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Foundations II (Jess) > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

Explain the Weber test

A

Place tuning fork on midline of head/forehead.
Conductive hearing loss= lateralized to bad ear
sensorineural loss= lateralized to good ear

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2
Q

Explain the Rinne test

A

Place tuning fork on the mastoid and then move beside ear and ask if audible

In nl: AC > BC
Conductive: BC > AC

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3
Q

Most common cause of cerumen impaction?

clinical presentation?

A

self-induced

hearing loss
earache
itchiness
reflex cough
dizziness
tinnitus
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4
Q

Tx of cerumen impaction

A
  • detergent ear drops
  • mechanical removal
  • irrigation
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5
Q

Requirements for irrigating the ear

A
  • body temp water
  • perform only when you know TM is intact
  • canal need to be dried after irrigation
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6
Q

What are the most common symptoms of foreign body in the ear?

A

often asymptomatic!

  • decreased hearing/pain
  • drainage
  • chronic cough/hiccups
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7
Q

Treatment of FB in the ear:
what is urgent?
how it it performed?

A

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
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8
Q

Other name for Otitis Externa and most common bacterial cause

A

Swimmer’s ear

Pseudomonas- 38%- gram negative rod

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9
Q

Risk factors of Otitis Externa

A
  • warmer climates w/ high humidity
  • increased water exposure
  • debris form dermatologic conditions- psoriasis
  • trauma
  • occlusive devices
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10
Q

Clinical presentation of otitis externa

A 
otalgia
pruritis
purulent discharge
hearing loss
fullness
hx of recent water exposure or mechanical trauma
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11
Q

What might you see on PE of a pt with otitis externa?

A
  • 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
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12
Q

How do you treat otitis externa?

A
  • 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
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13
Q

Most common neoplasm of the ear canal?

A

squamous cell carcinoma of external canal

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14
Q

What is another name for HSV of the outer ear canal?

A

Ramsay Hunt syndrome

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15
Q

Complications of otitis externa

A
  • periauricular cellulitis
  • contact dermatitis (most common= from neomycin)
  • malignant otitis externa
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16
Q

What is malignant otitis externa?

who is at risk?

A

Osteomyelitis of temporal bone/skull base

pts with diabetes or immunocompromised are at highest risk

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17
Q

What is the sx of a pt with malignant otitis externa?
How do you diagnose?
Tx?

A

foul-smelling discharge, granulations in ear canal, deep otalgia, cranial nerve palsies, HA

DX: CT- see osseous erosion

Tx: IV- abx (quinilones), surgery

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18
Q

How do you treat Hematoma of the external ear?

+ name of complication

A

Drainage to prevent significant ear deformity or blockage of canal (“Cauliflower ear”)

Must be recognized promptly

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19
Q

What is acute otitis media? What is it normally precipitated by?

A

Bacterial infection of the middle ear

usually precipitated by URI

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20
Q

What are the reasons for having underlying poor drainage from Eustachian tubes? (3)

A
  • age
  • inflammation/edema
  • congenital malformation
21
Q

Most common causative organisms of acute otitis media?

A
  • Streptococcus pneumoniae
  • Haemophilus influenza
  • Moraxella catarrhalis
  • Strep pyrogens
  • Staph aureus
22
Q

Who is acute otitis media most common in, when?

A
  • children 4-24 months

- increased in fall and winter

23
Q

What are risk factors of acute otitis media?

A
  • fam hx
  • day care
  • lack of breastfeeding
  • tobacco smoke/air pollution
  • pacifier use
24
Q

Clinical presentation and PE findings in pt with acute otitis media

A

Presentation:

  • otalgia/pressure
  • hearing loss
  • fever
  • URI sx

PE:

  • TM will be immobile w/ erythema and bulging
  • TM may rupture
25
Q

Bullae is associated with?

A

mycoplasma infection

exam finding on TM

26
Q

1st line tx of acute otitis media

A

Amoxicillin

-pt with allergy= cephalosporin or macrolide

27
Q

What kind of tx do you need to include in pt with perforated TM?

A

topical abx with low ototoxicity (ofloxacin)

28
Q

What is a way to prevent acute otitis media? (hint: is something we can recommend/give as providers)

A

vaccinate against strep pneumo

29
Q

What is the observation way of treatment in acute otitis media?
Who do you give abx to immediately?

A

obs- then give abx only if worsening or no improvement in 48-72 hrs

Abx:

  • children < 6 mo
  • children < 24 mo if severe
30
Q

Complications of acute otitis media

A
  • labyrinthitis
  • hearing loss
  • mastoiditis
  • non-response to meds
  • recurrent infection: tympanostomy (PE tubes)
31
Q

What is the presentation of chronic otitis media?

What could you see on exam?

A

chronic otorrhea

  • perforated TM
  • conductive hearing loss
32
Q

Tx of chronic otitis media

A
  • removal of infected debris
  • earplug use
  • topical or oral abx
  • surgery- TM repair
33
Q

What is serous otitis media caused by?

A

prolonged blockage of Eustachian tube

negative pressure causes transudation of fluid into middle ear

34
Q

Who is serous otitis media more common in? Why?

A

Children

Eustachian tubes are narrower and more horizontal

35
Q

How might a pt with serous otitis media present?

PE findings?

A
  • no acute signs of illness or inflammation
  • conductive hearing loss
  • fullness

PE:

  • TM is dull and hypomobile
  • bubbles visible
  • conductive hearing loss
36
Q

how do you treat serous otitis media?

A

?degongestants
?antihistamines
nasal steroids- if allergies

(no abx because not bacterial infection!)

37
Q

What is Cholesteatoma? Explain how it is caused

A

-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
38
Q

Presentation and PE of cholesteatoma

A

Presentation:

  • chronic infection- ear drainage
  • asymptomatic or hearing loss

PE:
TM pocket
TM perforation exuding debris

39
Q

Treatment and complication of Cholestratoma

A

Tx:

  • abx drops
  • surgical removal

Complication:
-erosion into inner ear, facial nerve, brain abscess

40
Q

What Eustachian tube dysfunction? caused by?

A

edema of tubal lining-> air trapped in middle ear causing negative pressure

Often follows viral URI or allergies

41
Q

If a pt has Eustachian tube dysfunction, what might they complain of?

A
  • fullness
  • fluctuating hearing
  • pain w/ pressure change
  • popping or cracking sensation
42
Q

What might you see on exam of pt with Eustachian tube dysfunction?

A
  • retraction of TM

- decrease mobility of TM on pneumatic otoscopy

43
Q

How do you treat Eustachian tube dysfunction?

A
  • decongestants (topical or systemic)
  • autoinflation (swallowing, yawning, blowing against pinched nostril)
  • desensitization therapy (allergies)
  • intranasal corticosteroids
44
Q

ETD causes increased risk of?

A

serous otitis media

45
Q

what is otic barotrauma?

A

inability to equalized the pressure exerted on the middle ear during:
air travel
rapid altitude change
underwater diving

46
Q

In barotrauma, is otalgia more likely during airplane descent or ascent?

A

descent

47
Q

How do you treat barotrauma?

A

Enhance Eustachian tube function:

  • take systemic decongestants or use topical nasal decongestants
  • Pt education: swallow/yawn/autoinflate frequently during airplane descent
48
Q

Complications of otic barotrauma

A
  • TM rupture
  • persistent pressure after landing

For diving if descend too quickly:

  • hemotympanum
  • perilymphatic fistula
49
Q

How do small vs large TM ruptures heal?

What is important to avoid with TM rupture

A

Small- close on their own
large- may require tympanoplasty

do not let water get in ear
avoid ototoxic ear drops (aminoglycoside)

Foundations II (Jess) (8 decks)

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