Ear Conditions Flashcards
tuning fork test used to confirm unilateral hearing loss–to determine wether loss is sensorineural or conductive–details
Weber Test
- -conductive: heard best on affected side
- -sensorineural: heard best on unaffected side
causes of conductive hearing loss (3)
TX
- cerumen impaction
- auditory (eustachian) tube dysfunction associated w/ URI
- Otosclerosis (stapes bone impeded)
- -medical and surgical
weber test heard best on ________ side
unaffected
air conduction > bone conduction –but not __:__ ratio like normal hearing
Rinne test,
2:1
sensory hearing loss etiology (5)
- age
- excessive noise exposure
- diabetes
- head trauma
- ototoxicity
patient hears sound when tuning fork is pressed on mastoid bone
Rinne test
progressive loss of high-fq sounds w/ age advancement
prsbyacusis
Neural etiology of presbyacusis
- MS
- Cerebrovascular disease
- acoustic neuroma
- CN VIII lesion
SUDDEN sensorineural hearing loss etiologies:
TX
usually idiopathic, ototoxic, vascular infarct,
–oral steroids asap
most frequent cause of PROGRESSIVE sensory hearing loss
presbycusis–most pt’s notice loss of speech discrimination
acoustic neuroma aka
vestibular schwannoma
non-malignant tumor of CN 8–most of cerebellopontine angel tumors CPAs in adults–
test
TX
vestibular schwannoma,
MRI,
neurosurgery
etiology of tinnitus (4)
- conductive hearing loss
- sensorineural hearing loss
- ototoxic drugs
- head and neck injury
______ _____ activated w/ tinnitus, exacerbated by emotional cues
limbic system
conductive ________ fq
sensorineural _____ fq
lower,
high
________ tinnitus has vascular etiology
Pulsatile
prevention of tinnitus: screen for (4)
- Hypertension
- cholesterol
- thyroid
- diabetes
treatment for tinnitus
- steroid for sudden sensorineural HL
- benzos
- habituation
- sleep hygiene (Trazodone for sleep)
hematoma of subperichondrial space caused by blunt trauma
Traumatic auricular hematoma aka caulaflower ear –
insect in canal
paralyze w/ lidocaine
most common etiology of otitis externa (7)
- Staph. epidermidis
- S. aureus
- pseudomonas (may become necrotizing)
- anaerobes
- fungal (candida, aspergilis nigres)
- contact dermatitis
- seborrheic (chronic)`
Physical exam otitis externa(4)
- pain w/ tragal pressure
- pain when auricle pulled superiorly
- edema and erythema of canal
- debris (yellow, brown, white)
Tx otitis externa (3)
- remove debris
- antibiotic (Cipro) and steroid
- Fungal (Fluconazole)
otitis extera may progress into _______ may require ____ _____
cellulitis ,
IV antibiotics
erythema and pruritus of external auditory canal from contact w/ allergen; ex causes
Contact dermatitis,
hair spray, cheap ear rings, etc.
differential Dx of contact dermatitis (2)
- seborrheic dermatitis
2. psoriasis
Rare, very aggressive tumor of ear canal.
Most common type?
External auditory canal carcinoma,
squamous cell carcinoma
external auditory canal carcinoma presentation (3)
- bloody otorrhea
- friable lesion in ear canal–surrounding pus
- hearing loss/ facial paralysis
bony overgrowths of ear canal
exostosis and osteomas
exostoses generally acquired from repeated exposure to cold water–rq surg removal
“surfer’s ear”
history for eustachian (auditory) tube dysfunction
- ear pain
- ear fullness
- “plugged ear”
- -different from ear infection
eustachian tube fails to provide adequate ventilation
Eustachian tube dysfunction
Dx of eustachian tube dysfunciton
Meniere disease
etiology of eustachian tube dysfunction (5)
- days-weeks after viral URI
- allergies
- irritants (tobacco!)
- GERD
- hormonal changes
middle-ear effusion WITHOUT acute signs of infection–Tx
serous otitis media (otitis media w/ effusion) (ALLERGIES),
same as auditory tube dysfunction oral corticosteroids (antibiotics have little/no benefit)
history w/ serous otitis media
- hearing loss
- fullness in ear
- ear pain
- tinnitus
P/E of otitis media w/ effusion
- dull TM
- bubbles may be visible
- hypomobile TM
- decreased hearing
barotrauma aka
barotitis media
middle ear infection
etiology (4)
acute otitis media,
- Strep pneumoniae
- H. influenzae
- M. catarrhalis
- viral
pathophys of acute otitis media
- URI –> edema of eustachian tube, nose, nasopharynx
- negative pressure in middle ear
- virus/bac enters middle ear
- microb overgrowth
- effusion
history and PE of otitis media
- ear pain, hearing loss, vertigo
- otorrhea, swelling, erythema around ear may indicate spread to mastoid
3.
children w/ otitis and conjunctivitis likely from
H. influenza
symptoms of AOM usually resolve w/in ___-___ hrs of antibiotic tx
24-72 – recheck
wait and see w/ uni/bilateral AOM w/out otorrhea in pt’s ___ ___ or older w/ ______ AOM
6 months,
uncomplicated
Tx for AOM
high dose amoxicillin (if no relief–may be organism resistant to beta-lactam antibiotics)
augmentin used when:
- antibiotics prescribed w/in last 30 days
- otitis-conjunctivitis syndrome
- pt’s recieving amoxicillin for chemoprophylaxis for recurrent AOM
3+ distinct episodes of AOM w/in 6 months or 4+ w/in 12 months may indicate
TM tubes
inflammation of mastoid air cells of temporal bone resulting from unresolved otitis media
acute mastoiditis
___ and ____should always be perfomred when mastoiditis suspected
CT and CBC
chronic infection of middle ear due to recurrent AOM
Chronic suppurative (purulent ear discharge) otitis media CSOM
CSOM often have,
Tx
- ruptured TM
- sclerosis
- granulation tissue
- -Cipro
squamous epithelium-lined sac, fills w/ keratin debris when obstructed/closed–will then become chronically infected
cholesteatoma
complications of cholesteatoma
erosion and mastoiditits, facial nerve palsy or intracranial complications
dislodged otoconia (otoliths) causing vertigo–most common type
BPPV
DDX of vertigo VINDICATE
Vascular–basilar or cerebral artery aneurysm
Inflammatory/ Infection: Meniere, acute labyrinthitis, otits media, migraine, meningitis
Neoplasm–acoustic neuroma, pituitary adenoma, brain tumor, olfactory meningioma, cerebellar lesion/tumor
Deficiency–
Intoxication–
Congenital–
Autoimmune– MS
Trauma– allergic rhinitis, wax, concussion , TM perf, subdural hematoma
Endocrine–
rhythmic oscillation of eyes occuring physiologically from vestibular and optokinetic stimulation or pathologically in wide variety of diseases
nystagmus
2 types of vertigo
Central vs. peripheral
brief positional vertigo
benign paroxysmal positional vertio BPPV – Ca++ debris w/in POSTERIOR semicircular canal
most common form of positional vertigo – 1/2 of pt’s w/ peripheral vestibular dysfunction
BPPV
*Best treatment for BPPV
Antihistamine (meclizine)
lorazepam
benzodiazepine
most common cause of temporary vertigo accompanied by N&V
vestibular neuronitis (labyrinthitis)
Neuritis:
Labyrinthitis:
- -inflammation of nerve–affects vestibular nerve
- -inflammation of labyrinth (inner ear) CAUSES hearing changes AS WELL AS dizziness or vertigo
labyrinthitis may be post (5)
viral URI, EBV, Measles, Mumps, Herpetic
idiopathic vertigo due to endolymphatic hydrops
Menier’s syndrome (endolymphatic hydrops)
2 know causes of Menier’s
syphilis and head trauma
distention of the endolymphatic compartment of inner ear as pathologenesis of this disorder
Menier’s disease
PE of Menier’s
peripheral nystagmus
concussion due to head trauma–traumatic peripheral vestibular injury causing vertigo, N&V, imbalance worse following trauma, improves over days/months
traumatic vertigo
vertigo secondary to neck injury–position receptors located in facets of cervical spine are important physiologically in coordination of head and eye movements
cervical vertigo
lesions of the midbrain or cerebellum can result in
UP/DOWN beat nystagmus
normally air conduction is 2X ______ than bone conduction
greater
if ac and bc are equally bad
CN VIII issue
In Weber’s test: lateralization will be ______ from side w/ neurosensory deficit
AWAY
In Weber’s test: lateralization will be ______ side of air conduction deficite
TO
