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Clinical Medicine II > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

Auricular Hematoma

A
  • Collection of blood around the external ear
  • Blunt trauma
  • Sporting events or altercations
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2
Q

Auricular Hematoma management inlcudes?

A
  • Prompt drainage to prevent the re-accumulation of blood
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3
Q

T or F

Cauliflower ear is the permanent deformity

A
  • True
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4
Q

Auricular Hematoma management for < 2cm and present within 48 hours ?

A
  • Needle aspiration
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5
Q

Auricular Hematoma management for > 2cm and present from 48 to 7 days ?

A
  • I & D
Aftercare
- Prevent re-accumulation of blood 
- Compression bandage or bolster 
- Recheck 
Every 24 hours 
For 3-5 days
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6
Q

Cerumen impaction

A
  • Very common but most won’t build up

- Cerumen is a protective secretion

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7
Q

Cerumen impaction causes?

A

Repeated stimulation of the ear canal

  • Ear plugs
  • Loud music
  • Ear buds
  • Q-tips
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8
Q

Cerumen impaction symptoms?

A
  • 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
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9
Q

Cerumen impaction management ?

A
  • 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
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10
Q

Cerumen impaction management preferred treatment ?

A
  • The least invasive method
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11
Q

A cooperative patient helps facilitate the removal of a foreign body ?

T or F

A
  • True
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12
Q

Removal of a foreign body ?

A

Attempted with

  • Loop
  • Irrigation
  • Commercial devices
  • Alligator forceps
  • Lights for insects
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13
Q

Should you consider Abx for a pt with a foreign body?

T or F

A
  • True

- For trauma to the canal

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14
Q

Otitis externa

A
  • Infection of the external auditory canal
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15
Q

Otitis externa causes include?

A
  • Warm summer months
  • Frequent swimming
  • Warm humid environment
  • Mechanical trauma
  • Scratching
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16
Q

Most common pathogen causing Otitis Extrerna ?

A

1 Pseudomonas MC

#3 Anerobes
Bacteroides
Clostridil
Strep
Fungi
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17
Q

Otitis externa presenting symptoms?

A
  • Ear pain - Very Painful
  • Pruritus
  • Discharge
  • Hearing loss
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18
Q

Otitis externa PE findings?

A
  • 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

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19
Q

Otitis Externa management includes ?

A
  • Clean out the ear canal
  • Gentle irrigation
  • Goal is to reduce inflammation and infection
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20
Q

Otitis Externa topical Abx Tx includes?

A
  • 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

21
Q

When to use Oral Abx for Otitis Externa treatment?

A
  • Deep tissue infections that extend beyond the EAC
  • Infections not responding to topical drops
  • First line choice: Quinolones
    (pseudomonas coverage)
22
Q

Otitis externa pain medication is helpful wen treating ?

T or F

A
  • True
  • NSAIDS
  • Narcotics might be required
23
Q

Otitis Externa follow up should be ?

A
  • 24 hours if wick is in place
  • 48 to 72 hrs if not improving
  • Because infection can spread
24
Q

Another name for Otitis Externa ?

A
  • Swimmers Ear
25
Q

Oral or Systemic antibiotics are specifically not recommended for Otitis externa unless the patient is ?

A
  • Immunocompromised

or

  • Infection is spreading to the pinna cartilage of the external ear
  • Outside of the external auditory canal
26
Q

Eustachian Tube Dysfunction

A
  • Common in adults

- Difficulty equalizing the pressure associated with changes in altitude

27
Q

Eustachian Tube Dysfunction associated with?

A
  • Upper respiratory infection

- Allergic Rhinitis

28
Q

Eustachian Tube Dysfunction

A
  • Swelling around the opening of the Eustachian tube in the nasopharynx
  • Cannot ventilate or open the tube
29
Q

Adult Eustachian Tube Dysfunction adult pt’s complain of ?

A
  • 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
30
Q

What exacerbates the pain of eustachian tube dysfunction ?

A
  • Sniffling from nasal congestion

- Changes in altitude (flying, diving)

31
Q

Eustachian tube dysfunction PE findings?

A
  • Dull retracted TM that does not move
  • No cone of light present
  • Due to pressure difference
32
Q

Eustachian tube dysfunction treatment includes?

A
  • 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
33
Q

Eustachian tube dysfunction medication treatments include?

A
  • Afrin (Immediate relief)
    MAX of 3 days
  • Nasal steroids for ongoing care
34
Q

What happens if you use Afrin for more than 3 days?

A
  • Rebound congestion due to over use
35
Q

Barotrauma

A
  • Failure of the Eustachian tube to allow pressure equalization
  • Bruising
  • Bleeding
  • Or Rupture of the ear drum
  • Even perilymph fistula
36
Q

Barotrauma symptoms include?

A
  • Pain
  • Hearing loss
  • Vertigo
37
Q

Avoidance of barotrauma ?

A
  • 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
38
Q

Otitis Media with Effusion

A
  • 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
39
Q

Effusion in the ear is always due to infections?

T or F

A
  • False
40
Q

Acute otitis media (AOM)

A
  • Extremely common in children
  • Middle ear fluid
    1) Inflammation
    2) Infection
  • Related to obstruction of the Eustachian tube
41
Q

In children an URI can lead to ?

A
  • AOM

- Acute Otitis Media

42
Q

Most common pathogens of AOM?

A

1 Strep. Pneumoniae (44%) (CAP)

43
Q

Acute otitis media symptoms include?

A
  • Fever
  • Ear pain
  • Diminished hearing
44
Q

Acute otitis media PE findings?

A
  • Typically unilateral but not always
  • Erythematous
  • Bulging tympanic membrane
  • Opacification
  • Lack of or poor mobility
45
Q

The detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of otitis media with effusion (OME)

T or F

A
  • True
46
Q

Treatment for AOM ?

A
  • Pain control
  • Avoid inappropriate Abx use
  • Prevent complications (mastoiditis)
  • Sometimes oral abx required
47
Q

Use Abx with AOM in patients ?

A
  • 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
48
Q

T or F

May choose to observe AOM instead of ABx?

A
  • True

- 70% self limited

Clinical Medicine II (9 decks)

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