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ENT > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

Name the Disorders of the Ear

A 
ET Dysfunction
Otitis Media
Otitis Externa
TM Perforation
Barotrauma
FB of the Ear
Cerumen Impaction
Mastoiditis
Acoustic Neuroma
Vertigo Syndromes
Presbycusis
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2
Q

How to Examine EAC?

A

Pull auricle up and back
Visualize canal
Look at the TM

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3
Q

Landmarks of the TM

A

Umbo
Handle of Malleus
Light reflex

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4
Q

Define Eustachian Tube Dysfunction

A

Failure of the system at the proximal end to regulate the middle-ear and mastoid gas cell system at its distal end

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5
Q

What system is affected by ET Dysfunction?

A

Auditory

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6
Q

Eustachian Tube Functions

A

Ventilation/regulation of middle ear pressure
Protection from nasopharyngeal secretions
Drainage of middle ear
Closed at rest
Open with yawning, swallowing, sneezing

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7
Q

What kind of hearing loss occurs with pressure differences

A

Conductive hearing loss

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8
Q

Cycle of dysfunction includes 1 of 3 functions of the system

A

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

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9
Q

Epidemiology of ET Dysfunction

A

Children

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10
Q

Pediatric Considerations of ET Dysfunction

A

Horizontal ET
Shorter ET
Associated with URI, adenoid hypertrophy, allergic rhinitis, GERD

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11
Q

Risk Factors for ET Dysfunction

A 
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
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12
Q

Pediatric Risk Factors for ET Dysfunction

A 
2nd-hand smoke
Prematurity/low birth weight
Young age
Craniofacial abnormalities
Daycare
Crowded living conditions
Low SES
Prone sleeping position
Prolonged bottle use
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13
Q

Common Associated Conditions with ET Dysfunction

A 
Hearing loss
Middle ear effusion
Cholesteatoma
Allergic rhinitis
Chronic sinusitis
URI
Adenoid hypertrophy
GERD
Cleft palate
Down Syndrome
Obesity
Nasopharyngeal CA
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14
Q

Avoid decongestants in which patients

A

Hypertensive

Cardiac

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15
Q

Treatment of ET Dysfunction

A 
Decongestants
Nasal steroids
2nd-generation H1 antihistamines
Antihistamine nasal sprays
Antibiotics
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16
Q

Types of Decongestants Used

A

Phenylephrine
Pseudoephedrine (Sudafed)
Oxymetazoline (Afrin)

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17
Q

Types of Nasal Steroids

A 
Beclomethason (Beconase, Vancenase)
Budesonide (Rhinocort)
Flunisolide (Nasarel, Nasalide)
Fluticasone (Flonase)
Ciclesonide (Omnaris)
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18
Q

Types of 2nd-Generation H1 Antihistamines

A

Loratadine (Claritin)
Desloratidine (Clarinex)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)

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19
Q

Types of Antihistamine Nasal Sprays

A

Olotpatadine (Patanase)

Asteline (Azelastine)

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20
Q

Antibiotic if ET Dysfunction with OM

A

Amoxicillin

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21
Q

Define Otitis Media

A

Infection of the middle ear with acute onset, presence of middle ear effusion and signs of middle ear inflammation

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22
Q

Risk Factors of Otitis Media

A 
Bottle feeds while supine
Daycare
Formula feeding
Smoking in house
Male gender
Family Hx of middle ear disease
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23
Q

Signs/Symptoms of Otitis Media

A 
Earache
Tugging on ears
Fever
Accompanying URI symptoms
Irritability 
Difficulty sleeping
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24
Q

Otoscopic Exam in OM

A 
Decreased visibility of landmarks
Decrease TM mobility
Bulging TM
Opaque
Red
Pus in middle ear
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25
Q

Bacterial Culprits of OM

A

Strep pneumo (30-35%)
H. flu (20-25%)
M. cat (10-15%)

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26
Q

Beta-lactam Resistant OM Bacteria

A

H. flu

M. cat

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27
Q

Antibiotic Treatment of OM

A 
Amoxicillin
Augmentin
Cephalosporins
Erythromycin
Azithromycin
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28
Q

Treatment of Pain/Fever in OM

A

Ibuprofen
Tylenol
Auralgan

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29
Q

Follow up

A

48-72 hours if failure to improve

14-21 days if resolved symptoms

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30
Q

Management of OM

A

Most improve spontaneously
Antibiotics
Analgesics

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31
Q

When to provide antibiotics in OM

A
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32
Q

Define OM with Effusion

A

Presence of middle ear effusion in the absence of acute signs of infection

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33
Q

Symptoms of OM with Effusion

A 
Hearing loss
Fullness in ear
Tugging at ear
Delayed speech/language development
Unsteady gait
Pain (rarely)
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34
Q

Otoscope Exam in OM with Effusion

A

TM dull & retracted
No mobility of TM
Straw/tan color of TM
Sterile fluid in middle ear

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35
Q

What is the single most recommended diagnostic method to establish the diagnosis of otitis media with effusion?

A

Pneumatic otoscopy

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36
Q

Treatment of OM with Effusion

A

Watchful waiting for 3 months

Then hearing test

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37
Q

What to do in the watchful waiting period for OM with effusion?

A 
Speak close to the child
Face the child when speaking
Speak clearly
Repeat phrases
Preferential seating in the classroom
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38
Q

When should a hearing test be performed with OM with effusion?

A

After 3 months of watchful waiting

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39
Q

How often should you re-examine children with OM with effusion?

A

3-6 month intervals

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40
Q

Define Chronic Suppurative Otitis

A

Perforated tympanic membrane with persistent drainage from the middle ear

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41
Q

Risk Factors for Chronic Suppurative Otitis

A

Hx of multiple episodes of AOM
Living in crowded conditions
Daycare
Family member of large family

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42
Q

Bacterial Culprits of Chronic Suppurative Otitis

A

Pseudomonas aeruginosa (50-98%)
Staph aureus (15-30%)
Klebsiella
Proteus

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43
Q

Sequelae of Chronic Suppurative Otitis

A

Conductive hearing loss

Intracranial complications

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44
Q

Presentation of Chronic Suppurative Otitis

A

Otorrhea
Edematous external canal
Not tender
Granulation tissue in medial canal of middle ear space
Middle ear mocosa (edematous, polypoid, pale or erythematous)
Discharge

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45
Q

Labs for Chronic Suppurative Otitis

A

Culture for sensitivity

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46
Q

Treatment for Chronic Suppurative Otitis

A

Removal of exudate

Ciprofloxin (failed cases)

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47
Q

Define Cholesteoma

A

Skin growth that occurs in the middle ear behind the eardrum

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48
Q

Cause of Cholesteoma

A

Repeated infection

Poor ET function

49
Q

Presentation of Cholesteoma

A 
Otorrhea
Feeling of pressure in ear
Hearing loss
Achy ear
Dizziness
Facial weakness on affected side
50
Q

Diagnostics of Cholesteoma

A

Otoscopy
Audiometry
Xray/CT of mastoid

51
Q

Treatment of Cholesteoma

A

Surgical treatment

52
Q

Define Otitis Externa

A

Inflammation of the external auditory canal or auricle

53
Q

Causes of Otitis Externa

A

Infectious
Allergic
Dermal disease

54
Q

Bacterial Culprits of Otitis Externa

A

Staph aureus
Pseudomonas aeruginosa (swimmers ear)
Proteus

55
Q

Signs/Symptoms of Otitis Externa

A 
Otalgia
Pain at triages
Pain when auricle pulled
Pruritis
Discharge
Hearing loss
56
Q

Otoscopic Exam in Otitis Externa

A 
Edematous
Erythematous
Yellow, brown, white, or grey debris
No middle ear fluid
TM mobile
57
Q

Treatment of Otitis Externa

A

Cleaning of ear canal
Protect ear canal from water
Treatment of inflammation and infection

58
Q

Inflammation/infection Treatment in Otitis Externa

A

Cortisporin
Cipro HC
Tobradex

59
Q

Define Malignant External Otitis (Necrotizing Otitis Externa)

A

Invasive infection of the external auditory canal and skull base

60
Q

High Risk Patients for Malignant External Otitis (Necrotizing Otitis Externa)

A

Elderly with DM
AIDS
Immunocompromised

61
Q

Main Bug of Malignant External Otitis (Necrotizing Otitis Externa)

A

Pseudomonas aeruginosa

62
Q

Clinical Manifestations of Malignant External Otitis (Necrotizing Otitis Externa)

A

Otalgia

Otorrhea

63
Q

Otoscopic Exam of Malignant External Otitis (Necrotizing Otitis Externa)

A

Granulation in inferior portion of the external auditory canal

64
Q

Complications of Malignant External Otitis (Necrotizing Otitis Externa)

A

Osteomyelitis in base of skull
Mastoiditis
TMJ osteomyelitis
Cranial nerve palsies

65
Q

Diagnosis of Malignant Otitis Externa

A

Elevated ESR
Positive culture
Imaging

66
Q

Treatment of Malignant Otitis Externa

A

Ciprofloxin

NO TOPICAL ANTIBIOTICS

67
Q

Clinical Manifestations of TM Perforations

A

Clear, pus-filled or bloody drainage from ear
Sudden decrease in ear pain
Hearing loss
Tinnitus

68
Q

Causes of TM Perforations

A 
Middle ear infection
Airplane ear
Acoustic trauma
FB in ear
Loud, sudden noise
69
Q

Treatment of TM Perforation

A 
Heal on own
No antibiotics
Keep ear dry
Ear drum patch
Tympanoplasty
70
Q

Most frequent cause of Barotrauma

A

Flying

Diving (2nd)

71
Q

Clinical Manifestations of Barotrauma

A

Pressure in the ear
Pain due to stretching of TM
Hearing loss
Tinnitus

72
Q

Treatment of Barotrauma

A

Valsalva maneuver
Decongestants
Myringotomy

73
Q

Prevention of Barotrauma

A 
Avoidance
Pre flight decongestants
Chewing gum
Yawning 
Swallowing
74
Q

Treatment of FB in the Ear

A

Removal

75
Q

How to remove FB from ear

A

Adequate visualization
Appropriate equipment
Cooperative patient
Skilled provider

76
Q

Removal Techniques of Cerumen IMpactions

A

Hydrogen peroxide
Debrox
Irrigation
Suction

77
Q

When can you not irrigate for cerumen impaction?

A

TM not intact

78
Q

What is mastoiditis a complication of?

A

Otitis media

79
Q

Define Mastoiditis

A

Middle ear inflammation spreads to the mastoid air cells

80
Q

Characteristics of Mastoiditis

A

Postauricular pain
Post auricular erythema
Spiking fever
Tender mass

81
Q

Diagnostics of Mastoiditis

A

ENT consult
CT
MRI if intracranial involvement

82
Q

Treatment for Mastoiditis

A 
IV antibiotics
Ceftriaxone (Rocephin)
Piperacillin & tazobactam sodium (Zosyn)
Oxacillin (Bactocill)
Gentamicin (Garamycin)
83
Q

Why are acoustic neuroma’s dangerous?

A

Can eventually compress the pons

Hydrocephalus

84
Q

Risk Factor for Acoustic Neuroma

A

Exposure to loud noise
Neurofibromatosis type 2
Hx of parathyroid adenoma
Cell phones??

85
Q

Symptoms of Acoustic Neuroma

A 
Hearing loss
Tinnitus
Unsteadiness while walking
Facial numbness
Hypestesia
Pain
Facial paresis
Taste disturbances
86
Q

Diagnostics of Acoustic Neuroma

A

Demonstration of asymmetric sensorineural hearing loss
MRI or CT
ENT referrel
Audiometry

87
Q

Treatment for Acoustic Neuroma

A

Surgery

88
Q

Define Vertigo Syndromes

A

Symptoms of illusory movement

89
Q

How Does Vertigo Syndromes Appear?

A

Transient spinning dizziness
Sense of swaying or tilting
Sense of falling backing

90
Q

Causes of Vertigo Syndromes

A

Asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem

91
Q

Characteristics of Peripheral Vertigo Syndromes

A

Sudden onset
Horizontal nystagmus
Visual fixation inhibits nystagmus

92
Q

Characteristics of Central Vertigo Syndromes

A 
Gradual onset
Any direction nystagmus
Visual fixation doesn't stop nystagmus
Signs of brainstem dysfunction
Instability
93
Q

Symptoms of Peripheral Vertigo Syndromes

A 
Blurred vision
Fatigue
Headache
Palpitations
Inability to concentrate
Increased risk for motion sickness
N/V
Reduced cognitive function
Photophobia
Sound sensitive
Sweating
94
Q

Symptoms of Central Vertigo Syndromes

A 
Double vision
Headache
Impaired consciousness
Inability to speak
Lack of coordination
N/V
Weakness
95
Q

Benign Paroxysmal Positional Vertigo

A

Dizziness due to debris which has collected in the inner ear

Debri derived from utricle

96
Q

Characteristics of Benign Paroxysmal Positional Vertigo

A

Recurrent & brief episodes
Predictable head movements/positions precipitate symptoms
Horizontal nystagmus

97
Q

Which test is best for determining benign paroxysmal positional vertigo?

A

Dix-Hallpike maneuver

98
Q

What is the Dix-Hallpike Maneuver?

A

Person is brought from sitting to supine position with the head turned 45 degrees to the side and extended 20 degrees backward

99
Q

What does a positive Dix-Hallpike test consist of?

A

Burst of nystagmus

100
Q

Treatment for Benign Paroxysmal Positional Vertigo

A

Wait it out

Epley Maneuver

101
Q

What is the Epley Maneuver?

A

Sequential movement of the head into 4 positions staying in each position for about 30 seconds

102
Q

Define Labrynthitis

A

Inflammation of the inner ear

103
Q

Clinical Course of Labrynthitis

A

Vertigo
Gradually goes away
Possible temporary hearing loss

104
Q

Possible Causes of Labyrinthitis

A

Viral URI

Middle ear infection

105
Q

Treatment of Labyrinthitis

A

Usually goes away on own (several weeks)

Medications for N/V

106
Q

Medications for N/V in Labyrinthitis

A

Prochlorperazine (Compazine)
Meclazine (Antivert)
Diazepam/Lorazepam

107
Q

What does Meniere’s Disease result from?

A

Distention of the endolymphatic compartment of the inner ear

108
Q

Clinical Presentation of Meniere’s Disease

A

Episodic vertigo lasting 1-8 hours
Low frequency sensorineural hearing loss
Tinnitus
Sensation of aural pressure

109
Q

Diagnostic Criteria for Meniere’s Disease

A

2 spontaneous episodes >20 minutes
Audiometric confirmation of sensorineural hearing loss
Tinnitus

110
Q

Treatment of Meniere’s Disease

A

Dietary restrictions

Medications

111
Q

Dietary Restriction Treatment Options

A

Caffeine
Tobacco
Salt

112
Q

Medication Treatment Options

A 
Diuretics
Antiemetics
Anxiolytics
Antihistamines
Scopolamine
113
Q

Define Presbycusis

A

Sensorineural hearing impairment in elderly individuals

114
Q

What does sensory presbycusis refer to?

A

Epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of Corti

115
Q

What does neural presbycusis refer to?

A

Atrophy of nerve cells in the cochlea and central neural pathways

116
Q

What does metabolic presbycusis result from?

A

Atrophy of the stria vascularis causing a flat hearing curve

117
Q

What does mechanical presbycusis result from?

A

Thickening and secondary stiffening of the basilar membrane of the cochlea

118
Q

Clinical Presentation of Presbycusis

A

Difficulty understanding rapidly spoken language, complex vocabulary, speech in noisy, distracting environment

119
Q

Treatment of Presbycusis

A

Amplification devices (hearing aides)
Lip reading
Cochlear implants
Assistive listening devices

ENT (10 decks)

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