Ear Disorders 2 Flashcards
Traumatic Auricular Hematoma
etiology and S/Sx
Symptoms: Pain, paresthesia, and ecchymosis, Swelling
Etiology
Vessel rupture after blunt trauma which causes blood and serum accumulation between the perichondrium and cartilage. They are relatively common injuries in contact sports such as wrestling and boxing.
Misc
If the mechanism of trauma is large, such as a motor vehicle accident, the practitioner must rule out temporal bone trauma as well as assessing the patient for other injuries.
Traumatic Auricular Hematoma
PE
Exam
evaluation of the external ear
evaluation of the tympanic membrane with an otoscope
evaluation for any coexistent lacerations or trauma of the head and neck
evaluate for facial nerve weakness as the facial nerve passes through the ear and can be damaged when there is trauma to the ear
Physical exam findings consistent with auricular hematoma include contour irregularity of ear with swelling and fluctuant area overlying the ear’s cartilaginous portions
Traumatic Auricular Hematoma
Dx
Diagnostic Studies
Ultrasound can be used to rule out an auricular abscess.
If significant trauma has occurred, there is concern for a foreign body or an abscess or it is determined that it is important to evaluate middle or inner ear structures, CT or MRI can be ordered.
CT and MRI should not be used routinely to evaluated auricular hematomas.
Traumatic Auricular Hematoma
Tx
Treatment
must be drained to prevent significant cosmetic deformity (cauliflower ear) or canal blockage resulting from dissolution of supporting cartilage.
External Auditory Canal Neoplasm
Etiology
Etiology
Squamous carcinoma is the most frequent neoplasm in the external auditory canal (EAC), about four times more common than basal carcinomas
These tumors have been associated with chronic suppurative otitis media and exposure to chemicals, though the most important factor may be previous radiotherapy (radiation) for nasopharyngeal cancer
Most squamous cell carcinomas (SCC) of the temporal bone occur in the fifth and sixth decades of life
External Auditory Canal Neoplasm
Sx
Symptoms
Otorrhea (ear drainage) is the primary symptom, and otalgia, hearing loss, and bleeding may be frequent as well
Diagnosis is usually delayed because symptoms are quite similar to other benign otologic conditions such as chronic suppurative otitis media
External Auditory Canal Neoplasm
PE and Dx
Exam
Obvious abnormality of tissue in the canal
Facial nerve paralysis and lymph node involvement are associated with decreased survival rates
Diagnostic Studies
Biopsy
CT or MRI
External Auditory Canal Neoplasm
Tx
Treatment
Treated with either a lateral (LTBR) or an extended temporal bone resection (total or subtotal)
Parotidectomy is performed in patients with suspected clinical or radiological invasion
Radiotherapy is used often
When tumor is not fully removed surgically, survival rates drop significantly
Misc
Don’t forget about the auricle- usually from basal cell and not squamous
Otitis Externa
Etiology
Etiology
There is often a history of recent water exposure (ie, swimmer’s ear) or mechanical trauma (eg, scratching, cotton applicators).
External otitis is usually caused by gram-negative rods (eg,Pseudomonas, Proteus) or fungi (eg,Aspergillus), which grow in the presence of excessive moisture.
Otitis Externa
S/Sx
Symptoms
Painful erythema and edema of the ear canal skin
Purulent exudate
Frequently accompanied by pruritus
Otisis Externa
Exam and Dx
When is CT necessary
Exam
erythema and edema of the ear canal skin
often with a purulent exudate
Manipulation of the auricle elicits pain
Because the lateral surface of the tympanic membrane is ear canal skin, it is often erythematous
TM moves normally with pneumatic otoscopy
When the canal skin is very edematous, it may be impossible to visualize the tympanic membrane
Diagnostic Studies
CT only necessary with malignant OE
Otitis Externa
Tx
Treatment
In cases of moisture in the ear (eg, swimmer’s ear), acidification with a drying agent (ie, a 50/50 mixture of isopropylalcohol/white vinegar) is often helpful
When infected, an otic antibiotic solution or suspension of an aminoglycoside (eg,neomycin/polymyxin B) or fluoroquinolone (eg,ciprofloxacin), with or without a corticosteroid (eg,hydrocortisone), is used
Purulent debris filling the ear canal should be gently removed to permit entry of the topical medication. Might need to place a wick.
Oral fluoroquinolones (eg,ciprofloxacin, 500 mg twice daily for 1 week) are used for cellulitis
Any case of persistent otitis externa in an immunocompromised or diabetic individual must be referred for specialty evaluation.
malignant Otitis Externa
Misc
Diabetic/immune compromised
Dx Tx
Misc
In diabetic or immunocompromised patients, osteomyelitis of the skull base (“malignant external otitis”) may occur
Malignant external otitis typically presents with persistent foul aural discharge, granulations in the ear canal, deep otalgia, and in advanced cases, progressive palsies of cranial nerves VI, VII, IX, X, XI, or XII.
Diagnosis is confirmed by the demonstration of osseous erosion on CT scanning.
Antipseudomonal antibiotic administration, often for several months. Although intravenous therapy is often required initially (eg,ciprofloxacin200–400 mg every 12 hours), selected patients may be graduated to oralciprofloxacin(500–1000 mg twice daily).
Surgical debridement of infected bone is reserved for cases of deterioration despite medical therapy.
Eustachian Tube Dysfunction
Etiology & S/Sx
Viral upper respiratory tract infections and allergy that cause inflammation of the tube
Symptoms
The pain ofETDis usually modest, often described by a patient as discomfort or fullness.
Fluctuating hearing
Discomfort with barometric pressure change
When the tube is only partially blocked, swallowing or yawning may elicit a popping or crackling sound
Eustachian Tube Dysfunction
Exam and Dx
Exam
Examination may reveal retraction of the tympanic membrane
Decreased mobility on pneumatic otoscopy
Diagnostic Studies
Tympanometry