Ear MDT Flashcards
Accumulation of blood in the subperichondrial space, usually secondary to blunt trauma
Tearing of the cartilage and the blood vessels can result in necrosis
Auricular hematoma
Superichondrial collection can lead to stimulation of the overlying perichondrium, which can lead to new cartilage formation and deformity.
Cauliflower ear
Treatment of:
Auricular hematoma
Local anesthesia
Semicircular incision to drain hematoma
Irrigation
Topical antibiotics and bandage
Symptoms and physical exam:
- Specific MOI
- Muffled sounds
- Severe pain
- Hearing disturbances/changes
Foreign body in the ear
Instruments of choice for removal of foreign objects in the ear
Cerumen loops/scoops, a right-angle hook, and alligator forceps
What should you use to drown live objects in the ear?
Lidocaine solution
What should you use for small particles such as sand or cerumen stuck in the ear?
Room temperature water
Symptoms and exam findings:
Decrease in hearing and or a sensation of pressure or fullness
Symptoms are often precipitated by the use of cotton-tipped applicators
Cerumen impaction
Cerumen impaction:
If irrigation fails, what can you use?
Cerumenolytic (Carbamide Peroxide)
-2 to 5 drops BID for 4 days
Complication of acute otitis media
Infection spreads from the middle ear to the mastoid air cells
The mastoid cavity becomes filled and inflamed
Mastoiditis
Sx: Postauricular pain and erythema accompanied by a spiking fever
Edema, tenderness, protrusion of the auricle, obliteration of the post auricular crease.
Mastoiditis
Labs/Studies:
Mastoiditis
Mastoid Radiography
CT
Culture and drainage
Treatment of:
Mastoiditis
IV antibiotics: -Ceftriaxone 240mg IV q 24 hours or -Levofloxacin 750mg IV q24 hours or -Cefazolin 0.5-1.5g IV TID
MEDEVAC (Medical emergency)
Diffuse inflammation of the external ear canal with or without inflammation of the auricle and/or tympanic membrane
Otitis Externa
Acute otitis externa is almost exclusively from what two organisms?
Pseudomonas aeruginosa
Staphylococcus aureus
Labs/studies:
Otitis externa
Gram staining of discharge
Treatment of:
Otitis externa
Acidification with drying agent (50/50 isopropyl alcohol/white vinegar)
Otic antibiotic or a suspension of aminoglycoside
-Fluoroquinolone or Neomycin/polymyxin B
Treatment of:
Severe otitis externa
Ciprofloxacin 500mg PO BID
Bacterial infection of the mucosal lined air-containing spaces of the temporal bone
Purulent material forms in middle ear and mastoid air cells and petrous apex
Usually precipitated by viral URI that causes blockage of eustachian tube
Otitis media
Most common pathogens for otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Streptococcus pyogenes
Sx: Otalgia, aural pressure, decreased hearing, and often fever and history of an URI
Erythema and hypomobility of tympanic membrane
Severe: TM bulging (rupture is imminent, Mastoid tenderness
Otitis media
Labs/Studies:
Otitis media
Tympanocentesis and fungal culture by an experienced physician
Treatment for:
Otitis media
Amoxicillin 1g TID 5-7 days
or
Amoxicillin/Clavulanate 2g/125mg PO BID 5-7 days
Nasal decongestants
Treatment for:
Otitis media with PCN allergies
Ceftriaxone 1g IM one dose
or
Doxycycline 100mg PO BID x 10 days
Surgical drainage of the middle ear, reserved for patients with severe otalgia or when complications of otitis have occured
Myringotomy
Represents a spectrum of disorders involving an impairment in the functional valve of the eustachian tube of the middle ear
Eustachian Tube Dysfunction (ETD)
Sx: Severe ear pain, fullness or “underwater sensation”, hearing loss or “muffled hearing”, tinnitus, “popping and snapping noises”
Eustachian tube dysfunction
Labs/studies:
Eustachian tube dysfunction
Audiometric testing for conductive hearing loss to established baseline with condition
Treatment for:
ETD
Pseudoephedrine
Oxymetazoline
Fluticasone propionate (Flonase)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Treatment for:
ETD
Pseudoephedrine
Oxymetazoline
Fluticasone propionate (Flonase)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
ETD:
Chronic cases, monitor pressure equalization tubes every:
6 to 12 months
Occur secondary to middle ear infections or as a result of barotrauma, blunt/penetrating/acoustic trauma, or lightning strikes
TM Perforation
When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the:
Pars Tensa (usually anteriorly or inferiorly)
Sx: Acute onset of pain and hearing loss; associated vertigo or tinnitus; nausea and vomiting; history of recurrent ear infections
Signs: Visible perforation of the tympanic membrane, otorrhea
TM Perforation
Treatment of:
TM Perforation
Spontaneous healing occurs in most cases
Systemic antibiotics
-Augmentin or Doxycycline
Perforations from penetrating trauma send to otolaryngologist within 24 hours.
Benign tumor (composed of stratified squamous epithelium) in the middle ear or mastoid.
Slowly growing lesion that destroys bone and normal ear tissue
Cholesteatoma
Most common cause of cholesteatoma
Prolonged eustachian tube dysfunction
Labs/studies:
Cholesteatoma
CT to visualize bony destruction
Treatment for:
Cholesteatoma
Surgical marsupialization of the sac or its complete removal
Refer urgently to ENT
Acute ear pain or damage to the tympanic membrane caused by rapid changes in pressure
Otic barotrauma
Most common etiology of barotrauma
Flying
Symptoms and physical exam:
- Middle ear pain
- Hearing loss due to deformation of tympanic membrane that can hinder membrane mobility
- Specific MOI to include sx associated with changes in inner ear pressure
SEVERE: Sensorineural hearing loss and vertigo due to damage
Barotrauma
Treatment for:
Barotrauma
Treat underlying illness (URI)
Pseudoephedrine
Nasal decongestants (oxymetazoline)
Antihistamines for symptomatic relief
Sudden hearing loss is classified as:
3 days or less
Sensorineural hearing loss
Cochlea, auditory nerve, or centrally auditory processing
Conductive hearing loss is:
External ear, TM, and ossicles
Which hearing loss is more reversible between conductive and sensory?
Conductive
Most common form of sensory hearing loss
Presbycusis (loss with advancing age)
Second most common cause of sensory hearing loss
Noise trauma
Usually begins in the 4000 Hz
Labs/studies for:
Hearing loss
Audiogram testing confirms significant hearing loss
Weber and Rinne test
Treatment for:
Hearing loss
Remove member from exposure
Educate member on wearing earplugs
Refer to ENT if necessary
Results from hair damage in the cochlea, carotid artery/jugular vein turbulence, or temporomandibular joint problems
Tinnitus
Two types of tinnitus
Objective and subjective
Symptoms and physical exam:
Ringing noise, conductive hearing loss/changes, headache, noise intolerance, vertigo, TMJ dysfunction
Tinnitus
Labs/studies for:
Tinnitus
CBC
TSH
HIV
RPR/autoimmune panel
MRI
CT scan for pulsatile tinnitus
