ear/nose Flashcards
conductive hearing loss
dysfunction of middle or external ear
- obstruction, effusion, stiffness or ossicle disruption
- most common: cerumen impaction or eustachian tube dysfunction (temp/reversible)
- if persistent: chronic inf., trauma, otosclerosis (stiffening of membrane)
- can be corrected w. hearing aids/surgery
sensory hearing loss
cochlear pathology: loss of hair cells from organ of Corti
(often combo w/ neural)
-may be due to excessive noise/trauma
-high freq. lost w/ age
-not surgically correctable but preventable
neural hearing loss
lesion of CN VIII, auditory nuclei, ascending tracts or cortex
-acoustic neuroma, MS, neuropathy
Weber test
-sound will be louder in affected ear if bone
conduction loss, opposite with sensory neural
(whisper test first)
Rinne test
air should exceed bone >2:1
who gets referred for testing
- everyone w/ hearing loss unless you have an obvious reversible cause
- i.e. mastoiditis
traumatic auricular hematoma (TAH) if untreated can lead to
cauliflower ear (boxers) (cartilage necrosis)
chondritis/perichondritis vs cellulitis
earlobe spared in chondritis (not cartilage)
main cause of cerumen impaction
how to tx?
cause: Qtips in canal
- use curettes to clean out
- soften earwax w/ warm water
- Debrox: peroxide drops, softens earwax
if insect in ear
drown in lidocaine, flush out
what else in ears
toys, hairtip, Qtip tips
irrigate and/or use alligator forceps or refer to ENT
external otitis assoc. w/
excess moisture, tropics, swimmers, DM
pathogens in otitis externa
G- rods, fungi, pseudomonas
can get Cs if purulent
tx of otitis externa
acetic acid/etOH drops (dry out, kill fungus)
FQ drops +/- oral abx (if severe/malignant)
if swollen shut w/ otitis externa
use ear wick: into canal thru inflammation: put numbing meds + abx on strip–>expands–>relief (also use oral abx to avoid noncompliance)
complications with otitis externa
mastoiditis: fluid in/obstruction of air cells
meningitis, facial nerve palsy, encephalopathy, sinus cavernous thrombosis, tymp. mem. rupture
squamous cell carcinoma (SCC): most common neoplasm (typ. local, not usually metastasis)
eustachian tube disorders
present w/ fullness, hearing changes, popping/pain w. pressure changes, inc. risk for serous otitis
eustachian tubes with age
babies/kids: more horizontal
adults: vertical, stiffened (less dysfunction)
how to tx serous otitis
nasal spray (steroids): dec. congestion/inflamm of meatuses for drainage (clears eustachian tubes) -oral steroids if that does not work
if on plane with congestion
valsalva, blowing out
-nasal sprays first, then sedated (dry out sinuses) and phenylephrine (nasal spray)–>can be addictive! rebound congestion when wears off
divers can get
barotrauma
acute otitis media tx
amoxicillin, augmentin
acute OM pathogens
strep. pneumo, strep, pyogenus (only in Current), H. influenza, 10% staph aureus
chronic OM pathogens
pseudomonas, proteus, staph
OM observ. on PE
*dec. mobility of TM, erythematous (insuflate) +/- fever
OM tx
nasal spray for symps. amoxicillin–>w/ clauvulinic acid (augmentin) if not improving or fever
if allergic: erythromycin + sulfonamide
or cephalosporins if no type 1 hypersens
chronic otitis media
sim. abx tx, usually longer
OM complications
cholesteatoma, mastoiditis, petrous apicitis, paralysis, sinus thrombosis, CNS spread, chronic perf., scarring of TM, meningitis (S. pneumo)
severe ear pain with normal presentation
look for signs of inf, treat pain, neurogenic
-shingles: tingling comes before rash, Ramsey-Hunt
referred ear pain
neurogenic pain (trigeminal, facial gloss pharyngeal, vagal and cervical innervation of ear structures), TMJ
otoxicity
ASA: typ. rev and dose related aminoglycosides loop diuretics (Furosamide) Ca meds
sudden hearing loss considered idiopathic may respond to..
corticosteroids, refer to audiology
sens. hearing loss beginning in adulthood often
hereditary, assoc. w/ connexin-26 mutation
how to tx tinnitis
avoid offending substance
-tricyclic antidepressants (nortriptaline)
peripheral vertigo
sudden +/- tinnitis, hearing loss
horizontal fatiguable nystagmus
dizziness may stop, prolonged imbalance
central vertigo
gradual +/- audio symptoms
vertical unfatiguable nystagumus
smtms rotary nystagmus (PCP/ketamine)
motion imbalance
causes of peripheral vertigo
vestibular neuritis/labyrinthitis meniere disease benign positional vertigo etOH intox inner ear barotrauma semicircular canal dehiscence
causes of central nystagmus
seizure MS Wernicke encephalopathy Chiari malformation cerebellar ataxia syndromes
mixed central and peripheral causes of vertigo
migraine, stroke, vasc. insuff., PICA, AICA stroke, vert. art. insuff, vasculitides, cogan syndrom, susac syndrome granulomatosis w. polyantiitis (wegener) Behcet disease cerebellopontine angle tumors vestibular schwannoma meningioma infections: lyme disease, syphilis vascular compression hyperviscosity syndromes Waldenstrom macroglobulinemia endocrinopathies hypothyroidism pendred syndrome
ddx vertigo + audio symps
secs: perilymphatic fistula
hrs: endolymphatic hydrops (meniere, syphilis)
days: labyrinthitis, labyrinthine concussion, AI inner ear dis
mos: acoustic neuroma, ototoxicity
ddx vertigo - audio symps
secs: positioning vertigo (cupulolithiasis), vertebrobasilar insuff., migraine-assoc.
hrs: migraine-assoc.
days: vestibular neuronitis, migraine-assoc.
mos: MS, cerebellar degen.
viral rhinosinusitis
the common cold
(rhinovirus, coronovirus, adenovirus)
typ. self-limited
viral rhino sinusitis can lead to bacterial inf.
if >7-10 days
other complications from viral rhinosinusitis
otitis media (inflamm. of sinuses), bronchitis (inflames epithelial cells) also causes laryngospasm-->asthma
viral rhinosinusitis presentation
runny nose +/- fever, cough (wet/dry)
clear vs. purulent mucus
“green boogers” day 10 OR chronic–>tx for bac inf
cobblestoning, hyponosmia, malsaise, sore throat, HA
how to tx the common cold
oral hydration, rest, tylenol (phenylephrine/dayquil), decongestants, sudafed
localized steroid, afrin, nasal saline spray, breaks up mucus and dilutes pathogens
bacterial rhinosinusitis
not as common as viral
imp. mucociliary clearance, obstruction of osteomeatal complexes (secondary inf.)
bac rhinosin pathogens
strep pneumo/cocci, staph, H. flu, moraxella
clinical criteria for BF
purulent discharge, mucus
length/severity to ddx from viral
types of BR
maxillary (dental pain), ethmoiditis, sphenoid sinusitis (behind eye pressure), frontal sinusitis, hospital-assoc. sinusitis (IC, tubes in body, nosocomial pathogen exposure, lying down, surgery, nasal packing)
?? if low grade fever consider
thromboembolism
how to see sinuses
CT, MRI
how to tx BR: first-line
amoxicilin, trimethoprim-sulfamethoxazole, doxycycline, amoxicillin-clavulanate
how to tx BR: first-line after recent abx use
levofloxacin
amoxicillin-clavulanate
how to tx BR: second-line
amoxicillin-clavulanate, moxifloxacin
potential complications of BR
orbital/periorbital cellulitis, empyenas on brain, meningitis, mastoiditis, osteomyelitis–>sprd to frontal bone–>Pott’s puffy tumor (debridement/surgery)
who comes to the hospital w/ BR
frontal osteomyelitis
orbital cellulitis
immunecomps, chemo pts., already done 1st/2nd line tx, need IV
facial cellulitis
allergic rhinitis
- seasonality: pollens, spores, some year round: dust
- s/s sim to viral rhinitis
- ddx from vasomotor rhinitis: allergy tx, vasomotor improves w/ apotropium spray
allergic rhinitis tx
- intranasal corticosteroid: can take 2-4 wks, probe: not supposed to sniff up, may cause anosmia, nosebleeds
- antihistamines: non-sed. vs sedating (Claritin, Zertec, Allegra, Alvert), work faster than nasal spray, complications: over dry, sedation, dev. resistance, need to switch class
adjunct tx for allergic rhinitis
- antileukotriene meds (montelukast)
- mast cell stabilizers (cromolyn sodium, sodium nedocroil)
- anticholinergic nasal sprays (ipratropium bromide) -for vasomotor rhinitis
olfactory dysfunction
send to neurologist?
caused by obstruction of nasal cavity by polyps, tumors, septal deformity
-dec. taste, may cause anorexia
transient w/ cold s/s nasal allergies
idiopathic, trauma, worry about safety concern: CO/gas/fire detectors
epistaxis
typ. anterior and unilateral
* Kiesselbach’s plexus
causes of epistaxis
nasal trauma, rhinitis, dry mucosa, deviated septum, HTN, atherosclerosis, hereditary hemorrhagic telangiectasia (osler-weber-rendu syndrome)
cocaine/etOH use
epistaxis: det. causes and area
trauma
lean back? no will swallow blood, use direct pressure
blow out to det. where, oozing or bleeding?-phenylephrine spray to constrict/cauterize vessels, packing, cocaine (vasoconstr)
tx options for epistaxsis
direct pressure, topical nasal decong. topical cocaine (4%) patch (surgicel) packing thrombin: aerosol in nos, forms clot embolization
