Ear Diseases Flashcards
things to look at in the ear
- Lateral process of malleus
- Pars flaccida
- Pars tensa
- Umbo
- Light reflex (suppose to be anterior-inferior quadrant)
- Promontory of the cochlea (lightest)
- Opening of Eustachian tube (darkest- anterior superior quadrant)
- Incus
- Anterior over hang
- chorda tympani nerve (part of facial nerve- right under malleus)
management of conducted hearing loss
often corrected through treatment of middle ear effusion (ear tube placement) or surgical correction of the abnormal sound-conducting mechanism
- Cartilage can die if blood supply is cut off (similar to wrestlers ear)
- Can see where the infection stops-where cartilage ends (lobule looks normal)
perichondritis
what is a cholesteatoma
- Trapped epithelium cannot properly migrate out the ear canal. Inflammation present.
- Skin trapped in deep retractions cannot slough properly (Primary Cholesteatoma)
- drainage from infected debris
benefits of multichannel cochlear implants
Cochlear implantation before age 2 yr (and even 1 yr) improves hearing and speech, enabling more than 90% of children to be in mainstream education. Most develop age-appropriate auditory perception and oral language skills.
___ occurs with trauma to the pinna between the ___ and ___
Hematoma
cartilage and the perichondrium
aka cauliflower ear (commonly seen in wrestlers)
what do kayakers or surfers often get in their ear?
exostosees (from cold water)
what does a perforated TM look like
shiny middle ear mucosa visible through perforation
*be able to draw quadrant location and give percentage
the indications for ENT referral of ear disorders
- Auricular Hematoma: Need to refer due to potential deformity if not corrected immediately
- Otitis Externa: May need ENT referral
- Granulomas: Refer to ENT if cannot be resolved in primary care
- Exostosis: Refer if cerumen trapped
- Osteoma: Refer to ENT
- TM Perforation: Refer to ENT if vertiginous after injury or infection
- TM Retractions: If retractions are too great (visualization of incus and stapes), refer to ENT
- Cholesteatoma: Always refer to ENT
- Appears with black dots
- Sx: some pressure and DRAINAGE
fungal otitis externa
*tx w/ antifungal drops
how do you treat TM perforations?
- Refer immediately if vertiginous after injury or infection
- Even large perforations can spontaneously heal
- Refer if not healed after two weeks
what is glomus tympanicum
- Benign tumor of paraganglion
- reddish mass behind the TM
- freq. presents w/ a pulsatile tinnitus
types of boney ear growths
- osteoma- benign boney tumor
2. exostoses- benign
difficult even for children with normal hearing to listen selectively in the presence of noise, to combine information from the 2 ears properly, to process speech when it is slightly degraded, and to integrate auditory information when it is delivered faster although they can process it when delivered at a slow rate
central auditory processing disorders
what is tympanosclerosis
aka scar plaque
- Calcified mass between the layers of the membrane (often seen after PE tubes)
- does not effect hearing
hearing aid can be fitted in children as young as
2 months of age
complications that can occur from TM retraction
- it can put pressure on the ossicles leading to bony erosion and conductive hearing loss
- Can get a sudden drop in hearing (30%) if incus erodes a lot and incus and stapes touch
*Skin must be able to slough and move out the canal with the cerumen
Sensorineural hearing loss is associated w/ excessively high risk of
pneumococcal meningitis–> must be vaccinated with PCV 13
what is conductive hearing loss (CHL) caused by
caused by dysfunction in the transmission of sound through the external or middle ear or by abnormal transduction of sound energy into neural activity in the inner ear and the 8th nerve
how can a TM joint disorder effect the ear
Any TM joint disorder (ie. inflammation) will give you ear pain
-AKA anterior over hang (part of TM joint)
Do zinc supplements have benefit in healthy children
no
what is the Y part of ear
anti-helix
-if it is not there, the ear sticks WAY out (can be fixed– considered cosmetic)
how do you treat a hematoma on the pinna from trauma
must be drained and pressure dressing or bolster applied for
*considered a medical emergency–> if you fail to get the fluid out, it will parotid, calcify and be deformed forever
what is central (or retrocochlear) hearing loss?
- An auditory deficit originating along the central auditory nervous system pathways from the proximal 8th nerve to the cerebral cortex
- Tumors or demyelinating disease of the 8th nerve and cerebellopontine angle can cause hearing deficits but spare the outer, middle, and inner ear.
what is perichondritis and how do you treat it?
inflammation of the CT around the cartilage (often on pinna) (often caused by infected ear piercing)
-requires ORAL or IV antibiotics w/ good cartilage penetration
what is epithelial migration?
a process that serves as a self-cleaning and repair mechanism for the external auditory canal and tympanic membrane
*Epithelial migration of the lining of the EAC is essential for self-cleansing
what is congenital cholesteatoma
- Can arise from epithelial rests in the middle ear without a retraction behind an intact tympanic membrane (do not drain)
- whitish mass noted behind intact TM
- mostly in 5y/o boys
The epicenter of this epitheliam migration process appears to reside in the vicinity of the ___
umbo
why is catching hearing loss at such a young age so important?
if hearing-impaired infants are identified and treated by age 6 mo, these children (with the exception of those with bilateral profound impairment) should develop the same level of language as their age-matched peers who are not hearing impaired.
once hearing loss is identified what do you need
full developmental, speech, and language evaluation
what is the most common cause of conductive hearing loss in children?
SOM or OME
complications of cholesteatoma
- continues to enlarge and acts like tumor- tx is surgery (NEED TO REFER)
- can lead to hearing loss with deep retractions
- erode bones of hearing
- erode ear canal-
- can grow into TMJ
- can grow into the facial nerve and get paralysis
- can grow right up into the brain
-if left alone,pressure and enzymes cause erosion of bone
what is the darkest and lightest thing youll see when looking in a ear
darkest: opening of the eustachian tube (anterior superior quadrant)
lightest: promontory of the cochlea (right under the umbo)
sx of retractions
- often none
- can feel “full” in ear
- pain on planes or at high altitude
- can see round window if retracted far enough
what it the most common cause of CHL
acquired-
middle-ear fluid
when does AOM develop an effusion
After purulence resolves, it will leave an effusion which takes weeks to months to resolve
what is the difference between an osteoma and exostoses
Osteoma- Single lesion/bump, red in color, filling the ear canal
Exostoses- multiple lesions/bumps, light in color, if you touch it it will hurt and be very hard
Counseling and involvement of parents are required in ___ stages of evaluation and treatment and rehab with hearing loss
all
skin ulceration on the pinna that persist may be due to __
carcinoma
*beed biopsy
complications of congential cholesteatoma
- hearing loss (slight to moderate)
- mastoid extension
- possible bilateral disease
what is considered mild, moderate, severe or profound bilateral hearing loss
mild (20-30 dB),
moderate (30-50 dB),
severe (50-70 dB), or
profound (more than70 dB)
Amoxicillin use between ages 20-24 months may cause
dental enamel defects
when do you treat the pre-auricular pits?
no need for intervention until its infected
*will require excision w/ tissue behind the superior pinna if it becomes repeatedly infected (Goes all the way around the pinna) –> need to remove it COMPLETELY or it will return
types of hearing loss
- conductive hearing loss (CHL)
what is otitis externa and what is it commonly caused by
-bacterial (Psuedomonas) or fungal infection of the external ear canal
what is mixed hearing loss
a combination of CHL and SNHL
what is the difference between primary acquired and secondary acquired cholesteatoma
- Primary acquired results from retraction pockets
- Secondary Acquired results from ingrowth from a pre-existing perforation
what does tympanosclerosis look like
- bright white, surrounded by normal appearing TM*** (aka rim of normal ear drum)
- move w/ pneumotoscopy
Total communication therapy approach includeds
mixture of sign language, lip reading, hearing aids, and speech
what direction does epithelial migration occur in
- occurs in a lateral direction from the tympanic membrane to the external auditory canal.
- The underlying mechanism, which determines the direction of this laterally directed movement has not been elucidated
how do you tx otitis externa
dramatic resolution after topical drops (given for every day draining ear) even in the setting of tubes or perforation
**Drops can be ototoxic in the setting of a perforation
what is the number one foreign body that gets stuck in kids ears
popcorn kernel
*use right angle to slip behind it and pull it out
-Brown’s sign-blanching of the reddish TM with pressure
glomus tympanicum
what is the percent of resolution of acute otitis w/ effusion at different months out
50% at 1 month
75% at 2 months
90% at 3 months
what is the most reliable landmark of the ear
lateral process of the malleus
what is glomus jugulare
Benign tumor of paraganglion arising in the jugular forament
what is sensorineural hearing loss
Damage to or maldevelopment of structures in the inner ear
most common type of hearing loss in children and
conductive hearing loss
*occurs when sound transmission is physically impeded in the external and/or middle ear
what is exostoses
-Benign bony growth
-Usually multiple
-normal hearing
-Cold water exposure:
aka Surfer’s ear, kayakers
*can get big enough and trap wax in ear–> requires surgery
what should the relationship be with the malleus and incus
parallel to each other
*these bone are fused together so when one moves so does the other
how can you differentiate between a hard bone bump (exostose) and a cyst in the ear
If you touch it w/ a probe it will hurt if it is bone –>if you touch it and it doesn’t hurt it is soft (possibly a cyst) and not an exostoses
what do you do if hearing loss is from persistent/recurrent OM
put in PE tubes
Glomus tumors
glomus tympanicum
glomus jugulare
what is the immunization schedule for PCV 13
1st: 2-6 months
2nd: 7-11 months
3rd: 12-23 months
4th: 24-59 months
Four basic theories present the pathogenesis of ACQUIRED cholesteatoma:
- Invagination of the tympanic membrane (retraction pocket cholesteatoma)
- Basal cell proliferation
- epithelial in-growth through a perforation (the immigration theory)
- Squamous metaplasia of middle ear epithelium
the epithelial migration takes place at a rate of approximately ___
0.07mm/day
what is the spontaneous resolution rates of AOM from different pathogens
90% spontaneous resolution when infected with M. catarrhalis,
50% with H. influenza,
10% with S.pneumonia,
overall 80% resolve within 2-14 days
Infants and young children with profound congenital or prelingual onset of deafness need
mutichannel cochlear implants
Multiple exposures to Halothane anesthesia associated with __
learning disabilities
What are the 5 ways in which an ear can manifest disease?
- hearing loss
- otalgia or pressure
- tinnitus
- veritgo2
- drainage
what is an osteoma
Benign bony tumor causes problems if grows to touch TM or occlude canal impeding epithelial migration
*needs to be removed
Middle ear gasses resorb , and creates negative pressure
retraction
*par flaccida is the first to retract
what in utero infections can cause hearing loss
Toxoplasmosis Rubella CMV Herpes Simplex Syphilis
TORCHS
Common causes of CHL in the ear canal include _____.
In the middle ear , ____
and ___
atresia or stenosis, impacted cerumen, or foreign bodies
- perforation of the tympanic membrane (TM), discontinuity or fixation of the ossicular chain, otitis media (OM) with effusion, otosclerosis,
- and cholesteatoma can cause CHL.
when can genetic counseling be beneficial w/ hearing loss
- should be completed in diagnosis of SNHL or syndrome associated with SNHL and/or CHL in the case of future pregnancies and how baby might be effected
- Can also help evaluate child with hearing loss to potentially guide treatment based on establishing a dx
tx of idiopathic sudden SNHL
- oral prednisone
- Intratympanic dexamethosone perfusion
- combo of both
sx of AOM
Irritability, fever, hearing loss with TM appearance including hyperemia, purulence, inflammation
how do multichannel cochlear implants work?
-These implants bypass injury to the organ of Corti and provide neural stimulation by way of an external microphone and a signal processor that digitizes auditory stimuli into digital radiofrequency impulses
causes of sensorineural hearing los
hair cell destruction from noise, disease, or ototoxic agents; cochlear malformation; perilymphatic fistula of the round or oval window membrane; and lesions of the acoustic division of the 8th nerve
Fluid in middle ear without evidence of infection (often orange color)
SOM or OME
craniofacial anomalies associated w/ hearing loss
morphologic abnormalities of the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
what is salmon colored tissue in the ear canal?
- granulation tissue
- Chopped full of blood vessels, if you touch it, it bleeds
- 1st try to calm it down via topical steroids (ciprodex drops)
- if the granulation tissue is there, refer to ENT for further investigation
when do you need urgent removal of foreign bodies in the ear?
when it is organic material
especially food material!
EVERY draining ear gets ___
ear drops (even w/ perforations)
*use ciprodex if they can afford it– for inflammation and possible infection
Pericondrium of the cartilage has been separated away from the cartilage and fluid is filling the space (pericondrium gives the nutritional support to the cartilage
auricular hematoma
- Pool of “goo” (infection)
- salmon colored red thing (tissue)-
granuloma
treatment of granulomas
- topical steroids
- Ciprodex ear drops
- refer to ENT if you can’t get granulation to resolve
potential complications of TM perforation
perilymphatic fistula
sx of perilymphatic fistula
vertignious after injury or infection that resulted in TM perforation
