Ear Disorders Flashcards
What are some defenses of the ear?
- ear flap/tragus
- hair follicles
- cerumen
How does cerumen protect the ear?
- “washes” the ear
- creates acidic environment
What is perichondritis?
infection of the ear CARTILAGE
-serious
(usually unilateral)
What is perichondritis caused by?
- usually secondary to trauma
- usually caused by pseudomonas
Why is perichondritis difficult to cure?
poor vascularity
What is a big difference between cellulitis and perichondritis?
- cellulitis is an infection of the SKIN
- might see lobe involvement with cellulitis
What is relapsing polychondritis?
- relapsing
- bilateral
- probably autoimmune
What is Otitis Externa?
Generic term for generic disorders of the EAR CANAL
Culprits/causes of otitis externa
- pseudomonas
- fungus
- staph aureus
- seborrheic dermatitis
How does Hadley describe swimmer’s ear?
dishwasher’s hands of the ear
What otitis external might you see in DM?
malignant external otitis
-requires referral!
If an otitis external is vesicular, what should you consider?
consider a herpes zoster outbreak
*ENT emergency
sx of otitis externa
- otalgia
- pruritis
- discharge
exam findings on otitis externa
- erythema
- edema
- pain tugging on pain
- can’t really see TM
Tx of otitis externa
- for the most part treated topically, not oral abs usually
- otic drops (usually steroidal for swelling)
- abx if bacterial (vs. purulent)
- isopropyl alcohol for drying (swimmer’s ear)
- acetic acid for fungal or pseudomonal
How can you get drops deeper?
wick left in for a few days
If you prescribe abs for otitis external what should you consider?
- bacterial
- must cover for pseudomonas (cipro or cortisporin)
What could you use to treat fungal or pseudomonal otitis external?
2% HAc (acetic acid/half strength vinegar)
What is creaminess?
- excess, accumulation of cerumen
- clogs ear and affects hearing
Tx of ceruminosis
- gently irrigate/ ear lavage
- cerumenex to soften wax before irrigation
What is acute otitis media
-bacterial infection of the middle ear
What are the bacterial causes of acute otitis media?
- *S. pneumo
- M. cat
- H. flu
What is acute otitis media usually precipitated by?
a URI which causes cascade of congestion which obstructs ET drainage
What is the single best predictor of acute otitis media?
second best?
- TM immobility
- “cloudiness”
AAP update for acute otitis media
notes about what should be present/ what you should see
- moderate to severe TM bulge
- Mild TM bulge AND ear pain or intense TM erythema
- no effusion, no AOM
According to the AAP, what 3 things does a dx of AOM require?
- hx of acute onset s/s
- presence of MEE (middle ear effusion = fluid)
- s/s middle ear inflammation
Is Acute otitis media more common in children or adults? and why?
children
-because of angle of eustachian tube
sx of acute otitis media
- otalgia
- fever
- cough
- runny nose
- decreased hearing
Exam findings of AOM
- bulging TM
- decreased, distorted, or absent light reflex
- redness
- DOCUMENTED EVIDENCE OF TYMPANIC IMMOBILITY (AAP guideline)
Normal TM looks/findings
- translucent/transparent
- gray or pink color
- neutral position
- fully mobile with pneumatic otoscope
- no effusion
What is tympanometry
- distinguishes between retracted and distended TM
- can help distinguish b/t AOM and OME
TM characteristics of AOM
- opaque
- red, yellow, white color
- BULGING or full position
- reduced mobility but may respond to POS press on pneumatic otoscope
- effusion present
TM characteristics of Otitis Media with Effusion (OME)
- transluscent or opaque
- gray or pink color
- neutral or RETRACTED position
- reduced mobility which responded to NEG press on pneumatic otoscope
- effusion present
Tx goals of AOM
-decrease pain and fever
Tx of AOM
- tx pain with tylenol/ibuprofen (because it’s an inflammatory problem)
- auralgan (antipyrine, benzocaine, dehydrated glycerin)
abs treatment of AOM
- amoxicilin first line
- Augmentin second line (amox-clav)
Should see improvement in _____ (with AOM abx)
in 72 hrs
- if not, change antibiotic
- effusion can persist for 12 wks
when do you recommend tubes?
more than 3 in 6 months
What had led to a pathogen shift from pneumococcus to H flu?
pneumococcal conjugate vaccine
55% of H. flu from children with AOM that doesn’t resolve from oral abx are________ producers
B-lactamase
Otitis Media with Effusion (OME)
- effusion w/o acute sx
- no infection!!
- fluid in middle ear without s/s of acute ear infection
concerns of OME
hearing loss, effects on speech, language, learning
what is the preferred initial procedure for persistent OME
tympanostomy tube insertion
______ testing should be conducted for children who have hearing loss
language testing
dix-hallpike maneuver
to localize labyrinthine dysfunction
epley maneuver
to reposition otoliths
-habituate vertigo by performing movements that reproduce sx
classic triad of meniere disease?
- hearing loss
- vertigo
- tennitus
Meniere disease s/s
- hearing loss
- vertigo
- tinnitus
- usually unilateral
- intermittent attacks
What distinguishes Meniere disease from BBPV
-hearing loss
no hearing loss in BBPV
cause of miner disease
- buildup of endolymph pressure
- idiopathic
meniere disease treatment
scopolamine, diuretics, meclizine/antivert
vestibular neuronitis
- sudden onset vertigo
- due to imbalance in vestibular syst
- may involve latent herp v1
labyrinthitis
- inflammatory disorder of INNER ear/labyrinth
- hearing loss always present
- does NOT tend to recur (unlike vestibular neuronitis)
What is a variant of labyrinthitis?
- Herpes zoster Oticus (Ramsay-hunt syndrome)
- reactivation of latent varicella zoster
- initial sx deep burning auricular pain followed by vesicular rash in external canal
