Ear Diseases Flashcards
dry, scaley, painless plaque due to sun damage
Actinic Keratosis (AK)
Aka solaris keratosis
Actinic Keratosis -> cancer?
10-20% will convert to squamous cell carcinoma in 10-20 years
Trmnts for Actinic Keratosis?
- Cryotherapy
- spf
- fluoruracil (5-FU) - chemo cream
- Imiquimod (Aldara) - warts
fully covered cyst, non-tender, well defined, mobile, slow growing
Epidermal Inclusion Cyst (EIC)
Aka Sebaceous cysts
small, symmetrical, fully brown mole since childhood
Melanocytic Nevus
local proliferation of melanocytes
treatment
Epidural Inclusion Cyst
- excise if bothersome
- ABX if infx
looks like crisco
most common malignant tumor of the skin
Basal Cell Carcinoma (BCC)
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
if basal cell carcinoma is left untreated, it can begin to look …
rat bitten ulceration
what is it and trmnt?
hard, non-tender, red, nodule or plaque
Squamous Cell Carcinoma
trmnt: sx excision, cryotherapy, fluoruracil (5-fu)
sort from best to worst prognosis:
* melaoma
* basal cell carcinoma
* squamous cell carcinoma
basal, squamous, melanoma
what and trmnt?
pt is a wrestler with painful big bruise
Auricular Hematoma
* I&D
* Pressurre dressing, splint
* ABX (staph)
Auricular Hematoma left untreatred -> ______ deformity
cauliflower
48-72 hrs -> aseptic or septic necrosis
what and trmnt?
inflammation only at the pinna (spares the lobe)
2ndary to cellulitis, frostbite, trauma
Perichondritis
corticosteroids + ENT referral
relapsing polychondritis is a structural issue caused by ___
autoimmune issue
more common in adults
what? trmnt?
honey crusted veisculopustular skin infx commonly seen with thick yellow crusty lesions
Impetigo
Bac: staph or strep
Bactroban, Cephalexin (Keflex), etc
what, bac, trmnt?
deep skin infx, red, warm, swollen
Cellulitis
Bac: Staph, Strep, H. Influenzae, etc
Rx: ABX
mark borders to track progress
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
Herpes Zoster Oticus puts you at risk for what?
Ramsey-Hunt Syndrome
buy otc ____ up to 4 days to soften cerumen impaction
Debrox
rule out a ____ prior to irrigating ear canal
TM perforation
Mix warm water + _____ for ear wax rmvl
Warm water + H2O2 Hydrogen Peroxide
_____ can kill insects in ears
mineral oil, lidocaine, alcohol
use anti-inflammatory ____ drops if ear canal or TM is traumatized
cortisporin otic drops
swimmer’s ear = ____
Acute Otitis Externa (AOE)
most common cause of otitis externa
Psuedomonas aeruginosa
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)
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)
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
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
Mycoplasma or H. influenza G(-)
same presentation and management as AOM
middle ear infx, fever, doughy feel, red, hot, malaise, pain
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)
Chronic Otitis Media Complication
- cholesteatoma
- petrous apicitis
- otogenic skull base osteomyelitis
- facial paralysis
- sigmoid sinus thrombosis
- CNS infx
What drops can you use for TM perforation + bacterial infection
Floxin Otic Drops
(Absolutely no neomycin toxic drops)
Red pulsatile middle ear mass, pulsatile tinnitus, hearing loss
Glomus Tympanum (benign)
Order ___ for pulsatile tinnitus
MR Angiography
Acute Otitis Media trmnt in children
Amoxicillin. Azithromycin if PCN Allx