Ear Disorders Flashcards
cerumen impaction
pushing back the cerumen of the ear causing hearing loss, pruritis, fullness, odor, etc.
how do you treat cerumen impaction?
dx with direct visualization
removal with cerumenolytic + manual removal or office irrigation
temperature of fluid used in cerumen irrigation
tepid/warm
cerumenolytics are CI in who?
TM damage freq. infection TM perforation Otolgic surgery Drainage from ear + ear pain
drug name used for cerumenolytic
Carbamide Peroxide 6.5% (Debrox)
cerumen patient education
clean only external ear, use wash cloth or finger
DONT use Q Tips
otitis externa signs
inflammation and edema in the ear canal
purulent exudate
manipulation of auricle or triages elicits pain
may be hard to visualize TM due to exudate
typically suspected in patients who have recently been sum urged in water
treatment for otitis externa
protection from moisture/drying agent *alcohol)
ciprodex drops
remove purulent debris (wick)
pathogens typically causing otitis external
gram negative rods (PSEUDOMONAS), staph aureus or fungi (immunocompromised)
malignant otitis externa (MOE)
EO that progresses into osteomyelitis of temporal bone
can be life threatening (get into skull.bone, nerve damage)
hallmark finding of MOE
granulation tissue at the floor of osseocartilaginous junction
treatment of MOE
Emergent ENT consult, CT scan, admission
start ABx immediately (gives better results) and surgically remove damage tissue
eustachian tube
connection between middle ear and throat that opens to equalize pressure in cavity with that of atmosphere
eustachian tube dysfunction
occurs when air trapped in the middle ear is absorbed and negative pressure results
typically caused by URI and allergies
eustachian tube dysfunction treatment
Sudafed
oxymetazoline (farina and nostrilla)
auto-inflation (yawning, chewing)
corticosteroids for allegires
barotrauma
patient with poor eustachian tube function are unable to equalize under pressure
can be caused by air travel or diving
suggest chewing, yawning, decongestant use
TM perforation
can be caused by any ear ache
may present with acute pain that subsides quickly, hearing loss
be sure to avoid water and tx topical flouroquinalones
Serous otitis media
prolong eustachian tube dysfunction with negative pressure causes accumulation of fluid
mc in children or following allergies, URI and barotrauma in adults
Serous otitis media symptoms
hearing loss
tugging or pulling at one or both ears
loss of balance
delayed speech impairment
Serous otitis media exam findings
tm is dull and hyper mobile
with air bubbles and conductive hearing loss
Serous otitis media treatment
short course of oral corticosteroids +/- ABX
acute otitis media
etiology
bacterial colonization of middle ear in eustachian tube dysfunction
typically precipitated by URI that causes obstruction
MC pathogens in acute otitis media
Strep pneumonia
H flu (AOM + conjunctivitis)
strep pyogenes
criteria for AOM diagnosis
acute onset
presence of middle ear effusion
signs of middle ear inflammation (red TM, pain, and fever)
what is NOT AOM?
erythema of TM without middle ear effusion
ear pain with normal TM
AOM treatment
antibiotics (if age appropriate)
also use pain management agents (ibuprofen or tylenol)
decongestants are discouraged
DOC: Amoxicillin (unless H Flu) 10 days
AOM medication ADR
rash, headache, eosinophilia/anemia, GI upset
AOM in adults
first line: Amoxicillin
first line if PCN allergic : Azithromycin or Claritohrmycin
chronic supperative otitis media (CSOM)
develops after recurrent AOM
typically has TM perforation
** Purulent discharge **
conductive hearing loss
bacteria pathogens in CSOM
P. aeruginosa, propus, staph aureus, anaerobic
CSOM treatment
removal of pus
topical ABx drops (cipro + desmethasone)
definitive tx - surgical TM repair
complications of otitis media
myringosclerosis/tympanosclerosis
cholestoma
acute mastoiditis
myringosclerosis/tympanosclerosis
large, chalky white patch on TM with irregular margins
scar tissue typically due to recurrent OM
cholesteatoma
destructive epithelial cyst in mid ear that may extend to mastoid air cells (cyst)
causes erosion of bones
typically caused by repeated ear infection
can be filled with keratin and chronically infected
cholesteatoma
symptoms
persistent infection, foul drainage, pressure, pain worse at night
can have CNS symptoms develop possible as it grows intracranially
may see perforation in TM that leaks keratin debris or granulation tissue
cholesteatoma
treatment
surgical marsupialization or complete removal
may require creation of mastoid bowl
joined into large common cavity that must be cleaned
mastoiditis
extension of infection into the air cells
complication of AOM
pain and tenderness over the mastoid, edema, and erythema of post auricular soft tissues and fever
s. pneumo, h. flu, s. pyogenes
coalescence of mastoid air cell
mastoiditis tx
broad spectrum Abx
esp. Ancef
Equilibrium
done by dynamic equilibrium semicircular canals – three loops respond to changes in angular motion
moving fluid in these canals disturbs crust ampullaris - detects rotational motion
vestibule and equilibrium
between conceal and semicircular canals
contains static equilibrium receptors (maculae)
linear acceleration
proprioceptors that control balance
semi-circular canals crista ampullaris rotational motion vestibule maculae static equilibrium
vertigo
perceived sensation of moving
can be peripheral, CNS, or systemic
peripheral vertigo s/s
sudden onset
may have N/V
hearing loss
tinnitus
unable to walk or stand
peripheral vertigo cause
BPPV labyrinthitis Meniere''s disease positional vertigo vestibular neuoritis
central vertigo
slow onset
motor, sensory, or cerebellar defects
central vertigo
cause
brainstem vascular disease, arteriovenous malformation, tumors of brainstem of cerebellum, MS
vertigo PE
look for nystagmus
pneumatic otoscope cause nystagmus and vertigo in perilymph fistula
BPPV
mc cause of peripheral vertigo
otoconia particles from utricle or scull lodge in posterior semicircular canal
typically cured by Epley Maneuver
labyrinthitis
acute onset of continuous
usually severe vertigo lasting several days to a week
hearing loss and tinnitus
labyrinthitis treat
meclizine (Antivert)
cyclizing (Marezine)
dimenhydrinate (Dramamine)
motion sickness tx
vestibular neuronitis
paroxysmal
single attack of vertigo (w/o auditory impairment)
nystagmus present
Meniere’s Disease
disorder of the inner ear
distention of the endolymphatic compartment
triad of Meniere’s disease
low frequency
hearing loss
episodic vertigo and tinnitus (aural pressure)
Meniere’s disease management
primary treatment involves low salt diet, diuretics
endolympatic sac decompression
typically gives symptom free periods between a cluster of episodes
mechanisms of hearing
- stirrup vibrates oval window causes cochlear fluids to start moving stimulates organ of court in central canal of choclea
- organ of court has three parts - tectoral membrane bends and pulls hairs
- nerve impulses travel from cochlea to brain via cochlear nerve to medulla oblongata to midbrain to auditory context
hearing loss
may be acute or chronic
weber and rinne tests differentiate
conductive hearing loss
caused by impaired transmission of sound along external canal, across the ossicles and thru oval window
TEMPROARY
abnormalities in middle or external ear
mechanisms of conductive hearing loss
obstruction (cerumen impaction) mass loading (middle ear effusion) stiffness effect (otosclerosis) discontinuity (ossicular disruption)
conductive hearing loss tx
application, fluoride treatments, stapedectomy
sensorineural hearing loss
disruption in nerves or mechanics of hearing loss hair cell function
caused by neural degeneration, decrease cilia, ossicles
not correctable
weber test and hearing loss results
lateralizes teste
conductive loss - sound to bad ear
sensorineural loss - sound to good ear
rinne test and hearing loss test results
conductive loss: good ear AC > BC and bad ear BC > AC
sensorineural loss: AC > BC
acoustic neuroma
pathophys
Schwann cell derived benign tumors vestibular portion of eighth cranial nerve
asymmetrical hearing loss, tinnitus, instead walking
acoustic neuroma nerves effected
cochlear nerve vestibular nerve trigeminal nerve facial nerve tumor progression
cochlear nerve
acoustic neuroma
symptoms
hearing loss (unilateral and chronic) can be sudden
tinnitus
vestibular nerve
acoustic neuroma
symptoms
unsteady walking
acoustic neuroma
symptoms
trigeminal nerve
facial numbness (paresthesia), hypethesia, and pain
acoustic neuroma
symptoms
facial nerve
facial paresis
acoustic neuroma
symptoms
tumor progression
brainstem compression
cerebellar tonsil herniation
hydrocephalus and death
