Ear Diseases Flashcards
This typically occurs post-trauma (Wrestling, MMA Fighting, etc…) and presents with acute swelling and pain to the ear.
Auricular hematoma
If untreated, what would an auricular hematoma progress to?
Cauliflower Ear
How is an auricular hematoma treated?
What do you want to prevent?
I&D
Re-accumulation
Following an I&D on an auricular hematoma would you start the patient on ABx?
Why or why not?
Yes, concern for pseudomonas infections
This often presents as worsening ear pain, often times associated with swimming, slight hearing loss, and tenderness
Otitis Externa (Swimmer’s Ear)
Otitis externa is an infection of what parts of the ear?
Auditory Canal
Pinna
Other than swimming, in children what is another common cause of otitis externa?
Foreign Body
Other than swimming, in adults what is another common cause of otitis externa?
Mechanical injury
Otitis externa is commonly what two organisms?
Pseudomonas aeruginosa
Staph aureus
What are various treatment methods of Otitis Externa?
- Alcohol/Acetic Acid to acidify the environment
- Steroids if severe inflammation
- Fluoroquinolone drops
If you see pain out of proportion on examining a patient with suspected otitis externa, what should you think?
Malignant Otitis Externa
If you see a patient with suspected malignant otitis externa in a primary care setting, what should you management be?
ENT referral for debridement
What is the most concerning complication of a malignant otitis externa?
How is this treated?
What population is this most concerning in?
Necrotizing Otitis Externa (Medical Emergency)
IV ABx and debridement
Immunocompromisied and Diabetics
Ear canal lacerations are most commonly caused by what?
Foreign Body in the ear canal (Ex: Q-tips)
How are ear canal lacerations treated?
ABx
Steroids
Leave ‘clot’ in place as it acts like a scab
This is a variant of otitis externa primarily caused by fungal overgrowth
Otomycosis
What is the primary treatment for Otomycosis?
Fungal Debridement
Acidification
Antifungals (Ketoconazole)
What will happen if you treat otomycosis with ABx?
Exacerbation of the disease
This can present as a gradual hearing loss and a feeling of your ears “being plugged up”
Cerumen impaction
Other than hearing loss, what are additional Sx of cerumen impaction?
Pain
tinnitus
Vertigo
Fullness
Cerumen impaction can cause up to a ____ dB reduction in hearing.
40
When should you attempt to remove a foreign body from the ear canal?
Only if you feel comfortable removing it and understand the circumstances.
(Remember: Sometimes the complications outweigh the benefits)
What might children need in order to attempt to remove a foreign body from the ear canal?
Sedation
General Anesthesia
Why are batteries considered a medical emergency?
They can erode the tissues of the ear
What is concerning about organic materials in the ear canal?
There is a risk of swelling when wet
How do you treat insects in the ear canal?
What would be a contraindicated of this?
Kill with mineral oil or lidocaine
TM Perforation
This disease presents with a prolonged sense of fullness in the ear, trouble “popping” that ear, no drainage/purulence, and has a history of previous infections
Eustachian Tube Dysfunction
Acute Serous Otitis Media
How is Eustachian Tube Dysfunction/Acute Serous Otitis Media treated?
It is typically self limited however you can give nasal steroids and Afrin (only for 1-2 days)
This disease can present with ear pain, URI Sx, and a fever.
This is very common in pediatrics
Acute Supporative Otitis Media
What physical exam findings would you see in a patient with acute otitis media?
TM would be erythematous, bulging, purulence present, decreased mobility
This can sometimes occur in patients with acute otitis media which typically causes relief of the Sx.
TM Perforation
What bacteria are typically seen with Acute Otitis Media
Streptococcus pneumoniae
Hemophilus influenzae
Moraxella catarrhalis
What are the treatment options for Acute Otitis Media?
Amxoicillin (90mg/kg)
Augmentin
IM Rocephin
Fluorquinolones (Penicillin allergy)
What procedure can be done in patients with recurrent Oitis Media?
Placement of pressure equalization tubes
This disease is an infection of the middle ear which typically has a blister like appearance on physical examination. (VERY PAINFUL)
Bullous Myringitis
How is bullous myringitis treated?
Topical ABx
+/- Steroid drops
This disease is an ENT emergency often caused by recurrent ear infections
Mastoiditis
What unique physical exam findings are present in a patient with Mastoiditis?
What additional Sx may be present?
Swelling over the mastoid
Tenderness
Fever
Lethargy
Toxic Appearance
What complication is most concerning in a patient with mastoiditis?
It can quickly lead to intracranial complications and even death
What is mastoiditis destroying?
Mastoid air cells
What imaging study is frequently used to diagnose mastoiditis?
How it is treated?
CT Scan
Admission for IV Abx
+/- I&D, TM Tube placement
This can often occur due to trauma in the ear as well as a history of multiple tube placements and can present with mild pain, hearing lose, but NO fever.
TM Perforation
Why do you delay treatment in children with a TM perforation?
It can quickly become infected after repair
Other than surgical repair, how is a TM perforation treated?
Analgesics
ABx
Avoidance of water
Observance
If a patient had a perforation with chronic drainage, what would you be concerned over?
How is this treated?
Chronic suppurative otitis media
Abx (Floxin, Ciprodex, Cipro HCL)
Remember, you need to create a safe dry ear
This disease often occurs due to changes in pressure (ie: scuba diving, airplanes, etc…), can be painful at sudden onset, and they often have a hard time “popping” their ears?
Barotrauma
Other than pain, what additional Sx may be seen in a patient with barotrauma?
Dizziness
Hearing Loss
Fullness in the ears
How is barotrauma treated?
Analgesics
Nasal Steroids/Decongestants
Myringotomy
TM Tube Placement
This disease is a collection of squamous debris that can not migrate out of the ear.
Cholesteatoma
What might cholesteatoma be a result of?
End stage Eustachian tube dysfunction
What might you expect to see on physical examination of a patient with a cholesteatoma?
Crusting over the TM
When seen in a primary care setting, how do you treat a cholesteatoma?
ABx drops
Referral to ENT
(May need a CT and Surgery)
This syndrome presents similar to herpes simplex with a prodrome, unilateral rash, burning pain, and dizziness?
Ramsay Hunt Syndrome
What physical exam findings do you expect to find in a person with Ramsay Hunt Syndrome?
- Unilateral, dermatomal rash
- Pain out of proportion
- Weakness on the same side of the face as the rash
- Decreased hearing
- Herpetic lesions
How is Ramsay Hunt Syndrome treated?
- Urgent ophthalmic evaluation
- High dose Prednisone (60 mg)
- Antivirals (Acyclovir)
- ENT evaluation
What are three examples of acute hearing lose?
What are two examples of chronic hearing lose?
- Trauma (TM PErf, Temproal bone Fx, …)
- Infection (Bacterial, viral)
- Temporary process (Cerumen Impaction, FB,…)
- Conductive system disruption
- Progressive damage from noise
A patient present with complaints of decreased hearing in one ear, so you preform the Weber Test.
If the patient notes the sound is louder in the effected ear, then the hearing loss is likely ___________.
If the patient notes the sound is louder in the unaffected ear, then the hearing loss is likely __________.
Conductive
Sensorineural
When concerned over hearing lose, where might you refer a patient?
Audiologist
In chronic hearing lose, what frequency is typically lost first?
High frequency
How can chronic hearing lose be prevented?
Noise reduction
T/F: Hearing loss can be genetic (“run in the family”)
True
This is a fairly rare slow growing vestibular schwannoma which can cause graudal hearing lose and dizziness.
Acoustic Neuroma
What imaging study do you need to confirm an acoutstic neuroma?
MRI
