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PBR: Ophthalmology and ENT > Ear Disorders > Flashcards

Ear Disorders Flashcards

1
Q

A child with a preauricular pit is at increased risk for what kind of impairment?

A

Hearing impairment

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2
Q

Describe the relationship between preauricular sinus/pit and renal abnormalities.

A

There is no association between isolated preauricular sinus/pit and renal abnormalities. However, if the infant has other associated congenital abnormalities or hearing loss, a renal ultrasound should be performed to rule out associated syndromes.

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3
Q

What are the most common pathogens in otitis externa?

A

Pseudomonas aeruginosa and S. aureus

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4
Q

What physical exam finding can be used to distinguish otitis externa from otitis media?

A

Worsening pain with manipulation of the pinna is concerning for otitis externa, as it is not present in patients with otitis media.

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5
Q

What is the typical treatment for otitis externa?

A

Treatment consists of a topical antibiotic and glucocorticoid. Fluoroquinolones (ofloxacin and ciprofloxacin) are preferred, but aminoglycosides and polymyxin B may be used as well. Treat for 7-14 days. Fluoroquinolones are administered 2x/day, while the other antibiotics must be given 3-4x/day.

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6
Q

What is the typical management of foreign bodies in the ear?

A

Removal techniques include irrigation and instrumentation under direct visualization. Mineral oil or lidocaine can be placed in the ear canal to kill live insects prior to removal.

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7
Q

When should patients with foreign bodies of the ear be referred to ENT?

A

If proper instruments for removal are not available or if removal is difficult.

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8
Q

What is the recommended management of auricular hematoma?

A

Drain as soon as possible to prevent necrosis and cauliflower ear. Refer to ENT if drainage is delayed >7 days.

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9
Q

What is an auricular hematoma?

A

It is an accumulation of blood between the cartilage and the perichondrium that interrupts the blood supply to the cartilage.

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10
Q

What are the most common bacterial pathogens of acute otitis media?

A

S. pneumoniae, nontypeable H. influenzae, and Moraxella catarrhalis.

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11
Q

What are some (5) risk factors for development of otitis media?

A

Age (6-18 months), family history, day care attendance, lack of breastfeeding, and tobacco smoke exposure.

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12
Q

What physical exam findings are required for diagnosis of acute otitis media?

A

Bulging tympanic membrane, middle ear effusion, and opaque tympanic membrane.

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13
Q

What is the recommended antibiotic regimen for patients diagnosed with acute otitis media?

A

High dose (90 mg/kg/day) amoxicillin, with recommendation to broaden to amoxicillin/clavulanate or 2nd/3rd generation cephalosporin if patients fail to respond within 48 hours.

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14
Q

What is the recommended initial management of children 6 months - 2 years of age with unilateral AOM without otorrhea?

A

Observation, with initiation of antibiotic therapy only if the child worsens or fails to improve within 48-72 hours of onset.

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15
Q

What is the recommended initial management of children ≥2 years of age with unilateral or bilateral AOM without otorrhea?

A

Observation, with initiation of antibiotic therapy only if the child worsens or fails to improve within 48-72 hours of onset.

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16
Q

What is the definition of recurrent acute otitis media?

A

≥3 episodes in a 6 month period or ≥4 episodes in a 12 month period.

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17
Q

What is the recommended treatment for patients diagnosed with recurrent otitis media?

A

Prophylactic antibiotics (amox 40 mg/kg/day or sulfisoxazole 50 mg/kg/day) or tympanostomy tube placement.

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18
Q

What is otitis media with effusion and what is its typical clinical course?

A

It is a middle ear effusion without associated signs of infection. Spontaneous resolution typically occurs within 6 weeks.

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19
Q

Define chronic suppurative otitis media.

A

Chronic suppurative otitis media refers to a perforated tympanic membrane with chronic drainage lasting >6 weeks.

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20
Q

Which pathogens are typically implicated in chronic suppurative otitis media?

A

Pseudomonas and proteus

21
Q

What is the typical treatment for chronic suppurative otitis media?

A

Ototopical therapy with a quinolone (5 drops 3x/day for 2 weeks).

22
Q

What is a cholesteatoma?

A

An abnormal growth of squamous epithelium in the middle ear. Diagnosis is made on otoscopic exam when a white mass is visualized behind an intact ear drum.

23
Q

What are the worrisome complications of cholesteatoma?

A

Progressive growth can destroy the nearby ossicles, this causing hearing loss. It can also cause cranial nerve palsies and vertigo.

24
Q

In what patients is cholesteatoma more likely to be found?

A

Cholesteatoma occurs more commonly in children with recurrent or chronic otitis media, cleft palate, Trisomy 21, and Turner syndrome.

25
Q

What is the treatment for cholesteatoma?

A

Surgical removal is required, but there is >50% recurrence rate within 5 years of surgery.

26
Q

Define mastoiditis.

A

Mastoiditis occurs when the mastoid air cells of the temporal bone, which are contiguous with the middle ear cavity, become infected.

27
Q

What are the 3 most common pathogens in mastoiditis?

A

S. pneumoniae, S. pyogenes, and S. aureus.

28
Q

Describe the physical exam features typical of mastoiditis?

A

Fever; postauricular erythema, tenderness, and swelling; and protrusion of the auricle.

29
Q

What is the recommended treatment for uncomplicated mastoiditis?

A

IV Vancomycin +/- Ceftazidime or Cefepime until typanocentesis culture results are back. Once there is clinical improvement and culture results are known, the patient may be transitioned to oral antibiotics.

30
Q

At what decible threshold is a child considered to be deaf?

A

Deafness is defined as hearing loss at >90 dB.

31
Q

What is the definition of “mild” hearing loss?

A

“Mild” hearing loss is defined as a 25 dB hearing loss, but even a 15 dB loss can result in problems with speech perception, especially during early childhood.

32
Q

What is the pattern of inheritance for the majority of inherited deafness cases?

A

Deafness is inherited in ~50% of cases. Of these, 80% are inherited as autosomal recessive, 18% as autosomal dominant, and 2% as X-linked recessive.

33
Q

If a patient presents with syncope and hearing loss, what diagnosis should be suspected?

A

Jervell and Lange-Nielsen syndrome, which is a type of prolonged QT syndrome.

34
Q

What are the most common causes of conductive hearing loss in children?

A

Cerumen impaction, ossicular chain fixation, and fluid in the middle ear.

35
Q

What is the cause of conductive hearing loss?

A

Conductive hearing loss is due to disruption of mechanical components required for the transduction of sound wave energy.

36
Q

What is the cause of sensorineural hearing loss?

A

Sensorineural hearing loss is caused by dysfunction of the sensory epithelium, cochlea, or neural pathways leading to the auditory cortex via CN 8 and other connections.

37
Q

What is the most likely etiology for severe and profound hearing loss?

A

Severe and profound hearing loss is always sensorineural and most often affects higher frequencies.

38
Q

What is the most common infectious cause of congenital deafness?

A

CMV is the most common infectious cause of congenital deafness. It causes sensorineural hearing loss in 60% of symptomatic infants and 7% of asymptomatic infants.

39
Q

Name four congenital infections which can cause sensorineural hearing loss.

A

CMV, toxoplasmosis, rubella, and syphilis.

40
Q

List 9 risk factors for hearing loss in neonates.

A

FH of sensorineural hearing loss, congenital infection (especially CMV), presence of craniofacial anomalies, birth weight <1,500 g, neonatal jaundice requiring exchange transfusion, exposure to ototoxic medications, bacterial meningitis, Apgar scores ≤3 at 5 minutes, and physical findings consistent with a syndrome associated with hearing loss.

41
Q

What should you suspect in a child with hearing loss and a normal tympanogram?

A

Sensorineural hearing loss.

42
Q

What should you suspect in a child with hearing loss and a shallow tympanogram?

A

Ossicular fixation, TM scarring, or otosclerosis.

43
Q

What should you suspect in a child with hearing loss and a retracted or poorly mobile tympanogram?

A

Fluid behind the middle ear or perforation of eardrums.

44
Q

What should you suspect in a child with hearing loss and a negative pressure tympanogram?

A

Eustachian tube dysfunction

45
Q

How would you describe the tympanic membrane associated with this tympanogram? Fig 21-1***

A

Normal

46
Q

How would you describe the tympanic membrane associated with this tympanogram? Fig 21-2 ***

A

Shallow

47
Q

How would you describe the tympanic membrane associated with this tympanogram? Fig 21-3***

A

Disarticulation

48
Q

How would you describe the tympanic membrane associated with this tympanogram? Fig 21-4***

A

Retracted, poorly mobile

49
Q

How would you describe the tympanic membrane associated with this tympanogram? Fig 21-5***

A

Negative Pressure

PBR: Ophthalmology and ENT (9 decks)

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