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ENT > Ear Dz > Flashcards

Ear Dz Flashcards

1
Q

Eustachian Tube Dysfxn (ETD)

A

Blockage or dysfxn of the eustachian tube
May occur with pressure changes or infxn
Most common in kids <5 yrs

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2
Q

ETD Tx

A 
Decongestants (CI in HTN, cardiac risk factors)
Nasal steroids (buconase, flonase)
2nd gen antihistamines (claritin)
Antihistamine nasal sprays
Abx (if ass'd w/ OM, amox)
NSAID, APAP
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3
Q

Otitis Media

A

An infection of the middle ear with acute onset, presence of middle ear effusion, and signs of middle ear inflammation.
Common in kids

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4
Q

OM S/S

A 
Earache, otalgia
Most are afebrile
accompanying URI sx
irritability
Difficulty sleeping
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5
Q

OM otoscope exam

A

TM mobility decreases
Bulging TM
Decreased visibility of landmarks

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6
Q

Most common bacterial culprits of AOM

A

Strep pneumo (30 - 35%)
H. Flu (20 - 25%)
M. Cat

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7
Q

OM course

A

Symptoms usually resolve spontaneously in 24 hours.

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8
Q

OM Tx

A

Amoxacillin, augmentin
Z-pack
Pain, fever tx

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9
Q

OM w/ Effusion (OME)

A

The presence of middle ear effusion in the absence of acute signs of infxn.

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10
Q

S/S of OME

A

hearing loss
fullness in ear
Delayed speech language development
Generally painless

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11
Q

OME mgmt

A

Watchful waiting
should resolve in 3 months
Only tx is surgery if does not resolve

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12
Q

Chronic Suppurative Otitis

A

A perforated TM with persistent drainage from middle ear.

Chronic otorrhea

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13
Q

Chronic Suppurative Otitis cause

A

Initial episode of acute infection, granulation and perforation
Multiple episodes of AOM

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14
Q

Chronic Suppurative Otitis Bacterial causes

A

Pneudomonas (majority)
Staph A.
Klebs

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15
Q

Chronic Suppurative Otitis presentation

A

Otorrhea
Usually non-tender
Fever, pain, vertigo bad signs

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16
Q

Chronic Suppurative Otitis Tx

A

Remove exudate from canal (50% peroxide w/ sterile water)

Otic Abx?

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17
Q

Cholesteoma

A

A skin growth that occurs in the middle ear behind the eardrum.
Looks like cyst or pouch
Caused by repeated infxn, poor ET fxn

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18
Q

Cholesteoma presentation

A 
otorrhea
fullness in ear
Hearing loss
achy ear (esp. at night)
dizziness
unilateral facial weakness
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19
Q

Cholesteoma Tx

A

Referral

Surgical tx

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20
Q

Otitis Externa

A

Inflammation of the EAC or auricle.

Infectious, allergic, dermal dz

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21
Q

Otitis externa S/S

A 
Otalgia
pain at tragus when ear pulled
Pruritis
Discharge
Hearing loss
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22
Q

Otitis externa bacterial causes

A

Staph
Pneudomonas (swimmers)
Proteus

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23
Q

Otitis Externa Tx

A

Ear cleaning (w/ hydrogen peroxide, water)
Protect ear from water
Cortisporin (topical abx)

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24
Q

Malignant External Otitis

A

Necrotizing otitis externa
An invasive infxn of EAC and skull base
Common in elderly w/ DM
AIDS and immunocompromised

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25
Q

Most common cause of Malignant External Otitis

A

Pseudomonas (95%)

26
Q

Malignant External Otitis Presentation

A

Exquisite otalgia and otorrhea

granulation of inferior portion of EAC

27
Q

Complications of Malignant External Otitis

A

Osteolyelitis
Mastoiditis
TMJ osteomyelitis
Cranial nerve palsies

28
Q

Malignant External Otitis Tx

A

Ciprofloxacin 750 mg PO BID for 6-8 wks

No role for topical abx

29
Q

TM perforation S/S

A

Otorrhea
Sudden decrease in ear pain followed by drainage
Hearing loss
Tinnitus

30
Q

TM Perf Causes

A 
Middle ear infxn
barotrauma
Acoustic trauma
foreign objects
Loud, sudden noise
31
Q

TM Perf Tx

A 
Most heal on their own
Consider topical abx
keep ear dry
ear drum pach
Tympanoplasty
32
Q

Barotrauma

A

Usually begins with ET dysfxn
Most frequent cause is flying
Pressure in ear

33
Q

Barotrauma tx and prevention

A

Valsalva, decongestants

Chewing gum, yawning, swallowing

34
Q

Cerumen Impaction

A

Irrigate with water at body temp

Should only be performed when TM is intact

35
Q

Mastoiditis

A

A complication of AOM
Evolves several weeks after persistent AOM
Infection spreads to mastoid air cells
Leads to infxn and destruction of mastoid bone

36
Q

S/S of mastoiditis

A

Postauricular pain and erythema
Spiking fever
Tender mass

37
Q

Mastoiditis Tx

A

ENT consult
CT, MRI
Admission for IV abx

38
Q

Acoustic Neuroma (Vestibular Schwannoma)

A

Usually unilateral
Median age is 50 at dx
Benign, but can cause hydrocephalus

39
Q

Acoustic Neuroma S/S

A

Depend son nerves impacted
Hearing loss, tinnitus
Unsteadiness while walking
Facial numbness, pain, parasthesias

40
Q

Acoustic neuroma Dx and Tx

A

Referral, MRI, CT

Surgery

41
Q

Vertigo

A

A symptom of illusionary movement
Transient spinning, swaying, tilting, falling
Caused by asymmetry in vestibular system or involved structures.

42
Q

Peripheral Vertigo

A

Sudden onset
Horizontal nystagmus
Visual fixation stops nystagmus
Blurred Vision

43
Q

Central Vertigo

A 
Gradual onset of vertigo
Nystagmus generally vertical
Visual fixation does not stop nystagmus
Brainstem dysfxn
Instability
Weakness
Double vision
44
Q

Benign Paroxysmal Positional Vertigo (BPPV)

A

Dizziness caused by debris in the inner ear.

The debris is generally crystals formed by calcium carbonate

45
Q

BPPV S/S

A

Recurrent, brief episodes
Predictable head movements or positions precipitate sx
Horizontal nystagmus
Dix-Hallpike maneuver best for determining BPPV

46
Q

Dix-Hallpike maneuver

A

Bring pt from sitting to supine with head turned 45 degrees to side and extended 20 degrees backwards.
Positive test reveals burst of nystagmus

47
Q

BPPV Tx

A

Wait it out

Epley Maneuver

48
Q

Epley Maneuver

A

Sequential movement of head into four positions, waiting in each position for 30 seconds.
Repositions crystals

49
Q

Labyrinthitis

A 
Inflammation of the inner ear
Causes vertigo
May be accompanied by hearing loss
May be associated with URI
Generally goes away within days to weeks
50
Q

Labyrinthitis tx

A

Treat N/V

Diazepam, Lorazepam

51
Q

Meniere’s Dz

A

Endolymphatic Hydrops

Results from distention of endolymphatic compartment of the inner ear.

52
Q

Meniere’s Dz S/S

A

Episodic vertigo lasting 1-8 hrs
Can have N/V
Low frequency hearing loss Tinnitus
Aural pressure

53
Q

Meniere’s Dz Dx criteria

A
  1. 2 spontaneous episodes of rotational vertigo lasting at least 20 mins.
  2. Audiometric confirmation of sensorineural hearing loss.
  3. Tinnitus and/or aural fullness
54
Q

General Vertigo Syndrome Tx

A

Caffeine, tobacco, salt restriction
Meds:
Diuretics, antiemetics, antihistamines

55
Q

Presbycusis

A

Refers to sensorineural hearing loss in elderly patients.
Involves high-frequency hearing loss
Difficulty w/ speech discrimination

56
Q

Presbycusis Causes

A

Histologic changes with aging throughout the auditory system.

57
Q

Sensory Presbycusis

A

Refers to epithelial atrophy with loss of sensory hair cells in the organ of corti.

58
Q

Neural Presbycusis

A

Atrophy of nerve cells in the cochlea and central neural pathways.

59
Q

Metabolic Presbycusis

A

Atrophy of the stria vascularis which maintains chemical balance in the cochlea.
Generalized (flat) hearing loss because entire cochlea is infected.

60
Q

Presbycusis Tx

A

Amplification devices
Lip reading
Cochlear implants
Assisted listening devices

ENT (8 decks)

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