Ear Conditions (PN)

Question 1

Differentiate: Acute Otitis Media (AOM) vs Otitis Media with Effusion (OME)

1. ) Pain Presentation
2. ) Fever
3. ) Hearing
4. ) Tympanic Membrane on otoscopy
5. ) CRP
6. ) IgE
7. ) WBC

Answer 1

1.) Pain Presentation
        AOM: unilateral persistant pain
        OME: none but may experience bilateral stuffiness
2.) Fever
        AOM: Usually          OME: None
3.) Hearing
        AOM: Intact         OME: Reduced
4.) Tympanic Membrane
        AOM: Bulging with landmarks obscured. May perforate -> otorrhea
        OME: Retracted, opaque with fluid/air bubbles
5.) CRP
        AOM: Increased    OME: Normal
6.) IgE
        AOM: Normal        OME: May be raised
7.) WBC
       AOM: Elevated      OME: Normal

Question 2

What is the typical clinical presentation of labyrinthitis?

Answer 2

1. ) Acute Onset of Severe Vertigo following head trauma or URI/Otitis Media
2. ) Nystagmus
3. ) Possible Hearing Loss & Tinnitis

Suppurative Bacterial Labyrinthitis is a medical emergency

Question 3

1. ) Watchful waiting for 2-3 days without treatment is the standard in Otitis Media, except in what circumstance?
2. ) If after 2-3 days of watchful waiting the infection has not improved. What is the gold standard treatment?

Answer 3

1. ) Febrile infants < 2 months

2. ) Amoxicillin is administered

Question 4

Vestibular Neuronitis vs. Labyrinthitis. Which would you treat with antibiotics?

Answer 4

Purulent Labyrinthitis requires IV antibiotics. Note: this is a medical emergency due to a high risk of meningitis

Vestibular neuronitis is generally treated by bed rest and vestibular sedatives (Gravol) or diazepam

Question 5

What is the most common form of otitis media?

Answer 5

Otitis Media with Effusion

OME is a non-infectious condition generally resulting from eustachian tube dysfunction.

Question 6

What is the typical presentation of Cholesteatoma?

Answer 6

1. ) Ear Canal is full of discharge
2. ) Waxy appearance on the superior & posterior aspects of the tympanic membrane
3. ) Possible presence of an aural polyp

If Cholesteatoma is left untreated it may destroy the ossicles leading to deafness, imbalance, and vertigo

Question 7

What is the main treatment of otosclerosis?

Answer 7

Stapedectomy

Question 8

What are the causes of labyrinthitis?

Answer 8

1. ) Most commonly bacterial or viral proceeding a URI
2. ) Head Trauma
3. ) Extreme Stress
4. ) Medication’s Adverse Effect

Question 9

Essential fatty acid deficiency is a risk factor for what conductive hearing loss condition?

Answer 9

Ceruminosis

Question 10

Vestibular Neuronitis vs. Labyrinthitis. Which typically resolves faster?

Answer 10

Vestibular neuronitis resolves over days leaving a residual imbalance that lasts days to weeks

Question 11

What is the treatment for cholesteatoma?

Answer 11

Surgical resection of the growth while maintaining normal functions of the temporal bone

Question 12

What bacteria commonly infect the external ear canal?

Answer 12

E.coli, Pseudomonas aeruginosa, Proteus spp

Question 13

What cranial nerves may be involved in otitis externa?

Answer 13

VII, IX, XI, XII

Question 14

Vestibular Neuronitis vs. Labyrinthitis.

Both present with vertigo. Which condition presents with hearing loss?

Answer 14

Labyrinthitis

Question 15

Is bone or air conduction better in someone with otosclerosis?

Answer 15

Bone conduction because the pathology is a conductive issue (i.e. the stapes footplate is unable to vibrate because it is fused to the oval window)

Question 16

Destructive and expanding growth of keratinized squamous cells of the middle ear. This condition may affect the ossicles and spread to the base of the skull and the brain

Answer 16

Cholesteatoma

Question 17

What is the most common cause of conductive hearing loss in adults?

Answer 17

Otosclerosis

Question 18

What is Schwartz’s sign and in what condition will you find it?

Answer 18

The pinkish hue observed behind the tympanic membrane in people with otosclerosis