Ear Disorders Flashcards
Explain the Weber test
Place tuning fork on midline of head/forehead.
Conductive hearing loss= lateralized to bad ear
sensorineural loss= lateralized to good ear
Explain the Rinne test
Place tuning fork on the mastoid and then move beside ear and ask if audible
In nl: AC > BC
Conductive: BC > AC
Most common cause of cerumen impaction?
clinical presentation?
self-induced
hearing loss earache itchiness reflex cough dizziness tinnitus
Tx of cerumen impaction
- detergent ear drops
- mechanical removal
- irrigation
Requirements for irrigating the ear
- body temp water
- perform only when you know TM is intact
- canal need to be dried after irrigation
What are the most common symptoms of foreign body in the ear?
often asymptomatic!
- decreased hearing/pain
- drainage
- chronic cough/hiccups
Treatment of FB in the ear:
what is urgent?
how it it performed?
Urgent: button battery, live insects, penetrating FB
firm objects:
-remove with loop, hook, or irrigation
organic FB (beans, insects):
- do not irrigate
- immobilize living insects with lidocaine before removing
Other name for Otitis Externa and most common bacterial cause
Swimmer’s ear
Pseudomonas- 38%- gram negative rod
Risk factors of Otitis Externa
- warmer climates w/ high humidity
- increased water exposure
- debris form dermatologic conditions- psoriasis
- trauma
- occlusive devices
Clinical presentation of otitis externa
otalgia pruritis purulent discharge hearing loss fullness hx of recent water exposure or mechanical trauma
What might you see on PE of a pt with otitis externa?
- erythema and edema of ear canal skin
- purulent exudate
- tenderness w/ tarsal pressure or manipulation of auricle
- TM may be erythematous
- TM will move normally w/ pneumatic otoscopy
- edema of canal may be so significant that TM is not visible
How do you treat otitis externa?
- for 7-10 days with topical aminoglycoside or fluoroquinolone abx with or without corticosteroids
- keep canal dry
- avoid additional moisture or scratching
- remove debris
- place wick if swelling is significant
- severe OM with cellulitis of periauricular tissue or recalcitrant cases need oral abx
- Referral to ENT for any pt with persistent OE who is immunocompromised/DM
Most common neoplasm of the ear canal?
squamous cell carcinoma of external canal
What is another name for HSV of the outer ear canal?
Ramsay Hunt syndrome
Complications of otitis externa
- periauricular cellulitis
- contact dermatitis (most common= from neomycin)
- malignant otitis externa
What is malignant otitis externa?
who is at risk?
Osteomyelitis of temporal bone/skull base
pts with diabetes or immunocompromised are at highest risk
What is the sx of a pt with malignant otitis externa?
How do you diagnose?
Tx?
foul-smelling discharge, granulations in ear canal, deep otalgia, cranial nerve palsies, HA
DX: CT- see osseous erosion
Tx: IV- abx (quinilones), surgery
How do you treat Hematoma of the external ear?
+ name of complication
Drainage to prevent significant ear deformity or blockage of canal (“Cauliflower ear”)
Must be recognized promptly
What is acute otitis media? What is it normally precipitated by?
Bacterial infection of the middle ear
usually precipitated by URI
What are the reasons for having underlying poor drainage from Eustachian tubes? (3)
- age
- inflammation/edema
- congenital malformation
Most common causative organisms of acute otitis media?
- Streptococcus pneumoniae
- Haemophilus influenza
- Moraxella catarrhalis
- Strep pyrogens
- Staph aureus
Who is acute otitis media most common in, when?
- children 4-24 months
- increased in fall and winter
What are risk factors of acute otitis media?
- fam hx
- day care
- lack of breastfeeding
- tobacco smoke/air pollution
- pacifier use
Clinical presentation and PE findings in pt with acute otitis media
Presentation:
- otalgia/pressure
- hearing loss
- fever
- URI sx
PE:
- TM will be immobile w/ erythema and bulging
- TM may rupture
Bullae is associated with?
mycoplasma infection
exam finding on TM
1st line tx of acute otitis media
Amoxicillin
-pt with allergy= cephalosporin or macrolide
What kind of tx do you need to include in pt with perforated TM?
topical abx with low ototoxicity (ofloxacin)
What is a way to prevent acute otitis media? (hint: is something we can recommend/give as providers)
vaccinate against strep pneumo
What is the observation way of treatment in acute otitis media?
Who do you give abx to immediately?
obs- then give abx only if worsening or no improvement in 48-72 hrs
Abx:
- children < 6 mo
- children < 24 mo if severe
Complications of acute otitis media
- labyrinthitis
- hearing loss
- mastoiditis
- non-response to meds
- recurrent infection: tympanostomy (PE tubes)
What is the presentation of chronic otitis media?
What could you see on exam?
chronic otorrhea
- perforated TM
- conductive hearing loss
Tx of chronic otitis media
- removal of infected debris
- earplug use
- topical or oral abx
- surgery- TM repair
What is serous otitis media caused by?
prolonged blockage of Eustachian tube
negative pressure causes transudation of fluid into middle ear
Who is serous otitis media more common in? Why?
Children
Eustachian tubes are narrower and more horizontal
How might a pt with serous otitis media present?
PE findings?
- no acute signs of illness or inflammation
- conductive hearing loss
- fullness
PE:
- TM is dull and hypomobile
- bubbles visible
- conductive hearing loss
how do you treat serous otitis media?
?degongestants
?antihistamines
nasal steroids- if allergies
(no abx because not bacterial infection!)
What is Cholesteatoma? Explain how it is caused
-type of chronic otitis media
- most commonly due to chronic Eustachian tube dysfunction
- chronic negative pressure draws in a part of the TM
- creates a sac lined w/ squamous epithelium- produces keratin
Presentation and PE of cholesteatoma
Presentation:
- chronic infection- ear drainage
- asymptomatic or hearing loss
PE:
TM pocket
TM perforation exuding debris
Treatment and complication of Cholestratoma
Tx:
- abx drops
- surgical removal
Complication:
-erosion into inner ear, facial nerve, brain abscess
What Eustachian tube dysfunction? caused by?
edema of tubal lining-> air trapped in middle ear causing negative pressure
Often follows viral URI or allergies
If a pt has Eustachian tube dysfunction, what might they complain of?
- fullness
- fluctuating hearing
- pain w/ pressure change
- popping or cracking sensation
What might you see on exam of pt with Eustachian tube dysfunction?
- retraction of TM
- decrease mobility of TM on pneumatic otoscopy
How do you treat Eustachian tube dysfunction?
- decongestants (topical or systemic)
- autoinflation (swallowing, yawning, blowing against pinched nostril)
- desensitization therapy (allergies)
- intranasal corticosteroids
ETD causes increased risk of?
serous otitis media
what is otic barotrauma?
inability to equalized the pressure exerted on the middle ear during:
air travel
rapid altitude change
underwater diving
In barotrauma, is otalgia more likely during airplane descent or ascent?
descent
How do you treat barotrauma?
Enhance Eustachian tube function:
- take systemic decongestants or use topical nasal decongestants
- Pt education: swallow/yawn/autoinflate frequently during airplane descent
Complications of otic barotrauma
- TM rupture
- persistent pressure after landing
For diving if descend too quickly:
- hemotympanum
- perilymphatic fistula
How do small vs large TM ruptures heal?
What is important to avoid with TM rupture
Small- close on their own
large- may require tympanoplasty
do not let water get in ear
avoid ototoxic ear drops (aminoglycoside)
