Ear Disorders Flashcards
Cerumen Impaction methods of removal
ceruminolytic agents: debrox, hydrogen peroxide, rubbing alcohol
Irrigation
manual removal through scope or under microscope
Otitis externa is
ear canal infection - swimmers ear
Otitis externa sx
pain - painful tragus or outer ear
blocked/ full sensation
decreased hearing
Otitis externa PE findings
painful tragus or outer ear
swollen ear canal
blocked by debris
cant see TM
Otitis externa bacterial organisms
staph aureus
pseudomonas
Otitis externa fungal organisms
aspergillus niger
candida albicans
(otomycosis)
Zoster Oticus: Ramsay Hunt syndrome presents as
severe pain with facial paralysis
hearing loss/ vertigo
vesicular eruption - ear/face/palate
Zoster Oticus: Ramsay Hunt syndrome treatment
Corticosteroids, HSV antiviral
analgesics, topical abx
eye care
Treatment of otitis externa
clear ear canal
acidify ear canal - acetic acid, boric acid
place wick if needed to facilitate drops placement
keep water out of ear
Otitis Externa antibacterial ototopicals
cortisporin or ciprofloxacin
Otitis Externa anti inflammatory ototopicals
abx combined with steroids to reduce inflammation
VoSol HC
Ciprodex
Cipro HC
Cortisporin
Otitis Externa Antifungal ototopicals
clotrimazole
nystatin
voraconizole
Otitis externa fungal infections strongly suggest
EENT for evacuation of canal
expect recurrence ~ 4-6 wks later
Auricular Hematoma is usually from
trauma - wrestling
shear injury at anterior auricular skin
hematoma between cartilage/ perichondrium
Auricular Hematoma treatment
needle aspiration - inadequate
I&D recommended
compressive dressing
anti-staph abx
Auricular Hematoma complications
Infection/ abscess - cauliflower ear
Foreign body ear canal removal - bugs how to do it
drown insects with mineral oil or lidocaine before attempting removal
Eustachian tube is the connection between
middle ear and nasopharynx
function of the eustachian tube
equalizes pressure in middle ear
drains thin mucus produced in middle ear
prevents reflux of fluid into middle ear
The eustachian tube is normally
closed - by tissue elasticity
The eustachian tube is opened by
palate muscles - yawning swallowing, etc
Eustachian tube treatment
treat underlying sinus issue
nasal steroid spray
air travel - gum chewing, decongestant spray
PET - patulous eustachian tube = estrogen nasal drops, wt stabilization, surgery?
PET - patulous eustachian tube is when
TM moves with nasal respiration and may be seen on exam
rapid wt loss
‘bucket over the head’ (autophony)
TM perforation causes
infection
eustachian tube dysfunction
penetrating trauma (Qtip)
base of skull fracture
pressure changes (barotrauma)
TM perf evaluation
side, location, size
condition of mucosa
secondary structures involved
safe vs unsafe
degree of hearing loss
Treatment of TM perf
Most close with time (4-6 wks)
Keep water out of ear
surgical eval if non-healing after 6 wks
Types of otitis media
serous or suppurative
Two durations of otitis media
acute or chronic
two designations of otitis media
with or without perforation
otitis media with effusion (OME) is
presence of fluid in the middle ear without signs or sx of an acute ear infection
Acute otitis media (AOM) is
infectious, inflammatory condition of the middle ear
effusion behind the intact TM
may be suppurative or serous
Contributing factor for AOM
URI
Eustachian tube dysfunction
Acute serous Otitis Media treatment
treat underlying illness
NOT a bacterial middle ear infection, abx not needed
surgical drainage
Acute suppurative otitis media treatment
amoxicillin
augmentin
PCN allergy = erythromycin or clindamycin with bactrim
fluoroquinolone (for adults only)
Otitis Media complications
mastoiditis
meningitis
brain abscess
facial paralysis
Unilateral Otitis Media in adults should raise suspicion for
nasopharyngeal mass blocking eustachian tube orifice
Indication for tubes
Recurrent AOM:
greater than or equal to 3 seperate episodes of AOM in 6 months or greater than or equal to 4 episodes of AOM in 12 months
Cholesteatoma is
keratoma or skin where it does not belong - this is a surgical disease
Acute mastoiditis is associated with
AOM
Acute Mastoiditis is
infection that spreads beyond mucosa of middle ear cleft
Vertigo is
an abnormal sense of motion characterized by a spinning sensation
Vertigo testing
audiogram
positional testing
MRI with Gadolinium contrast - gold standard
A positive Dix Hallpike is pathognomonic for
BPPV - but a neg test is meaningless
BPPV is
benign paroxysmal positional vertigo - a phantom sensation of motion elicited by specific changes in head position
Meniere’s syndrome four main features
attacks of vertigo
fluctuating hearing loss
tinnitus (ringing in ears)
aural fullness (pressure sensation in ears)
Meniere’s syndrome is a
condition of excess pressure accumulation in inner ear
Vestibular neuritis / neuronitis labyrinthitis is usually due to
viral infection / inflammation of nerve/ labyrinth
watch for ramsey hunt syndrome
Vertigo treatment
BPPV - Epley maneuver
Meniere’s Disease - low salt diet, avoidance of alcohol and caffeine, diuretics, vasodilators
Hearing loss two types
conductive or sensorineural
Conductive hearing loss is
caused by something that stops sounds from getting through the outer or middle ear
common reasons - blockage of ear canal, perforated drum, problems with the ossicles or fluid in middle ear
Sensorineural hearing loss is
most common type
loss due to pathology (damage) of cochlea, auditory nerve, or CNS
exposure to loud noises, genetic factors, or natural aging process
Acoustic Neuroma is
Sudden cause of unilateral sensorineural hearing loss
dizzy but not usually vertigo
MRI scan
Acoustic Neuroma treatment
observation if tumor is small and does not cause sx
surgical removal
radiation to stop from growing
Presbycusis is
age related hearing loss - gradual overtime
usually bilateral - usually greater for high pitched sounds
Presbycusis treatment
devices/ mechanical aids - vibrating alarms, flashing phone or doorbells, tv listening systems, personal amplifiers
hearing aids
Any child with speech delays suspect
hearing concerns
Tinnitus is
defined as the perception of noise in the absence of an acoustic stimulus outside of the body
sx not a disease - most often idiopathic, SNHL m/c identified cause
Tinnitus treatment
avoid dietary stimulants - coffee, soda, tea
smoking cessation
avoid meds - aspirin, NSAIDS, many others
reassurance
feedback training
white noise and other maskers
