Ear Diseases Flashcards by Shay S

dry, scaley, painless plaque due to sun damage

Actinic Keratosis (AK)

Aka solaris keratosis

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Actinic Keratosis -> cancer?

10-20% will convert to squamous cell carcinoma in 10-20 years

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Trmnts for Actinic Keratosis?

Cryotherapy
spf
fluoruracil (5-FU) - chemo cream
Imiquimod (Aldara) - warts

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fully covered cyst, non-tender, well defined, mobile, slow growing

Epidermal Inclusion Cyst (EIC)

Aka Sebaceous cysts

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small, symmetrical, fully brown mole since childhood

Melanocytic Nevus

local proliferation of melanocytes

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treatment

Epidural Inclusion Cyst

excise if bothersome
ABX if infx

looks like crisco

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most common malignant tumor of the skin

Basal Cell Carcinoma (BCC)

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What is it and trmnt?

Painless ulcer/nodule, pearly borders, in the sun a lot

Basal Cell Carcinoma

trmnt: Sx excision and 5-fluoruracil (5-Fu) cream

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if basal cell carcinoma is left untreated, it can begin to look …

rat bitten ulceration

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what is it and trmnt?

hard, non-tender, red, nodule or plaque

Squamous Cell Carcinoma

trmnt: sx excision, cryotherapy, fluoruracil (5-fu)

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sort from best to worst prognosis:
* melaoma
* basal cell carcinoma
* squamous cell carcinoma

basal, squamous, melanoma

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what and trmnt?

pt is a wrestler with painful big bruise

Auricular Hematoma

* I&D
* Pressurre dressing, splint
* ABX (staph)

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Auricular Hematoma left untreatred -> ______ deformity

cauliflower

48-72 hrs -> aseptic or septic necrosis

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what and trmnt?

inflammation only at the pinna (spares the lobe)

2ndary to cellulitis, frostbite, trauma

Perichondritis

corticosteroids + ENT referral

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relapsing polychondritis is a structural issue caused by ___

autoimmune issue

more common in adults

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what? trmnt?

honey crusted veisculopustular skin infx commonly seen with thick yellow crusty lesions

Impetigo

Bac: staph or strep
Bactroban, Cephalexin (Keflex), etc

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what, bac, trmnt?

deep skin infx, red, warm, swollen

Cellulitis

Bac: Staph, Strep, H. Influenzae, etc
Rx: ABX

mark borders to track progress

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what, trmnt?

pt began to have burning pain in one ear, headache, malaise and fever. 1 week later, pt has vesciles and facial paralysis

hx of chicken pox

Herpes Zoster Oticus

trmnt: acyclovir or Valacylovir (antivirals) and Corticosteroids if CN7 or 8 affected

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Herpes Zoster Oticus puts you at risk for what?

Ramsey-Hunt Syndrome

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buy otc ____ up to 4 days to soften cerumen impaction

Debrox

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rule out a ____ prior to irrigating ear canal

TM perforation

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Mix warm water + _____ for ear wax rmvl

Warm water + H2O2 Hydrogen Peroxide

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_____ can kill insects in ears

mineral oil, lidocaine, alcohol

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use anti-inflammatory ____ drops if ear canal or TM is traumatized

cortisporin otic drops

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swimmer's ear = ____

Acute Otitis Externa (AOE)

most common cause of otitis externa

*Psuedomonas* aeruginosa ## Footnote P. aeruginosa (38%) S. epidermidis (9%) S. aureus (8%) Strep pyogenes (6%)

treatment for Otitis Externa

* Ofloxacin/Ciprofloxacin (fluoroquinolones) * Ciprodex/Cipro Hydrocortisone (ABX/steroid combo) * Cortisporin Otic (neomycin/Polymyxin-B/HC) * Domeboro's sol OTC * Cotton ear wick to deliver meds and debride

prevent otitis externa by making alcohol drops after swimming

1/3 vinegar + 2/3 rubbing alcohol

complications of otitis externa

cellulitis, myringitis, osteomyeltitis of the skull base

# workup order ___ for malignant otitis externa

CT/MRI Ear canal biopsy (to rule out malig tumor)

# management malignant otitis externa

* Antipseudomonal IV ABX for 6-12 wks * Oral Cipro * Gallium scan (FU) ## Footnote p. aeruginosa

# management malignant otitis externa

* Antipseudomonal IV ABX for 6-12 wks * Oral Cipro * Gallium scan (FU)

Cellulitis trmnt

Ciprofloxacin oral

# what and trmnt itchy ears

Pruritis trmnt: mineral oil, clip nails, gloves, topical corticosteroids, oral antihistamines

ABX drops _____ can cause contact dermatitis OR ototoxicity

Cortisporin (neomycin/polymyxin)

flaking skin of ear canal =

seborrheic dermatitis

bony overgrowth in external ear canal =

exostosis/Osteomas

if otitis externa or otorrhea doesn't resolve w/trmnt, suspect _____

Squamous cell carcinoma & get biopsy!

absence or abnorm narrowing of an oprning or passage in the body

Atresia

# what congenital anomaly opening leading from ear canal or middle ear to pt's neck or anywhere near ear

First Branchial Cleft Anomalies | prone to infx

eustachian tube drains into the ____

nasopharynx

kids under 7 have more sinus related ear infectios due to ...

their eustachian tube being more flat/horizontal. easier for infections to travel.

# what eustachian tube does not open with yawning or swallowing, retracted TM with decreased mobility with valsalva, tympanogram is flat or retracted

Eustachian tube sydfunction (ETD)

# trmnts Eustachian Tube Dysfunction

- oral decongestants (sudafed) - intranasal topical decongestants (afrin up to 4 days bc it constricts blood vessels - nasal corticosteroids (flonase) - valsalva every day

eustachian tube dysfunction creates a ____ pressure

negative pressure vacuum

# what, trmnt? Bubbles, decreased hearing, plugged feeling, follows URI

Serous Otitis Media (SOM) | aka Otitis media with effusion (OME) ## Footnote trmnt: decongestats (sudafed), corticosteroids (flonase)

# concern for what? adult has had unil serous otitis media for a very long time

tumor

# trmnt? - TM and middle ear structural damage - child has Otitis Media Effusion for 4 months with hearing loss - child has speech and learning probs

Refer for Tympanostomy Tubes ## Footnote breaks vacuum (-) pressure to release fluid

# trmnts Barotrauma

- elevate head at night - meclizine (antivert) - steroids (prednisone) - avoid cough, sneeze - sx repair of fistula (sensorineural hearing loss) - myringotomy (conductive hearing loss)

risk factors for acute otitis media

- environmental: pollen, mold, tobacco, smoke - URI

workup for ___ is required for any neonate <1 month with acute otitis media

sepsis

most sensitive finding or acute otitis media

bulging red TM

# viral or bac? acute otitis media

most start viral (48%) - s. pneumonia (50%) - H. influenza (20-30%) - M. catarrhalis (1-5%)

# trmnt? AOM

# abnorm?

A. Flat, abnorm glare B. Otitis media C. Normal

inflammation of TM + Acute otitis media =

Bullous Myringitis ## Footnote Mycoplasma or H. influenza G(-) same presentation and management as AOM

middle ear infx, fever, doughy feel, red, hot, malaise, pain ## Footnote most frequent serous complication of middle ear infection

Mastoiditis

Mastoiditis trmnt

- CT - Hopsital - IV ABX - Mastoidectomy

Otitis Media + purulent aural discharge (TM Perf) =

Chronic Otitis Media (COM)

Bac of Chronic Otitis Media vs Acute Otitis Media

COM: P. Aeruginosa, Proteus species, S. Aureus, mixed anaerobic infx AOM: S. Pneumonia, H. Influenza, M. Catarrhalis

Trmnt: Chronic recurrent Otitis Media

- Perforation -> ABX drops (Ofloxacin or Ciprodex) - Suppressive Therapies X 6 months (Trimethoprim/Sulfamethoxazole OR Amoxicillin) - TM Tubes

Indications for tympanostomy tubes

Prolonged eustachian tube dysfunction causes TM to retract upwards. Keratin debris accumulates in the “attic”

Cholesteatoma

Order ___ for Cholesteatoma

CT/MRI

Cholesteatoma complications

- ossicular chain bone erosion - sensorineural hearing loss - facial nerve injury - dizziness

when infx from otitis media and mastoiditis spreads to the arrowed regions

Petrous Apicitis

pt has otitis media and presents with otorrhea, diplopia, and facial pain | otitis media + ____ syndrome = _____

otitis media + Gradenigo's Syndrome = Petrous Apicitis

Petrous Apicitis | imaging order and plan

* CT/MRI * prolonged ABX therapy (deep infx) * sx drainage

Unilateral hearing loss, past Hx of ipsilateral TM perf, tinnitus w/ persistent purulent otorrhea

Cholesteatoma caused by prolonged eustachian tube dysfunction.

Trmnt for Acute Otitis Media or Chronic Otitis Media + Facial Paralysis?

AOM: Myringotomy for drainage; IV ABX COM: treat underlying issue (chronic pressure on CN7 by cholesteatoma)

Most common intracranial complication of ear infection

CNS Infection - Otogenic meningitis

Pt has an ear infection. While laying on their back, extending their knees from a 90 degree position is painful. Flexing their neck causes pain and their hips and knees to flex too. What complication? Dx and trmnt?

CNS Infection - Otogenic Meningitis Dx. Lumbar puncture Inpatient ABX

Ear infection that spreads to the brain is most likely to affect which lobes?

Temporal or cerebellar

No infection, conductive hearing loss, vertigo, low pitched tinnitus

Otosclerosis (stapes footplate (oval window) is too bony)