Ear Conditions Flashcards
1
Q
tuning fork test used to confirm unilateral hearing loss–to determine wether loss is sensorineural or conductive–details
A
Weber Test
- -conductive: heard best on affected side
- -sensorineural: heard best on unaffected side
2
Q
causes of conductive hearing loss (3)
TX
A
- cerumen impaction
- auditory (eustachian) tube dysfunction associated w/ URI
- Otosclerosis (stapes bone impeded)
- -medical and surgical
3
Q
weber test heard best on ________ side
A
unaffected
4
Q
air conduction > bone conduction –but not __:__ ratio like normal hearing
A
Rinne test,
2:1
5
Q
sensory hearing loss etiology (5)
A
- age
- excessive noise exposure
- diabetes
- head trauma
- ototoxicity
6
Q
patient hears sound when tuning fork is pressed on mastoid bone
A
Rinne test
7
Q
progressive loss of high-fq sounds w/ age advancement
A
prsbyacusis
8
Q
Neural etiology of presbyacusis
A
- MS
- Cerebrovascular disease
- acoustic neuroma
- CN VIII lesion
9
Q
SUDDEN sensorineural hearing loss etiologies:
TX
A
usually idiopathic, ototoxic, vascular infarct,
–oral steroids asap
10
Q
most frequent cause of PROGRESSIVE sensory hearing loss
A
presbycusis–most pt’s notice loss of speech discrimination
11
Q
acoustic neuroma aka
A
vestibular schwannoma
12
Q
non-malignant tumor of CN 8–most of cerebellopontine angel tumors CPAs in adults–
test
TX
A
vestibular schwannoma,
MRI,
neurosurgery
13
Q
etiology of tinnitus (4)
A
- conductive hearing loss
- sensorineural hearing loss
- ototoxic drugs
- head and neck injury
14
Q
______ _____ activated w/ tinnitus, exacerbated by emotional cues
A
limbic system
15
Q
conductive ________ fq
sensorineural _____ fq
A
lower,
high
16
Q
________ tinnitus has vascular etiology
A
Pulsatile
17
Q
prevention of tinnitus: screen for (4)
A
- Hypertension
- cholesterol
- thyroid
- diabetes
18
Q
treatment for tinnitus
A
- steroid for sudden sensorineural HL
- benzos
- habituation
- sleep hygiene (Trazodone for sleep)
19
Q
hematoma of subperichondrial space caused by blunt trauma
A
Traumatic auricular hematoma aka caulaflower ear –
20
Q
insect in canal
A
paralyze w/ lidocaine
21
Q
most common etiology of otitis externa (7)
A
- Staph. epidermidis
- S. aureus
- pseudomonas (may become necrotizing)
- anaerobes
- fungal (candida, aspergilis nigres)
- contact dermatitis
- seborrheic (chronic)`
22
Q
Physical exam otitis externa(4)
A
- pain w/ tragal pressure
- pain when auricle pulled superiorly
- edema and erythema of canal
- debris (yellow, brown, white)
23
Q
Tx otitis externa (3)
A
- remove debris
- antibiotic (Cipro) and steroid
- Fungal (Fluconazole)
24
Q
otitis extera may progress into _______ may require ____ _____
A
cellulitis ,
IV antibiotics
25
erythema and pruritus of external auditory canal from contact w/ allergen; ex causes
Contact dermatitis,
| hair spray, cheap ear rings, etc.
26
differential Dx of contact dermatitis (2)
1. seborrheic dermatitis
| 2. psoriasis
27
Rare, very aggressive tumor of ear canal.
| Most common type?
External auditory canal carcinoma,
| squamous cell carcinoma
28
external auditory canal carcinoma presentation (3)
1. bloody otorrhea
2. friable lesion in ear canal--surrounding pus
3. hearing loss/ facial paralysis
29
bony overgrowths of ear canal
exostosis and osteomas
30
exostoses generally acquired from repeated exposure to cold water--rq surg removal
"surfer's ear"
31
history for eustachian (auditory) tube dysfunction
1. ear pain
2. ear fullness
3. "plugged ear"
- -different from ear infection
32
eustachian tube fails to provide adequate ventilation
Eustachian tube dysfunction
33
Dx of eustachian tube dysfunciton
Meniere disease
34
etiology of eustachian tube dysfunction (5)
1. days-weeks after viral URI
2. allergies
3. irritants (tobacco!)
4. GERD
5. hormonal changes
35
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)
36
history w/ serous otitis media
1. hearing loss
2. fullness in ear
3. ear pain
4. tinnitus
37
P/E of otitis media w/ effusion
1. dull TM
2. bubbles may be visible
3. hypomobile TM
4. decreased hearing
38
barotrauma aka
barotitis media
39
middle ear infection
| etiology (4)
acute otitis media,
1. Strep pneumoniae
2. H. influenzae
3. M. catarrhalis
4. viral
40
pathophys of acute otitis media
1. URI --> edema of eustachian tube, nose, nasopharynx
2. negative pressure in middle ear
3. virus/bac enters middle ear
4. microb overgrowth
5. effusion
41
history and PE of otitis media
1. ear pain, hearing loss, vertigo
2. otorrhea, swelling, erythema around ear may indicate spread to mastoid
3.
42
children w/ otitis and conjunctivitis likely from
H. influenza
43
symptoms of AOM usually resolve w/in ___-___ hrs of antibiotic tx
24-72 -- recheck
44
wait and see w/ uni/bilateral AOM w/out otorrhea in pt's ___ ___ or older w/ ______ AOM
6 months,
| uncomplicated
45
Tx for AOM
high dose amoxicillin (if no relief--may be organism resistant to beta-lactam antibiotics)
46
augmentin used when:
1. antibiotics prescribed w/in last 30 days
2. otitis-conjunctivitis syndrome
3. pt's recieving amoxicillin for chemoprophylaxis for recurrent AOM
47
3+ distinct episodes of AOM w/in 6 months or 4+ w/in 12 months may indicate
TM tubes
48
inflammation of mastoid air cells of temporal bone resulting from unresolved otitis media
acute mastoiditis
49
___ and ____should always be perfomred when mastoiditis suspected
CT and CBC
50
chronic infection of middle ear due to recurrent AOM
Chronic suppurative (purulent ear discharge) otitis media CSOM
51
CSOM often have,
| Tx
1. ruptured TM
2. sclerosis
3. granulation tissue
- -Cipro
52
squamous epithelium-lined sac, fills w/ keratin debris when obstructed/closed--will then become chronically infected
cholesteatoma
53
complications of cholesteatoma
erosion and mastoiditits, facial nerve palsy or intracranial complications
54
dislodged otoconia (otoliths) causing vertigo--most common type
BPPV
55
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--
56
rhythmic oscillation of eyes occuring physiologically from vestibular and optokinetic stimulation or pathologically in wide variety of diseases
nystagmus
57
2 types of vertigo
Central vs. peripheral
58
brief positional vertigo
benign paroxysmal positional vertio BPPV -- Ca++ debris w/in POSTERIOR semicircular canal
59
most common form of positional vertigo -- 1/2 of pt's w/ peripheral vestibular dysfunction
BPPV
60
*Best treatment for BPPV
Antihistamine (meclizine)
61
lorazepam
benzodiazepine
62
most common cause of temporary vertigo accompanied by N&V
vestibular neuronitis (labyrinthitis)
63
Neuritis:
Labyrinthitis:
- -inflammation of nerve--affects vestibular nerve
| - -inflammation of labyrinth (inner ear) CAUSES hearing changes AS WELL AS dizziness or vertigo
64
labyrinthitis may be post (5)
viral URI, EBV, Measles, Mumps, Herpetic
65
idiopathic vertigo due to endolymphatic hydrops
Menier's syndrome (endolymphatic hydrops)
66
2 know causes of Menier's
syphilis and head trauma
67
distention of the endolymphatic compartment of inner ear as pathologenesis of this disorder
Menier's disease
68
PE of Menier's
peripheral nystagmus
69
concussion due to head trauma--traumatic peripheral vestibular injury causing vertigo, N&V, imbalance worse following trauma, improves over days/months
traumatic vertigo
70
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
71
lesions of the midbrain or cerebellum can result in
UP/DOWN beat nystagmus
72
normally air conduction is 2X ______ than bone conduction
greater
73
if ac and bc are equally bad
CN VIII issue
74
In Weber's test: lateralization will be ______ from side w/ neurosensory deficit
AWAY
75
In Weber's test: lateralization will be ______ side of air conduction deficite
TO
