Ear Disorders Flashcards
Auricular Hematoma
- Collection of blood around the external ear
- Blunt trauma
- Sporting events or altercations
Auricular Hematoma management inlcudes?
- Prompt drainage to prevent the re-accumulation of blood
T or F
Cauliflower ear is the permanent deformity
- True
Auricular Hematoma management for < 2cm and present within 48 hours ?
- Needle aspiration
Auricular Hematoma management for > 2cm and present from 48 to 7 days ?
- I & D
Aftercare - Prevent re-accumulation of blood - Compression bandage or bolster - Recheck Every 24 hours For 3-5 days
Cerumen impaction
- Very common but most won’t build up
- Cerumen is a protective secretion
Cerumen impaction causes?
Repeated stimulation of the ear canal
- Ear plugs
- Loud music
- Ear buds
- Q-tips
Cerumen impaction symptoms?
- Feeling of fullness in the ear
- Pain in the ear
- Difficulty hearing, which may continue to worsen
- Tinnitus
- A feeling of itchiness in the ear
- Discharge from the ear
- Odor coming from the ear
- Dizziness
Cerumen impaction management ?
- Warm shower water
- Home wax removal kits
- Avoid Q tips
- Use something to soften the wax
1) Debrox
2) Colace - Irrigation
1) Commercial kits
2) Bulb suction
3) IV catheter - Warm water +
- Hydrogen peroxide
Cerumen impaction management preferred treatment ?
- The least invasive method
A cooperative patient helps facilitate the removal of a foreign body ?
T or F
- True
Removal of a foreign body ?
Attempted with
- Loop
- Irrigation
- Commercial devices
- Alligator forceps
- Lights for insects
Should you consider Abx for a pt with a foreign body?
T or F
- True
- For trauma to the canal
Otitis externa
- Infection of the external auditory canal
Otitis externa causes include?
- Warm summer months
- Frequent swimming
- Warm humid environment
- Mechanical trauma
- Scratching
Most common pathogen causing Otitis Extrerna ?
1 Pseudomonas MC
#3 Anerobes Bacteroides Clostridil Strep Fungi
Otitis externa presenting symptoms?
- Ear pain - Very Painful
- Pruritus
- Discharge
- Hearing loss
Otitis externa PE findings?
- Pain with manipulation of the tragus or auricle
- Insertion of the otoscope may be very painful
- Ear canal: edema and erythema
- Debris and cerumen
- TM
Partially visible
Fully visible
Depending on degree of swelling
Otitis Externa management includes ?
- Clean out the ear canal
- Gentle irrigation
- Goal is to reduce inflammation and infection
Otitis Externa topical Abx Tx includes?
- Cetraxal otic (Cipro)
- Ofloxacin (generic)
Combination
Abx + Steroids
- Ciprodex (Cipro + dexamethasone)
- Cipro HC (Cipro + hydrocortisone)
- TobraDex (tobramycin + dexamethasone)
Insert a wick for severely edematous canals
When to use Oral Abx for Otitis Externa treatment?
- Deep tissue infections that extend beyond the EAC
- Infections not responding to topical drops
- First line choice: Quinolones
(pseudomonas coverage)
Otitis externa pain medication is helpful wen treating ?
T or F
- True
- NSAIDS
- Narcotics might be required
Otitis Externa follow up should be ?
- 24 hours if wick is in place
- 48 to 72 hrs if not improving
- Because infection can spread
Another name for Otitis Externa ?
- Swimmers Ear
Oral or Systemic antibiotics are specifically not recommended for Otitis externa unless the patient is ?
- Immunocompromised
or
- Infection is spreading to the pinna cartilage of the external ear
- Outside of the external auditory canal
Eustachian Tube Dysfunction
- Common in adults
- Difficulty equalizing the pressure associated with changes in altitude
Eustachian Tube Dysfunction associated with?
- Upper respiratory infection
- Allergic Rhinitis
Eustachian Tube Dysfunction
- Swelling around the opening of the Eustachian tube in the nasopharynx
- Cannot ventilate or open the tube
Adult Eustachian Tube Dysfunction adult pt’s complain of ?
- Fullness in their ear
- Often mistake the fullness for an “Ear infection”
- Pain along the jaw line on affected side
- Very painful as pressure is allowed to build up in the middle ear
What exacerbates the pain of eustachian tube dysfunction ?
- Sniffling from nasal congestion
- Changes in altitude (flying, diving)
Eustachian tube dysfunction PE findings?
- Dull retracted TM that does not move
- No cone of light present
- Due to pressure difference
Eustachian tube dysfunction treatment includes?
- Self-care
(Yawn, swallow, chew gum or sip on a straw to auto-inflate the Eustachian tube) - A Valsalva will also help to maintain the patency of the Eustachian tube
Eustachian tube dysfunction medication treatments include?
- Afrin (Immediate relief)
MAX of 3 days - Nasal steroids for ongoing care
What happens if you use Afrin for more than 3 days?
- Rebound congestion due to over use
Barotrauma
- Failure of the Eustachian tube to allow pressure equalization
- Bruising
- Bleeding
- Or Rupture of the ear drum
- Even perilymph fistula
Barotrauma symptoms include?
- Pain
- Hearing loss
- Vertigo
Avoidance of barotrauma ?
- Nose/throat congestion, avoid flying / diving until better
- May use phenylephrine nose drops as prophylaxis 30 min-1 hour before ascent or descent
- Outside pressure increasing : yawn, chew gum, swallow
- Outside pressure decreasing: pinch nose shut, mouth closed, blow gently through nose
Otitis Media with Effusion
- Middle ear fluids
- Without signs of inflammation or illness
- Usually follows AOM but can be due to
1) Allergies
or
2) Barotrauma - Eustachian tube dysfunction
Predisposing factor
Effusion in the ear is always due to infections?
T or F
- False
Acute otitis media (AOM)
- Extremely common in children
- Middle ear fluid
1) Inflammation
2) Infection - Related to obstruction of the Eustachian tube
In children an URI can lead to ?
- AOM
- Acute Otitis Media
Most common pathogens of AOM?
1 Strep. Pneumoniae (44%) (CAP)
Acute otitis media symptoms include?
- Fever
- Ear pain
- Diminished hearing
Acute otitis media PE findings?
- Typically unilateral but not always
- Erythematous
- Bulging tympanic membrane
- Opacification
- Lack of or poor mobility
The detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of otitis media with effusion (OME)
T or F
- True
Treatment for AOM ?
- Pain control
- Avoid inappropriate Abx use
- Prevent complications (mastoiditis)
- Sometimes oral abx required
Use Abx with AOM in patients ?
- Children < 2 YO
- Any child with ear drainage
- Moderate or severe ear pain
- Pain > 48 hours
- Fever > 102 F
- Immunodeficient or craniofacial abnormalities
- Uncertain access to follow up
T or F
May choose to observe AOM instead of ABx?
- True
- 70% self limited
