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Clinical 1 (Part A) > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

Describe the outer ear

A
  • EAC (external auditory canal)

- auricle (pinna) - directs sound waves into the ear

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2
Q

Describe the middle ear

A

Made up of eardrum and 3 small bones (ossicles):

  • malleus/hammer
  • incus/anvil
  • stapes/stirrup
  • Vibrations of the eardrum are picked up by these bones and sent to the inner ear
  • Eustachian tube is a hollow tube which connects the middle ear with the nasopharynx
  • The eustachian tube functions as a pressure equalizing value for the middle ear which is normally filled with air
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3
Q

Describe the inner ear

A

Houses sensory and equilibrium system

Consists of:

  • cochlea
  • vestibule
  • semicircular canals
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4
Q

Compare the EAC (external auditory canal) in adults and children

A

Children:

  • EAC is shorter, straighter, and flatter than in adults.
  • Shape and direction of eustachian tube is more horizontal than vertical. This makes drainage more difficult

Adults:

  • EAC longer and forms an S shape.
  • Eustachian tube lengthens downward as it enters the nasal cavity
  • This design promotes drainage and inhibits aspiration of nasopharyngeal content into the middle ear
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5
Q

How do you put drops into a child’s ear? (under 3 yrs old)

A

pull down and back

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6
Q

How do you put drops into an adults’ ear? (over 3 yrs old)

A

pull up and back

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7
Q

List some special defences of the EAC (external auditory canal)

A
  • cerumen
  • epithelial migration
  • S shape of canal
  • hair located in the canal
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8
Q

What does failure of the defences or damage of the epithelium of the EAC result in?

A

otitis externa

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9
Q

Otitis Externa is an ______ ____ disorder

A

outer ear

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10
Q

Describe Otitis Externa

A
  • inflammation or infection of EAC
  • most often unilateral
  • symptoms range from pruritus (itchy skin) to severe pain and discharge
  • pain often worse with motion of the ear
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11
Q

Acute diffuse OE is generally referred to as?

A

swimmers ear

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12
Q

Do you have to refer swimmers ear?

A

yes

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13
Q

Cerumen (wax) impaction is an ___ ___ disorder

A

outer ear

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14
Q

water-clogged ears are an ___ ____ disorder

A

outer ear

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15
Q

3 outer ear disorders

A

1) otitis externa
2) cerumen impaction
3) water-clogged ears

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16
Q

acute otitis media (AOM) is a ____ ___ disorder

A

middle ear

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17
Q

What is acute otitis media

A
  • inflammation or infection of middl e ear
  • most often viral and self-limiting
  • symptoms include acute ear pain, fever, and reduced hearing
  • pain is often unilateral
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18
Q

Are topical agents used in AOM

A

no

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19
Q

What could you recommend for pain for AOM?

A

acetaminophen
ibuprofen

-local heat application may be beneficial

**systemic ABs (antibiotics) may be required

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20
Q

Secretor otitis media is an ___ ___ disorder

A

middle ear

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21
Q

Describe secretor otitis media

A
  • otitis media with effusion

- middle ear space becomes full with sticky effusion which is unable to escape

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22
Q

Chronic suppurative otitis media is an ____ ____ disorder

A

middle ear

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23
Q

Describe chronic suppurative otitis media

A

involves a hole in the eardrum and active bacterial infection within the middle ear space

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24
Q

Otic barotrauma or aerotitis media is a ____ ___ disorder

A

middle ear

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25
Q

What is otic barotrauma or aerotitis media commonly referred to as?

A

airplane ear

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26
Q

Describe otic barotrauma or aerotitis media

A
  • pain resulting from increased air pressure

- due to respiratory infection or mechanical pressure (from scuba diving or flying for example)

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27
Q

What is the only self-treatable middle ear disorder?

A

otic barotrauma or aerotitis media

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28
Q

Vertigo (and dizziness) is an ____ ___ disorder

A

inner ear

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29
Q

Describe vertigo

A
  • feeling that you or your surroundings are moving when there is no actual movement
  • major symptom of a balance disorder
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30
Q

If vertigo persists for more than __ hours = referral

A

24

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31
Q

What can vertigo be accompanied by?

A

tinnitus
decreased hearing
ear pain

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32
Q

Common causes of vertigo?

A
  • viral infections
  • inner ear disturbances (Ménière’s disease)
  • ototoxic drugs
  • trauma to ear or head
  • vascular disorders
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33
Q

What is tinnitus ?

A

ringing in the ear

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34
Q

Ménière’s disease is an ___ ____ disorder

A

inner ear

35
Q

What is Ménière’s disease believed to result from?

A

fluctuation pressure of the fluid within the inner ear

36
Q

Symptoms of Ménière’s disease?

A

-vertigo
-feeling of fullness/pressure in the ear
-fluctuation hearing loss
tinnitus

37
Q

Referral necessary for Ménière’s disease ?

A

yes

38
Q

Tinnitus > __ hours requires a referral

A

24

39
Q

Many ototoxic drugs can lead to??

A

tinnitus

vertigo problems

40
Q

What are some high risk ototoxic agents?

A

aminoglycosides
antineoplastics
IV diuretics

41
Q

What are some low risk ototoxic agents?

A

NSAIDs

antibiotics

42
Q

Examples of antineoplastics

A 
Cisplatin
Carboplatin
Vincristine
Vinglastine
Nitrogen Mustard
43
Q

What can cisplatin and carboplatin cause?

A

hearing loss

tinnutis

44
Q

What can vincristine and vinblastine cause?

A

hearing loss

45
Q

What can nitrogen mustard cause?

A

vertigo

46
Q

Examples of antibiotics

A

minocycline
erythromycin
vancomycin

47
Q

What can minocycline cause?

A

vertigo (generally reversible)

48
Q

What can erythromycin cause?

A
  • hearing loss or vertigo

- high doses generally reversible

49
Q

What can vancomycin cause?

A
  • hearing loss if used with ahminoglycosides

- little evidence of toxicity if used alone

50
Q

Examples of NSAIDs

A

ASA
Naproxen
Indomethacin

51
Q

What can ASA cause?

A

tinnitus
hearing loss
vertigo
(high doses - generally irreversible)

52
Q

What can naproxen cause?

A

hearing loss

maybe irreversible

53
Q

What can indomethacin cause?

A

tinnitus

generally reversible

54
Q

Does swimmer’s ear (otitis externa) need to be referred

A

yes

55
Q

Does otitis media need to be referred ?

A

yes

56
Q

Tinnitus, vertigo, and dizziness less than 24 hours need to be referred?

A

nope

57
Q

does sudden hearing loss need to be referred?

A

yes

58
Q

objects in the ear and perforated ear drums - do they need to be referred

A

yes

59
Q

does ear pain need to be referred (otalgia)

A

yes

60
Q

does ear drainage (otorrhea) need to be referred?

A

yes

61
Q

What 2 ear disorders are self-treatable? Why are they self-treatable?

A
  • cerumen impaction
  • water-clogged ears

*self-treatable because they involve no inflammation, infection, pain, or discharges

62
Q

Cerumen impaction and water-clogged ears are self-treatable for how many days?

A

max 4

63
Q

pH of cerumen

A

5-7.2 (acidic, bactericidal)

64
Q

wax build up is ?

A

self-limiting

65
Q

symptoms of cerumen impaction

A
  • feeling of pressure or fullness
  • pruritis
  • gradual hearing loss
  • general discomfort
66
Q

What is carbamide peroxide 6.5%?

A

cerumen softening agent

Murine Ear Wax Removal Drops

67
Q

Application for carbamide peroxide 6.5%?

A

5-10 drops in affected ear(s) BID for 4 days

68
Q 
Application for:
any type of oil
glycerol
hydrogen peroxide 3% diluted in water (1:1)
sodium bicarbonate (10-15% solution)

?

*these are all cerumen softening agents

A

4-6 drops in affected ear(s) BID for 4 days

69
Q

Cerumenex is a cerumenolytic agent which should not be left in the ear for more than ___ mins

*and should be followed by syringing or irrigation of the ear

A

15

70
Q

Cerumol is a cerumenolytic agent - has ___ In it

A

peanuts

71
Q

Describe self treatment approach for cerumen impaction

A

-recommend a cerumen-softening agent
(Murine is product of choice)
5-10 drops in affected ear(s) BID f 4 days

or use oil or glycerol
4-6 drops BID f 4 days
(these agents may be used daily or 2-3 times weekly for prevention)

72
Q

Cerumenolytics usually require ?

A

irrigation of the ear

73
Q

Cerumenex and Cerumol are ?

A

cerumenolytics

74
Q

duration of treatment for cerumen impaction

A

4 days

-up to 7 days if advised by a physician

75
Q

Irrigation fluid should be at ___ temp

A

body

76
Q

Recommended volume for ear irrigation = ___ mL

A

240 mL

77
Q

Isopropyl alcohol (95%) in 5% anhydrous glycerin (auro-dri or swim ear) is an ??

A

ear drying agent

78
Q

Recommended treatment for ear drying agents?

A

instill 4-5 drops in each ear daily after showering, swimming, or bathing for 4 days

*max 10 drops/ear per day

79
Q

Ear-drying agents are contraindicated with what type of pts?

A

Pts who have tympanostomy tubes

80
Q

Duration of treatment for ear-drying agents?

A

4 days for WCE ?

7-10 days for AEO (acute otitis externa)

81
Q

AOE (acute otitis externa) (swimmers ear) may need what treatment?

A

gentamicin/betamethasone (Rx)
ciproflox/dexamethasone (Rx)
polymyxin B + gramicidin (OTC)

82
Q

Should you use a local anesthetic for an ear disorder?

A

you can but it only has an onset of 45 mins so using an oral analgesic (acet or ibu) is better

83
Q

Risk factors for otic barotrauma? (Airplane ear)

A
  • any condition that blocks the eustachian tube or limits it’s function
  • a small eustachian tube, especially infants and toddlers
  • nasal congestion
  • sinus infection
  • hay fever (allergic rhinitis)
  • middle ear infection
  • sleeping on airplane during ascent or descent
  • scuba divers
  • mountain climbers/driving through mountains
  • falling/hitting water at high speed (water sports)
  • being slapped or hit on the ear
84
Q

Treatment for otic barotrauma (airplane ear)

A

mild case:
oral analgesics for pain
oral or topical decongestants

severe case:
refer

Clinical 1 (Part A) (15 decks)

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