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ear/nose Flashcards

1
Q

conductive hearing loss

A

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
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2
Q

sensory hearing loss

A

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

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3
Q

neural hearing loss

A

lesion of CN VIII, auditory nuclei, ascending tracts or cortex
-acoustic neuroma, MS, neuropathy

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4
Q

Weber test

A

-sound will be louder in affected ear if bone
conduction loss, opposite with sensory neural
(whisper test first)

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5
Q

Rinne test

A

air should exceed bone >2:1

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6
Q

who gets referred for testing

A
  • everyone w/ hearing loss unless you have an obvious reversible cause
  • i.e. mastoiditis
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7
Q

traumatic auricular hematoma (TAH) if untreated can lead to

A 
cauliflower ear (boxers)
(cartilage necrosis)
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8
Q

chondritis/perichondritis vs cellulitis

A

earlobe spared in chondritis (not cartilage)

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9
Q

main cause of cerumen impaction

how to tx?

A

cause: Qtips in canal
- use curettes to clean out
- soften earwax w/ warm water
- Debrox: peroxide drops, softens earwax

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10
Q

if insect in ear

A

drown in lidocaine, flush out

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11
Q

what else in ears

A

toys, hairtip, Qtip tips

irrigate and/or use alligator forceps or refer to ENT

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12
Q

external otitis assoc. w/

A

excess moisture, tropics, swimmers, DM

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13
Q

pathogens in otitis externa

A

G- rods, fungi, pseudomonas

can get Cs if purulent

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14
Q

tx of otitis externa

A

acetic acid/etOH drops (dry out, kill fungus)

FQ drops +/- oral abx (if severe/malignant)

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15
Q

if swollen shut w/ otitis externa

A

use ear wick: into canal thru inflammation: put numbing meds + abx on strip–>expands–>relief (also use oral abx to avoid noncompliance)

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16
Q

complications with otitis externa

A

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)

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17
Q

eustachian tube disorders

A

present w/ fullness, hearing changes, popping/pain w. pressure changes, inc. risk for serous otitis

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18
Q

eustachian tubes with age

A

babies/kids: more horizontal

adults: vertical, stiffened (less dysfunction)

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19
Q

how to tx serous otitis

A 
nasal spray (steroids): dec. congestion/inflamm of meatuses for drainage (clears eustachian tubes)
-oral steroids if that does not work
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20
Q

if on plane with congestion

A

valsalva, blowing out
-nasal sprays first, then sedated (dry out sinuses) and phenylephrine (nasal spray)–>can be addictive! rebound congestion when wears off

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21
Q

divers can get

A

barotrauma

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22
Q

acute otitis media tx

A

amoxicillin, augmentin

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23
Q

acute OM pathogens

A

strep. pneumo, strep, pyogenus (only in Current), H. influenza, 10% staph aureus

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24
Q

chronic OM pathogens

A

pseudomonas, proteus, staph

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25
OM observ. on PE
*dec. mobility of TM, erythematous (insuflate) +/- fever
26
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
27
chronic otitis media
sim. abx tx, usually longer
28
OM complications
cholesteatoma, mastoiditis, petrous apicitis, paralysis, sinus thrombosis, CNS spread, chronic perf., scarring of TM, meningitis (S. pneumo)
29
severe ear pain with normal presentation
look for signs of inf, treat pain, neurogenic | -shingles: tingling comes before rash, Ramsey-Hunt
30
referred ear pain
neurogenic pain (trigeminal, facial gloss pharyngeal, vagal and cervical innervation of ear structures), TMJ
31
otoxicity
``` ASA: typ. rev and dose related aminoglycosides loop diuretics (Furosamide) Ca meds ```
32
sudden hearing loss considered idiopathic may respond to..
corticosteroids, refer to audiology
33
sens. hearing loss beginning in adulthood often
hereditary, assoc. w/ connexin-26 mutation
34
how to tx tinnitis
avoid offending substance | -tricyclic antidepressants (nortriptaline)
35
peripheral vertigo
sudden +/- tinnitis, hearing loss horizontal fatiguable nystagmus dizziness may stop, prolonged imbalance
36
central vertigo
gradual +/- audio symptoms vertical unfatiguable nystagumus smtms rotary nystagmus (PCP/ketamine) motion imbalance
37
causes of peripheral vertigo
``` vestibular neuritis/labyrinthitis meniere disease benign positional vertigo etOH intox inner ear barotrauma semicircular canal dehiscence ```
38
causes of central nystagmus
``` seizure MS Wernicke encephalopathy Chiari malformation cerebellar ataxia syndromes ```
39
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 ```
40
ddx vertigo + audio symps
secs: perilymphatic fistula hrs: endolymphatic hydrops (meniere, syphilis) days: labyrinthitis, labyrinthine concussion, AI inner ear dis mos: acoustic neuroma, ototoxicity
41
ddx vertigo - audio symps
secs: positioning vertigo (cupulolithiasis), vertebrobasilar insuff., migraine-assoc. hrs: migraine-assoc. days: vestibular neuronitis, migraine-assoc. mos: MS, cerebellar degen.
42
viral rhinosinusitis
the common cold (rhinovirus, coronovirus, adenovirus) typ. self-limited
43
viral rhino sinusitis can lead to bacterial inf.
if >7-10 days
44
other complications from viral rhinosinusitis
``` otitis media (inflamm. of sinuses), bronchitis (inflames epithelial cells) also causes laryngospasm-->asthma ```
45
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
46
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
47
bacterial rhinosinusitis
not as common as viral | imp. mucociliary clearance, obstruction of osteomeatal complexes (secondary inf.)
48
bac rhinosin pathogens
strep pneumo/cocci, staph, H. flu, moraxella
49
clinical criteria for BF
purulent discharge, mucus | length/severity to ddx from viral
50
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)
51
?? if low grade fever consider
thromboembolism
52
how to see sinuses
CT, MRI
53
how to tx BR: first-line
amoxicilin, trimethoprim-sulfamethoxazole, doxycycline, amoxicillin-clavulanate
54
how to tx BR: first-line after recent abx use
levofloxacin | amoxicillin-clavulanate
55
how to tx BR: second-line
amoxicillin-clavulanate, moxifloxacin
56
potential complications of BR
orbital/periorbital cellulitis, empyenas on brain, meningitis, mastoiditis, osteomyelitis-->sprd to frontal bone-->Pott's puffy tumor (debridement/surgery)
57
who comes to the hospital w/ BR
frontal osteomyelitis orbital cellulitis immunecomps, chemo pts., already done 1st/2nd line tx, need IV facial cellulitis
58
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
59
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
60
adjunct tx for allergic rhinitis
- antileukotriene meds (montelukast) - mast cell stabilizers (cromolyn sodium, sodium nedocroil) - anticholinergic nasal sprays (ipratropium bromide) -for vasomotor rhinitis
61
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
62
epistaxis
typ. anterior and unilateral | * Kiesselbach's plexus
63
causes of epistaxis
nasal trauma, rhinitis, dry mucosa, deviated septum, HTN, atherosclerosis, hereditary hemorrhagic telangiectasia (osler-weber-rendu syndrome) cocaine/etOH use
64
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)
65
tx options for epistaxsis
``` direct pressure, topical nasal decong. topical cocaine (4%) patch (surgicel) packing thrombin: aerosol in nos, forms clot embolization ```

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