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FA17 HEENT > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

cerumen impaction

A

pushing back the cerumen of the ear causing hearing loss, pruritis, fullness, odor, etc.

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2
Q

how do you treat cerumen impaction?

A

dx with direct visualization

removal with cerumenolytic + manual removal or office irrigation

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3
Q

temperature of fluid used in cerumen irrigation

A

tepid/warm

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4
Q

cerumenolytics are CI in who?

A 
TM damage
freq. infection 
TM perforation
Otolgic surgery 
Drainage from ear + ear pain
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5
Q

drug name used for cerumenolytic

A

Carbamide Peroxide 6.5% (Debrox)

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6
Q

cerumen patient education

A

clean only external ear, use wash cloth or finger

DONT use Q Tips

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7
Q

otitis externa signs

A

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

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8
Q

treatment for otitis externa

A

protection from moisture/drying agent *alcohol)

ciprodex drops

remove purulent debris (wick)

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9
Q

pathogens typically causing otitis external

A

gram negative rods (PSEUDOMONAS), staph aureus or fungi (immunocompromised)

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10
Q

malignant otitis externa (MOE)

A

EO that progresses into osteomyelitis of temporal bone

can be life threatening (get into skull.bone, nerve damage)

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11
Q

hallmark finding of MOE

A

granulation tissue at the floor of osseocartilaginous junction

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12
Q

treatment of MOE

A

Emergent ENT consult, CT scan, admission

start ABx immediately (gives better results) and surgically remove damage tissue

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13
Q

eustachian tube

A

connection between middle ear and throat that opens to equalize pressure in cavity with that of atmosphere

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14
Q

eustachian tube dysfunction

A

occurs when air trapped in the middle ear is absorbed and negative pressure results

typically caused by URI and allergies

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15
Q

eustachian tube dysfunction treatment

A

Sudafed
oxymetazoline (farina and nostrilla)

auto-inflation (yawning, chewing)
corticosteroids for allegires

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16
Q

barotrauma

A

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

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17
Q

TM perforation

A

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

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18
Q

Serous otitis media

A

prolong eustachian tube dysfunction with negative pressure causes accumulation of fluid

mc in children or following allergies, URI and barotrauma in adults

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19
Q

Serous otitis media symptoms

A

hearing loss
tugging or pulling at one or both ears
loss of balance
delayed speech impairment

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20
Q

Serous otitis media exam findings

A

tm is dull and hyper mobile

with air bubbles and conductive hearing loss

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21
Q

Serous otitis media treatment

A

short course of oral corticosteroids +/- ABX

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22
Q

acute otitis media

etiology

A

bacterial colonization of middle ear in eustachian tube dysfunction

typically precipitated by URI that causes obstruction

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23
Q

MC pathogens in acute otitis media

A

Strep pneumonia

H flu (AOM + conjunctivitis)

strep pyogenes

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24
Q

criteria for AOM diagnosis

A

acute onset
presence of middle ear effusion

signs of middle ear inflammation (red TM, pain, and fever)

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25
Q

what is NOT AOM?

A

erythema of TM without middle ear effusion

ear pain with normal TM

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26
Q

AOM treatment

A

antibiotics (if age appropriate)

also use pain management agents (ibuprofen or tylenol)

decongestants are discouraged

DOC: Amoxicillin (unless H Flu) 10 days

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27
Q

AOM medication ADR

A

rash, headache, eosinophilia/anemia, GI upset

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28
Q

AOM in adults

A

first line: Amoxicillin

first line if PCN allergic : Azithromycin or Claritohrmycin

29
Q

chronic supperative otitis media (CSOM)

A

develops after recurrent AOM
typically has TM perforation

** Purulent discharge **

conductive hearing loss

30
Q

bacteria pathogens in CSOM

A

P. aeruginosa, propus, staph aureus, anaerobic

31
Q

CSOM treatment

A

removal of pus

topical ABx drops (cipro + desmethasone)

definitive tx - surgical TM repair

32
Q

complications of otitis media

A

myringosclerosis/tympanosclerosis

cholestoma

acute mastoiditis

33
Q

myringosclerosis/tympanosclerosis

A

large, chalky white patch on TM with irregular margins

scar tissue typically due to recurrent OM

34
Q

cholesteatoma

A

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

35
Q

cholesteatoma

symptoms

A

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

36
Q

cholesteatoma

treatment

A

surgical marsupialization or complete removal

may require creation of mastoid bowl

joined into large common cavity that must be cleaned

37
Q

mastoiditis

A

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

38
Q

mastoiditis tx

A

broad spectrum Abx

esp. Ancef

39
Q

Equilibrium

A

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

40
Q

vestibule and equilibrium

A

between conceal and semicircular canals

contains static equilibrium receptors (maculae)

linear acceleration

41
Q

proprioceptors that control balance

A 
semi-circular canals 
crista ampullaris 
rotational motion 
vestibule 
maculae 
static equilibrium
42
Q

vertigo

A

perceived sensation of moving

can be peripheral, CNS, or systemic

43
Q

peripheral vertigo s/s

A

sudden onset

may have N/V

hearing loss

tinnitus

unable to walk or stand

44
Q

peripheral vertigo cause

A 
BPPV 
labyrinthitis 
Meniere''s disease 
positional vertigo 
vestibular neuoritis
45
Q

central vertigo

A

slow onset

motor, sensory, or cerebellar defects

46
Q

central vertigo

cause

A

brainstem vascular disease, arteriovenous malformation, tumors of brainstem of cerebellum, MS

47
Q

vertigo PE

A

look for nystagmus

pneumatic otoscope cause nystagmus and vertigo in perilymph fistula

48
Q

BPPV

A

mc cause of peripheral vertigo

otoconia particles from utricle or scull lodge in posterior semicircular canal

typically cured by Epley Maneuver

49
Q

labyrinthitis

A

acute onset of continuous

usually severe vertigo lasting several days to a week

hearing loss and tinnitus

50
Q

labyrinthitis treat

A

meclizine (Antivert)
cyclizing (Marezine)
dimenhydrinate (Dramamine)

motion sickness tx

51
Q

vestibular neuronitis

A

paroxysmal

single attack of vertigo (w/o auditory impairment)

nystagmus present

52
Q

Meniere’s Disease

A

disorder of the inner ear

distention of the endolymphatic compartment

53
Q

triad of Meniere’s disease

A

low frequency

hearing loss

episodic vertigo and tinnitus (aural pressure)

54
Q

Meniere’s disease management

A

primary treatment involves low salt diet, diuretics

endolympatic sac decompression

typically gives symptom free periods between a cluster of episodes

55
Q

mechanisms of hearing

A
  1. stirrup vibrates oval window causes cochlear fluids to start moving stimulates organ of court in central canal of choclea
  2. organ of court has three parts - tectoral membrane bends and pulls hairs
  3. nerve impulses travel from cochlea to brain via cochlear nerve to medulla oblongata to midbrain to auditory context
56
Q

hearing loss

A

may be acute or chronic

weber and rinne tests differentiate

57
Q

conductive hearing loss

A

caused by impaired transmission of sound along external canal, across the ossicles and thru oval window

TEMPROARY

abnormalities in middle or external ear

58
Q

mechanisms of conductive hearing loss

A 
obstruction (cerumen impaction) 
mass loading (middle ear effusion)
stiffness effect (otosclerosis) 
discontinuity (ossicular disruption)
59
Q

conductive hearing loss tx

A

application, fluoride treatments, stapedectomy

60
Q

sensorineural hearing loss

A

disruption in nerves or mechanics of hearing loss hair cell function

caused by neural degeneration, decrease cilia, ossicles

not correctable

61
Q

weber test and hearing loss results

A

lateralizes teste

conductive loss - sound to bad ear

sensorineural loss - sound to good ear

62
Q

rinne test and hearing loss test results

A

conductive loss: good ear AC > BC and bad ear BC > AC

sensorineural loss: AC > BC

63
Q

acoustic neuroma

pathophys

A

Schwann cell derived benign tumors vestibular portion of eighth cranial nerve

asymmetrical hearing loss, tinnitus, instead walking

64
Q

acoustic neuroma nerves effected

A 
cochlear nerve 
vestibular nerve 
trigeminal nerve 
facial nerve 
tumor progression
65
Q

cochlear nerve

acoustic neuroma

symptoms

A

hearing loss (unilateral and chronic) can be sudden

tinnitus

66
Q

vestibular nerve
acoustic neuroma

symptoms

A

unsteady walking

67
Q

acoustic neuroma

symptoms
trigeminal nerve

A

facial numbness (paresthesia), hypethesia, and pain

68
Q

acoustic neuroma

symptoms
facial nerve

A

facial paresis

69
Q

acoustic neuroma

symptoms
tumor progression

A

brainstem compression
cerebellar tonsil herniation
hydrocephalus and death

FA17 HEENT (8 decks)

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