Ear Disorders Flashcards
1
Q
Describe the outer ear
A
- EAC (external auditory canal)
- auricle (pinna) - directs sound waves into the ear
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
3
Q
Describe the inner ear
A
Houses sensory and equilibrium system
Consists of:
- cochlea
- vestibule
- semicircular canals
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
5
Q
How do you put drops into a child’s ear? (under 3 yrs old)
A
pull down and back
6
Q
How do you put drops into an adults’ ear? (over 3 yrs old)
A
pull up and back
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
8
Q
What does failure of the defences or damage of the epithelium of the EAC result in?
A
otitis externa
9
Q
Otitis Externa is an ______ ____ disorder
A
outer ear
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
11
Q
Acute diffuse OE is generally referred to as?
A
swimmers ear
12
Q
Do you have to refer swimmers ear?
A
yes
13
Q
Cerumen (wax) impaction is an ___ ___ disorder
A
outer ear
14
Q
water-clogged ears are an ___ ____ disorder
A
outer ear
15
Q
3 outer ear disorders
A
1) otitis externa
2) cerumen impaction
3) water-clogged ears
16
Q
acute otitis media (AOM) is a ____ ___ disorder
A
middle ear
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
18
Q
Are topical agents used in AOM
A
no
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
20
Q
Secretor otitis media is an ___ ___ disorder
A
middle ear
21
Q
Describe secretor otitis media
A
- otitis media with effusion
- middle ear space becomes full with sticky effusion which is unable to escape
22
Q
Chronic suppurative otitis media is an ____ ____ disorder
A
middle ear
23
Q
Describe chronic suppurative otitis media
A
involves a hole in the eardrum and active bacterial infection within the middle ear space
24
Q
Otic barotrauma or aerotitis media is a ____ ___ disorder
A
middle ear
25
What is otic barotrauma or aerotitis media commonly referred to as?
airplane ear
26
Describe otic barotrauma or aerotitis media
- pain resulting from increased air pressure
| - due to respiratory infection or mechanical pressure (from scuba diving or flying for example)
27
What is the only self-treatable middle ear disorder?
otic barotrauma or aerotitis media
28
Vertigo (and dizziness) is an ____ ___ disorder
inner ear
29
Describe vertigo
- feeling that you or your surroundings are moving when there is no actual movement
- major symptom of a balance disorder
30
If vertigo persists for more than __ hours = referral
24
31
What can vertigo be accompanied by?
tinnitus
decreased hearing
ear pain
32
Common causes of vertigo?
- viral infections
- inner ear disturbances (Ménière's disease)
- ototoxic drugs
- trauma to ear or head
- vascular disorders
33
What is tinnitus ?
ringing in the ear
34
Ménière's disease is an ___ ____ disorder
inner ear
35
What is Ménière's disease believed to result from?
fluctuation pressure of the fluid within the inner ear
36
Symptoms of Ménière's disease?
-vertigo
-feeling of fullness/pressure in the ear
-fluctuation hearing loss
tinnitus
37
Referral necessary for Ménière's disease ?
yes
38
Tinnitus > __ hours requires a referral
24
39
Many ototoxic drugs can lead to??
tinnitus
| vertigo problems
40
What are some high risk ototoxic agents?
aminoglycosides
antineoplastics
IV diuretics
41
What are some low risk ototoxic agents?
NSAIDs
| antibiotics
42
Examples of antineoplastics
```
Cisplatin
Carboplatin
Vincristine
Vinglastine
Nitrogen Mustard
```
43
What can cisplatin and carboplatin cause?
hearing loss
| tinnutis
44
What can vincristine and vinblastine cause?
hearing loss
45
What can nitrogen mustard cause?
vertigo
46
Examples of antibiotics
minocycline
erythromycin
vancomycin
47
What can minocycline cause?
vertigo (generally reversible)
48
What can erythromycin cause?
- hearing loss or vertigo
| - high doses generally reversible
49
What can vancomycin cause?
- hearing loss if used with ahminoglycosides
| - little evidence of toxicity if used alone
50
Examples of NSAIDs
ASA
Naproxen
Indomethacin
51
What can ASA cause?
tinnitus
hearing loss
vertigo
(high doses - generally irreversible)
52
What can naproxen cause?
hearing loss
| maybe irreversible
53
What can indomethacin cause?
tinnitus
| generally reversible
54
Does swimmer's ear (otitis externa) need to be referred
yes
55
Does otitis media need to be referred ?
yes
56
Tinnitus, vertigo, and dizziness less than 24 hours need to be referred?
nope
57
does sudden hearing loss need to be referred?
yes
58
objects in the ear and perforated ear drums - do they need to be referred
yes
59
does ear pain need to be referred (otalgia)
yes
60
does ear drainage (otorrhea) need to be referred?
yes
61
What 2 ear disorders are self-treatable? Why are they self-treatable?
- cerumen impaction
- water-clogged ears
*self-treatable because they involve no inflammation, infection, pain, or discharges
62
Cerumen impaction and water-clogged ears are self-treatable for how many days?
max 4
63
pH of cerumen
5-7.2 (acidic, bactericidal)
64
wax build up is ?
self-limiting
65
symptoms of cerumen impaction
- feeling of pressure or fullness
- pruritis
- gradual hearing loss
- general discomfort
66
What is carbamide peroxide 6.5%?
cerumen softening agent
| Murine Ear Wax Removal Drops
67
Application for carbamide peroxide 6.5%?
5-10 drops in affected ear(s) BID for 4 days
68
```
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
4-6 drops in affected ear(s) BID for 4 days
69
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
15
70
Cerumol is a cerumenolytic agent - has ___ In it
peanuts
71
Describe self treatment approach for cerumen impaction
-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
Cerumenolytics usually require ?
irrigation of the ear
73
Cerumenex and Cerumol are ?
cerumenolytics
74
duration of treatment for cerumen impaction
4 days
| -up to 7 days if advised by a physician
75
Irrigation fluid should be at ___ temp
body
76
Recommended volume for ear irrigation = ___ mL
240 mL
77
Isopropyl alcohol (95%) in 5% anhydrous glycerin (auro-dri or swim ear) is an ??
ear drying agent
78
Recommended treatment for ear drying agents?
instill 4-5 drops in each ear daily after showering, swimming, or bathing for 4 days
*max 10 drops/ear per day
79
Ear-drying agents are contraindicated with what type of pts?
Pts who have tympanostomy tubes
80
Duration of treatment for ear-drying agents?
4 days for WCE ?
| 7-10 days for AEO (acute otitis externa)
81
AOE (acute otitis externa) (swimmers ear) may need what treatment?
gentamicin/betamethasone (Rx)
ciproflox/dexamethasone (Rx)
polymyxin B + gramicidin (OTC)
82
Should you use a local anesthetic for an ear disorder?
you can but it only has an onset of 45 mins so using an oral analgesic (acet or ibu) is better
83
Risk factors for otic barotrauma? (Airplane ear)
- 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
Treatment for otic barotrauma (airplane ear)
mild case:
oral analgesics for pain
oral or topical decongestants
severe case:
refer
