you have fluid behind the TM but no infection
antibiotics will do nothing
make them go home and if it’s still there in 12 weeks, put in tubes
Why might a child have a red TM and still be completely healthy?
crying iwll turn the TM red
What is the management for acute otitis media/
oral antibiotics (or topical antibiotic drops if the TM is already perforated).
What are the indications for PE tubes?
recurrent OM - over 3 episodes in 3 months or over 4 episodes in a year
persistent effusin over 3 months
poor response to ABx
cleft palate
immnocompromis
chronic eustachian tube dysfunction
