Ear Disorders Flashcards
Name the Disorders of the Ear
ET Dysfunction Otitis Media Otitis Externa TM Perforation Barotrauma FB of the Ear Cerumen Impaction Mastoiditis Acoustic Neuroma Vertigo Syndromes Presbycusis
How to Examine EAC?
Pull auricle up and back
Visualize canal
Look at the TM
Landmarks of the TM
Umbo
Handle of Malleus
Light reflex
Define Eustachian Tube Dysfunction
Failure of the system at the proximal end to regulate the middle-ear and mastoid gas cell system at its distal end
What system is affected by ET Dysfunction?
Auditory
Eustachian Tube Functions
Ventilation/regulation of middle ear pressure
Protection from nasopharyngeal secretions
Drainage of middle ear
Closed at rest
Open with yawning, swallowing, sneezing
What kind of hearing loss occurs with pressure differences
Conductive hearing loss
Cycle of dysfunction includes 1 of 3 functions of the system
Negative pressure develops in middle ear
Serous exudate drawn from middle ear or refluxed into middle ear
Infection of static fluid causes edema, inflammation, and obstruction
Epidemiology of ET Dysfunction
Children
Pediatric Considerations of ET Dysfunction
Horizontal ET
Shorter ET
Associated with URI, adenoid hypertrophy, allergic rhinitis, GERD
Risk Factors for ET Dysfunction
Tobacco/pollutant exposure GERD Allergy Chronic sinusitis OSA with CPAP Adenoid hypertrophy Neuromuscular disease Family history Altered immunity Early onset of ET dysfunction in siblings Native American, Inuit, or Australian Aborigine
Pediatric Risk Factors for ET Dysfunction
2nd-hand smoke Prematurity/low birth weight Young age Craniofacial abnormalities Daycare Crowded living conditions Low SES Prone sleeping position Prolonged bottle use
Common Associated Conditions with ET Dysfunction
Hearing loss Middle ear effusion Cholesteatoma Allergic rhinitis Chronic sinusitis URI Adenoid hypertrophy GERD Cleft palate Down Syndrome Obesity Nasopharyngeal CA
Avoid decongestants in which patients
Hypertensive
Cardiac
Treatment of ET Dysfunction
Decongestants Nasal steroids 2nd-generation H1 antihistamines Antihistamine nasal sprays Antibiotics
Types of Decongestants Used
Phenylephrine
Pseudoephedrine (Sudafed)
Oxymetazoline (Afrin)
Types of Nasal Steroids
Beclomethason (Beconase, Vancenase) Budesonide (Rhinocort) Flunisolide (Nasarel, Nasalide) Fluticasone (Flonase) Ciclesonide (Omnaris)
Types of 2nd-Generation H1 Antihistamines
Loratadine (Claritin)
Desloratidine (Clarinex)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Types of Antihistamine Nasal Sprays
Olotpatadine (Patanase)
Asteline (Azelastine)
Antibiotic if ET Dysfunction with OM
Amoxicillin
Define Otitis Media
Infection of the middle ear with acute onset, presence of middle ear effusion and signs of middle ear inflammation
Risk Factors of Otitis Media
Bottle feeds while supine Daycare Formula feeding Smoking in house Male gender Family Hx of middle ear disease
Signs/Symptoms of Otitis Media
Earache Tugging on ears Fever Accompanying URI symptoms Irritability Difficulty sleeping
Otoscopic Exam in OM
Decreased visibility of landmarks Decrease TM mobility Bulging TM Opaque Red Pus in middle ear
Bacterial Culprits of OM
Strep pneumo (30-35%)
H. flu (20-25%)
M. cat (10-15%)
Beta-lactam Resistant OM Bacteria
H. flu
M. cat
Antibiotic Treatment of OM
Amoxicillin Augmentin Cephalosporins Erythromycin Azithromycin
Treatment of Pain/Fever in OM
Ibuprofen
Tylenol
Auralgan
Follow up
48-72 hours if failure to improve
14-21 days if resolved symptoms
Management of OM
Most improve spontaneously
Antibiotics
Analgesics
When to provide antibiotics in OM
Define OM with Effusion
Presence of middle ear effusion in the absence of acute signs of infection
Symptoms of OM with Effusion
Hearing loss Fullness in ear Tugging at ear Delayed speech/language development Unsteady gait Pain (rarely)
Otoscope Exam in OM with Effusion
TM dull & retracted
No mobility of TM
Straw/tan color of TM
Sterile fluid in middle ear
What is the single most recommended diagnostic method to establish the diagnosis of otitis media with effusion?
Pneumatic otoscopy
Treatment of OM with Effusion
Watchful waiting for 3 months
Then hearing test
What to do in the watchful waiting period for OM with effusion?
Speak close to the child Face the child when speaking Speak clearly Repeat phrases Preferential seating in the classroom
When should a hearing test be performed with OM with effusion?
After 3 months of watchful waiting
How often should you re-examine children with OM with effusion?
3-6 month intervals
Define Chronic Suppurative Otitis
Perforated tympanic membrane with persistent drainage from the middle ear
Risk Factors for Chronic Suppurative Otitis
Hx of multiple episodes of AOM
Living in crowded conditions
Daycare
Family member of large family
Bacterial Culprits of Chronic Suppurative Otitis
Pseudomonas aeruginosa (50-98%)
Staph aureus (15-30%)
Klebsiella
Proteus
Sequelae of Chronic Suppurative Otitis
Conductive hearing loss
Intracranial complications
Presentation of Chronic Suppurative Otitis
Otorrhea
Edematous external canal
Not tender
Granulation tissue in medial canal of middle ear space
Middle ear mocosa (edematous, polypoid, pale or erythematous)
Discharge
Labs for Chronic Suppurative Otitis
Culture for sensitivity
Treatment for Chronic Suppurative Otitis
Removal of exudate
Ciprofloxin (failed cases)
Define Cholesteoma
Skin growth that occurs in the middle ear behind the eardrum
Cause of Cholesteoma
Repeated infection
Poor ET function
Presentation of Cholesteoma
Otorrhea Feeling of pressure in ear Hearing loss Achy ear Dizziness Facial weakness on affected side
Diagnostics of Cholesteoma
Otoscopy
Audiometry
Xray/CT of mastoid
Treatment of Cholesteoma
Surgical treatment
Define Otitis Externa
Inflammation of the external auditory canal or auricle
Causes of Otitis Externa
Infectious
Allergic
Dermal disease
Bacterial Culprits of Otitis Externa
Staph aureus
Pseudomonas aeruginosa (swimmers ear)
Proteus
Signs/Symptoms of Otitis Externa
Otalgia Pain at triages Pain when auricle pulled Pruritis Discharge Hearing loss
Otoscopic Exam in Otitis Externa
Edematous Erythematous Yellow, brown, white, or grey debris No middle ear fluid TM mobile
Treatment of Otitis Externa
Cleaning of ear canal
Protect ear canal from water
Treatment of inflammation and infection
Inflammation/infection Treatment in Otitis Externa
Cortisporin
Cipro HC
Tobradex
Define Malignant External Otitis (Necrotizing Otitis Externa)
Invasive infection of the external auditory canal and skull base
High Risk Patients for Malignant External Otitis (Necrotizing Otitis Externa)
Elderly with DM
AIDS
Immunocompromised
Main Bug of Malignant External Otitis (Necrotizing Otitis Externa)
Pseudomonas aeruginosa
Clinical Manifestations of Malignant External Otitis (Necrotizing Otitis Externa)
Otalgia
Otorrhea
Otoscopic Exam of Malignant External Otitis (Necrotizing Otitis Externa)
Granulation in inferior portion of the external auditory canal
Complications of Malignant External Otitis (Necrotizing Otitis Externa)
Osteomyelitis in base of skull
Mastoiditis
TMJ osteomyelitis
Cranial nerve palsies
Diagnosis of Malignant Otitis Externa
Elevated ESR
Positive culture
Imaging
Treatment of Malignant Otitis Externa
Ciprofloxin
NO TOPICAL ANTIBIOTICS
Clinical Manifestations of TM Perforations
Clear, pus-filled or bloody drainage from ear
Sudden decrease in ear pain
Hearing loss
Tinnitus
Causes of TM Perforations
Middle ear infection Airplane ear Acoustic trauma FB in ear Loud, sudden noise
Treatment of TM Perforation
Heal on own No antibiotics Keep ear dry Ear drum patch Tympanoplasty
Most frequent cause of Barotrauma
Flying
Diving (2nd)
Clinical Manifestations of Barotrauma
Pressure in the ear
Pain due to stretching of TM
Hearing loss
Tinnitus
Treatment of Barotrauma
Valsalva maneuver
Decongestants
Myringotomy
Prevention of Barotrauma
Avoidance Pre flight decongestants Chewing gum Yawning Swallowing
Treatment of FB in the Ear
Removal
How to remove FB from ear
Adequate visualization
Appropriate equipment
Cooperative patient
Skilled provider
Removal Techniques of Cerumen IMpactions
Hydrogen peroxide
Debrox
Irrigation
Suction
When can you not irrigate for cerumen impaction?
TM not intact
What is mastoiditis a complication of?
Otitis media
Define Mastoiditis
Middle ear inflammation spreads to the mastoid air cells
Characteristics of Mastoiditis
Postauricular pain
Post auricular erythema
Spiking fever
Tender mass
Diagnostics of Mastoiditis
ENT consult
CT
MRI if intracranial involvement
Treatment for Mastoiditis
IV antibiotics Ceftriaxone (Rocephin) Piperacillin & tazobactam sodium (Zosyn) Oxacillin (Bactocill) Gentamicin (Garamycin)
Why are acoustic neuroma’s dangerous?
Can eventually compress the pons
Hydrocephalus
Risk Factor for Acoustic Neuroma
Exposure to loud noise
Neurofibromatosis type 2
Hx of parathyroid adenoma
Cell phones??
Symptoms of Acoustic Neuroma
Hearing loss Tinnitus Unsteadiness while walking Facial numbness Hypestesia Pain Facial paresis Taste disturbances
Diagnostics of Acoustic Neuroma
Demonstration of asymmetric sensorineural hearing loss
MRI or CT
ENT referrel
Audiometry
Treatment for Acoustic Neuroma
Surgery
Define Vertigo Syndromes
Symptoms of illusory movement
How Does Vertigo Syndromes Appear?
Transient spinning dizziness
Sense of swaying or tilting
Sense of falling backing
Causes of Vertigo Syndromes
Asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem
Characteristics of Peripheral Vertigo Syndromes
Sudden onset
Horizontal nystagmus
Visual fixation inhibits nystagmus
Characteristics of Central Vertigo Syndromes
Gradual onset Any direction nystagmus Visual fixation doesn't stop nystagmus Signs of brainstem dysfunction Instability
Symptoms of Peripheral Vertigo Syndromes
Blurred vision Fatigue Headache Palpitations Inability to concentrate Increased risk for motion sickness N/V Reduced cognitive function Photophobia Sound sensitive Sweating
Symptoms of Central Vertigo Syndromes
Double vision Headache Impaired consciousness Inability to speak Lack of coordination N/V Weakness
Benign Paroxysmal Positional Vertigo
Dizziness due to debris which has collected in the inner ear
Debri derived from utricle
Characteristics of Benign Paroxysmal Positional Vertigo
Recurrent & brief episodes
Predictable head movements/positions precipitate symptoms
Horizontal nystagmus
Which test is best for determining benign paroxysmal positional vertigo?
Dix-Hallpike maneuver
What is the Dix-Hallpike Maneuver?
Person is brought from sitting to supine position with the head turned 45 degrees to the side and extended 20 degrees backward
What does a positive Dix-Hallpike test consist of?
Burst of nystagmus
Treatment for Benign Paroxysmal Positional Vertigo
Wait it out
Epley Maneuver
What is the Epley Maneuver?
Sequential movement of the head into 4 positions staying in each position for about 30 seconds
Define Labrynthitis
Inflammation of the inner ear
Clinical Course of Labrynthitis
Vertigo
Gradually goes away
Possible temporary hearing loss
Possible Causes of Labyrinthitis
Viral URI
Middle ear infection
Treatment of Labyrinthitis
Usually goes away on own (several weeks)
Medications for N/V
Medications for N/V in Labyrinthitis
Prochlorperazine (Compazine)
Meclazine (Antivert)
Diazepam/Lorazepam
What does Meniere’s Disease result from?
Distention of the endolymphatic compartment of the inner ear
Clinical Presentation of Meniere’s Disease
Episodic vertigo lasting 1-8 hours
Low frequency sensorineural hearing loss
Tinnitus
Sensation of aural pressure
Diagnostic Criteria for Meniere’s Disease
2 spontaneous episodes >20 minutes
Audiometric confirmation of sensorineural hearing loss
Tinnitus
Treatment of Meniere’s Disease
Dietary restrictions
Medications
Dietary Restriction Treatment Options
Caffeine
Tobacco
Salt
Medication Treatment Options
Diuretics Antiemetics Anxiolytics Antihistamines Scopolamine
Define Presbycusis
Sensorineural hearing impairment in elderly individuals
What does sensory presbycusis refer to?
Epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti
What does neural presbycusis refer to?
Atrophy of nerve cells in the cochlea and central neural pathways
What does metabolic presbycusis result from?
Atrophy of the stria vascularis causing a flat hearing curve
What does mechanical presbycusis result from?
Thickening and secondary stiffening of the basilar membrane of the cochlea
Clinical Presentation of Presbycusis
Difficulty understanding rapidly spoken language, complex vocabulary, speech in noisy, distracting environment
Treatment of Presbycusis
Amplification devices (hearing aides)
Lip reading
Cochlear implants
Assistive listening devices
