Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Foundations II Exam 1 > Ear I > Flashcards

Ear I Flashcards

1
Q

Disorders of external ear?

Disorders of middle ear?

A

Disorders of external ear

  • Cerumen impaction
  • Foreign body
  • Otitis externa (and malignant otitis externa)
  • Hematoma
  • Ramsey Hunt syndrome

Disorders of middle ear

  • Eustachian tube disorder
  • Acute otitis media
  • Chronic otitis media
  • Otitis media with effusion (serous otitis media)
  • Cholesteatoma
  • TM perforation
  • Otic barotrauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Weber and Rinne

  • What is a normal test?
  • What are the results for conductive and sensorineural hearing loss?
A

Weber (on top of head)

  • Normal exam: sound equal on both ears
  • Conductive: lateralizes to crummy ear
  • Sensorineural: lateralizes to super ear

Rinne (hold on mastoid bone)

  • Normal exam: AC > BC
  • Conductive: BC > AC
  • Sensorineural: AC > BC (normal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cerumen impaction

  • Physiology
  • Pathophysio
  • Clinical presentation
  • Treatment
    • Cautions during irrigation
  • Patient education
A

Cerumen impaction

  • External ear
  • Physiology
    • Cerumen is a protective secretion of external canal
  • Pathophysio
    • Most are self-induced
  • Clinical presenation
    • Hearing loss (MC)
    • Earache or fullness
    • Itchiness
    • Reflex cough
    • Dizziness
    • Tinnitus
  • Treatment
    • Detergent ear drops (Debrox / carbamide peroxide)
    • Mechanical removal
    • Irrigation
      • Body temp water
      • Do only if TM is intact
      • Canal needs to be dried after irrigation
  • Patient education
    • Proper hygiene
    • Do not put anything into ear canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Foreign body

  • Affects who most?
  • Urgent if?
  • Clinical presentation
  • Treatment
    • Firm objects
    • Organic fb
  • Complications
A

Foreign body

  • External ear
  • Affects children > adults
  • Urgent if:
    • Button batteries
    • Live insects
    • Penetrating foreign body
  • Clinical presentation
    • Usually asymptomatic
    • Hearing loss
    • Pain
    • Drainage
    • Chronic coughs / hiccups
  • Treatment
    • Firm object
      • Remove with loop or hook
      • Irrigation
      • Avoid pushing object closer closer to TM
    • Organic foreign bodies (e.g. beans, insects)
      • Do NOT irrigate
      • Immobilize living insects (use lidocaine)
  • Complications
    • Damage to canal
    • TM perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Otitis externa (swimmer’s ear)

  • Physiology
  • Causes
  • Risk factors
  • Clinical presentation
  • Physical exam
  • Differential diagnosis
  • Diagnostics
  • Treatment
  • Complications
A

Otitis externa (swimmer’s ear)

  • External ear
  • Physiology
    • Inflammation of external auditory canal
  • Causes
    • Infection (MC)
    • Allergic
    • Dermatologic condition
    • Bacteria
      • Gram negative rods
      • Pseudomonas (MC)
      • Fungi
  • Risk factors
    • Swimmers
    • Chronic exposure to water
    • Warm summer months
    • Warmer climates with high humidity
    • Debris from dermatologic conditions (e.g. psoriasis)
    • Trauma
    • Occulusive devices
  • Clinical presentation
    • Otalgia
    • Pruritis
    • Purulent discharge
    • Hearing loss
    • Fullness
    • Hx of recent water exposure
    • Hx of mechanical trauma
  • Physical exam
    • Fungal infection: more black and more itching
    • Erythema and edema of ear canal
    • Purulent exudate
    • Tenderness with tragal pressure or manipulation of auricle
    • TM may be erythematous
    • TM will move normally with pneumatic otoscopy
    • Edema of canal may be so significant that TM is not visible
  • Different diagnosis
    • Middle ear disease
    • Contact dermatitis
    • Psoriasis
    • Chronic suppurative otitis media
    • Squamous cell carcinoma of external canal
      • MC neoplasm of ear canal
      • Can mimic chronic infection
    • HSV - Ramsay Hunt
    • Radiation therapy
  • Diagnositcs
    • None needed
    • Can culture if recurrent or non responsive to tx
  • Treatment
    • 7-10 days with topical (otic suspension) of aminoglycoside or fluoroquinolone
      • With or without corticosteroids
      • Careful of ototoxicity with aminoglycosides! Must ensure TM is intact first.
    • Keep canal dry
    • Avoid moisture and scratching
    • Remove debris
    • Place wick if lots of swelling
    • May need oral abx if there is cellulitis or periauricular tissue
    • Refer to ENT with persistent OE who has DM or is immunocompromised
  • Complications
    • Periauricular cellulitis
    • Contact dermatitis (secondary, from medication)
    • Malignant otitis externa (most serious)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ramsay Hunt Syndrome (HSV - herpes zoster oticus)

  • Clinical presentation
A

Ramsay Hunt Syndrome (HSV - herpes zoster oticus)

  • External ear
  • Rare
  • Clinical presentation
    • Vesicles
    • Ear pain
    • Ipsilateral facial paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Malignant otitis externa

  • AKA
  • Complication from
  • Highest risk
  • Clinical presentation
  • How to dx
  • Treatment
A

Malignant otitis externa

  • External ear
  • Serious complication from OE
  • Necrotizing otitis externa
  • Osteomyelitis of temporal bone
  • Highest risk
    • DM
    • Immunocompromised
  • Clinical presentation
    • Foul smelling discharge
    • Granulations in canal
    • Deep otalgia
    • Cranial nerve palsies
    • Headache
  • Diagnosis
    • CT - osseous erosion
  • Treatment
    • IV antibiotics (quinolones)
    • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hematoma of external ear

  • Causes
  • Treatment
  • Complications
A

Hematoma of external ear

  • Cause: usually due to trauma, like in wrestling
  • Treatment: drainage
  • Must be recognized promptly, or necrosis can occur and permanent damage, like cauliflower ear can happen
  • Complications: cauliflower ear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute otitis media

  • Pathophysiology
    • Usually starts with
    • Causes of poor draining from eustachian tubes
  • Etiology
  • Epidemiology
  • Risk factors
  • Clinical presentation
  • Physical exam
  • Differential diagnosis
  • Treatment
  • When is observation okay
  • Complications
A

Acute otitis media

  • Middle ear
  • Pathophysiology
    • Bacterial infection of middle ear
    • Usually starts with URI
      • Eustachian tube becomes blocked
      • Fluid accumulates and secondary infection forms
    • Underlying poor drainage from eustachian tubes due to
      • Age
      • Inflammation
      • Congenital malformation
  • Etiology
    • Most commonly caused by
      • Strepococcus pneumonia
      • Haemophilus influenza
    • Recurrent cases associated with allergies and 2nd hand smoke
  • Epidemiology
    • Most common in children ages 4 - 24
    • Peak between 6-18 months
    • Increased in fall and winter
  • Risk factors
    • Family hx
    • Day care
    • Lack of breast feeding
    • Tobacco smoke / air pollution
    • Pacifier use
  • Clinical presentation
    • Otalgia
    • Pressure
    • Hearing loss
    • Fever
    • URI symptoms
  • Physical exam
    • TM is immobile, erythematous, and bulging
    • TM may rupture
    • Bullae is associated with mycoplasma infection
  • Differential diagnosis
    • Otitis media with effusion
    • Otitis externa
    • Eustachian tube disorder
    • Herpes zoster
    • Head or neck infection
  • Treatment
    • High dose amoxicillin
      • 80-90 mg a day
    • If PCN allergie, use cephalosporin, doxycyline, or macrolide
    • If amoxicillin fails, use high dose Augmentin (amoxicillin-clavulanate) or 2nd/3rd generation cephalosporin
    • Can also use analgesics and prevention (immunizations)
  • Treatment with perforated TM
    • Add topical abx with low ototoxicity (ofloxacin)
  • Immediately start abx for
    • Under 6 months
    • Under 24 months if severe
      • Moderate or severe pain
      • Pain for over 48 hours
      • Tempe over 102.2 F
      • Bilateral AOM
  • Observation okay if
    • Use abx only if worsening or no improvement in 48-72 hours
    • 6 months to 2 years with unilateral AOM and mild symptoms
    • Greater than 2 years with uni or bilateral AOM, if not severe
  • Complications
    • Labyrinthitis
    • Hearing loss
    • Mastoiditis (most serious)
      • Spiking fevers, post auricular pain, erythema
      • Treatment: IV abx or mastoidectomy
    • Not responsive to meds
      • If resistant organisms, check resistance patterns and change abx
    • Recurrent infection
      • Typanostomy tubes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic otitis media

  • Etiology
  • Clinical presentation
  • Physical exam
  • Treatment
A

Chronic otitis media

  • Eitology: recurrent AOM
  • Clinical presentation: chronic otorrhea (drainage)
  • Physical exam
    • Perforated TM
    • Conductive hearing loss
  • Treatment
    • Remove infected debris
    • Earplug use (to prevent things from getting into ear)
    • Topical or oral abx
    • Sx for TM repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Serous otitis media (otitis media with effusion)

  • Pathophysiology
  • Epidemiology
  • Clinical presentation
  • Physical exam
  • Treatment
A

Serous otitis media (otitis media with effusion)

Pathophysiology

  • Eustachian tube stays blocked for prolonged time
  • Negative pressure causes transudation of fluid into middle ear

Epidemiology

  • More common in children - eustachian tubes are narrower and more horizontal
  • Less common in adults - occurs after URI, barotrauma, or with chronic allergies

Clinical presentation

  • No signs of illness or inflammation
  • Conductive hearing loss
  • Fullness

Physical exam

  • TM is dull and hypomobile
  • Bubbles visible
  • Conductive hearing loss

Treatment

  • Decongestants
  • Antihistamines
  • Nasal steroids - if underlying allergies
  • Ventilating tubes - if resistant case
  • Can take 3-12 weeks to resolve, but do not wait more than 12 weeks to refer to ENT (especially with children because it can cause problems with speech development)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cholesteatoma

  • What is it
  • Etiology
  • Clinical presentation
  • Physical exam
  • Treatment
  • Complications
A

Cholesteatoma

  • Type of chronic otitis media
  • Looks like a growth or sac on the TM

Etiology

  • MC cause: eustachian tube dysfunction
  • Chronic negative middle ear pressure draws in a part of the TM
  • Creates a sac lined with squamous epithelium - produces keratin
  • Can get secondarily infected by Pseudomonas or Proteus

Clinical Presentation

  • Chronic discharge (it is a chronic infection)
  • Hearing loss or can be asymptomatic

Physical exam

  • TM pocket
  • TM perforation exuding debris

Treatment

  • Abx drops
  • Sx removal

Complications

  • Erosion into inner ear, facial nerve, brain abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Eustachian tube dysfunction

  • What is it
  • Etiology
  • Clinical presentation
  • Physical exam
  • Treatment
  • Complications
A

Eustachian tube dysfunction

  • Eustachian tube connects middle ear to nasopharynx
  • Provides ventilation and drainage for middle ear
  • It is normally closed, only opening during swallowing and yawning

Etiology

  • Edema of tubal lining, air is trapped in middle ear causing negative pressure
  • Viral URI
  • Allergies

Clinical presentation

  • Fullness
  • Fluctuating hearing
  • Pain with pressure change
  • Popping or crackling sensation

Physical exam

  • Retraction of TM
  • Decreased motility of TM

Treatment

  • Avoid air travel, altitude change, and underwater diving during symptoms
  • Decongestants
  • Autoinflation
  • Desensitization therapy (allergies)
  • Intranasal corticosteroids
  • Surgerical

Complications

  • Increased risk for serous otitis media
  • Cholesteatoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Otic barotrauma

  • Pathophysiology
  • Clinical presentation
  • Treatment
  • Complications
A

Otic barotrauma

Pathophysiology

  • Inability to equalize the pressure exerted on the middle ear during
    • Air travel
    • Rapid altitide change
    • Underwater diving
  • Poor eustachian tube function is a precursor and can be due to
    • Mucosal edema
    • Congenital narrowing

Clinical presentation

  • Otalgia
  • More likely during airplane descent

Treatment

  • Enhance eustachian tube function
    • Take systemic decongestants a few hours before air travel
    • Use topical nasal decongestants one hour before descent

Patient education

  • Swallow, yawn, or autoinflate frequently during airplane descent
  • Equalize pressure during descent phase of diving
  • You should NOT be diving if you have ETD

Complications

  • TM rupture (middle ear infection often follows a TM rupture)
  • Persistent pressure after landing
    • Decongestants’
    • Autinflation
    • Myringotomy
    • Ventilating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TM perforation

  • Small vs large
  • Avoid
A

TM perforation

  • Small ruptures in TM will close on their own
  • Larger ruptures may require tympanoplasty
  • Important to NOT let water in ear until rupture is closed
  • Avoid use of ototoxic ear drops (do NOT use aminoglycoside abx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly

Foundations II Exam 1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions