Ear MDT Flashcards by Draper Kauffman

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

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Superichondrial collection can lead to stimulation of the overlying perichondrium, which can lead to new cartilage formation and deformity.

Cauliflower ear

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Treatment of:

Auricular hematoma

Local anesthesia

Semicircular incision to drain hematoma

Irrigation

Topical antibiotics and bandage

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Symptoms and physical exam:

-Specific MOI
-Muffled sounds
-Severe pain
-Hearing disturbances/changes

Foreign body in the ear

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Instruments of choice for removal of foreign objects in the ear

Cerumen loops/scoops, a right-angle hook, and alligator forceps

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What should you use to drown live objects in the ear?

Lidocaine solution

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What should you use for small particles such as sand or cerumen stuck in the ear?

Room temperature water

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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

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Cerumen impaction:

If irrigation fails, what can you use?

Cerumenolytic (Carbamide Peroxide)
-2 to 5 drops BID for 4 days

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Complication of acute otitis media

Infection spreads from the middle ear to the mastoid air cells

The mastoid cavity becomes filled and inflamed

Mastoiditis

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Sx: Postauricular pain and erythema accompanied by a spiking fever
Edema, tenderness, protrusion of the auricle, obliteration of the post auricular crease.

Mastoiditis

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Labs/Studies:

Mastoiditis

Mastoid Radiography

Culture and drainage

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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)

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Diffuse inflammation of the external ear canal with or without inflammation of the auricle and/or tympanic membrane

Otitis Externa

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Acute otitis externa is almost exclusively from what two organisms?

Pseudomonas aeruginosa

Staphylococcus aureus

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Labs/studies:

Otitis externa

Gram staining of discharge

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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

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Treatment of:

Severe otitis externa

Ciprofloxacin 500mg PO BID

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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

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Most common pathogens for otitis media

Streptococcus pneumoniae

Haemophilus influenzae

Streptococcus pyogenes

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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

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Labs/Studies:

Otitis media

Tympanocentesis and fungal culture by an experienced physician

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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