Ear, Nose, Throat Flashcards
Identify the indications, contraindications, precautions, and patient preparation involved in removal of a foreign body from the ear
If the cerumen is deeper in the canal or is not cleared with the ceruminolytic agent and/or curette, irrigation with water or normal saline at body temperature using an ear syringe, a device specifically designed for ear irrigation, or a regular syringe with a flexible catheter can be performed.
• If not already used, a ceruminolytic agent may be instilled in the canal for 15 to 20 minutes before the irrigation to soften the cerumen and aid in its removal.
• The auricle should be straightened as much as possible and the irrigant directed upward in the canal to minimize the pressure against the TM.
• The canal should be irrigated until clear unless the patient experiences pain or dizziness.
• If the patient is immunocompromised, a sterile solution should be used
Tinnitus
Perception of sound when there is none (buzzing, ringing)
Low pitch may indicate idiopathic cause or Menaire Disease
High pitch is noise exposure or ototoxicity
Pulsing, rumbling = vascular echo
Check for impaction, check for cause, refer for audiogram
Tympanic Membrane Perforation
Refer to ENT if hearing loss, vertigo, or other signs occur
Will heal on its own, but protect from infection - avoid swimming or immersion in water
May be caused by trauma, infection, neoplasm = rule out causes that can be treated
Meniere Disease
Recurrent vertigo and hearing loss from excess fluid in ear
-vertigo, low frequency tinnitus/loss, ear fullness
Rule out other causes including thyroid and lyme disease
Refer to ENT
Response to steroids may indicate autoimmune cause
Acute Otitis Media
Fever, ear pain, hearing loss
TM may be red, inflamed
Watchful waiting, then consider antibiotics (usually PCN or Augmentin)
Otitis Media with Effusion
Fever, hearing loss, ear pain
May have infection elsewhere in ENT space (often pharyngitis)
TM are retracted, white pearly appearance due to fluid excess
Antibiotics (PCN usual medication choice) or watchful waiting
Antihistamines, nasal steroids may help
Otitis Externa
Severe ear pain or auricle pain (esp when moved)
Feeling of ear fullness, drainage may occur
Canal is red and sloughs, debris may be present
Culture the drainage only if no improvement in 14 days
Treat with NSAIDs for pain, topical antibiotics but not ototoxic drugs, lavage may help
High fever, severe pain, necrotizing appearance is referral to ENT
Vestibular Neuritis
Unilateral labrythine dysfucntion
brief vertigo, N/V, loss of peripheral vestibular function
—especially with head movement
Diagnosis by exclusion, may be caused by herpes simpex
Symptomatic treatment, treat suspected infections
Identify the indications, contraindications, precautions, and patient preparation involved in tympanometry
Indications
• Determine the degree of mobility of the tympanic membrane.
• Evaluate hearing loss and middle ear function.
• Evaluate the cause of ear pain.
• Make a diagnosis of or monitor recovery in middle ear infections and effusions or tympanic membrane perforations.
• Determine the effectiveness of pressure-equalization tubes in children.
• Evaluate the cause of developmental delays in hearing or speaking in children.
Contraindications
• Children younger than 5 months
• Otitis externa
• Obstruction of the ear canal with cerumen or foreign body
Identify the indications, contraindications, precautions, and patient preparation involved in audiometry
indications
• Evaluation of suspected hearing loss
• Complaints of tinnitus or exposure to loud noises
• Evaluation for pathology in children who have speech and language development delays, behavior problems, poor academic progress, and/or difficulties in interpersonal skills
• Unexplained behavior changes in the older adult that are suggestive of dementia.
Contraindications
• Children younger than 6 months (inaccurate readings)
• Active otitis external infection
• Cerumen impaction
Allergic Rhinitis
Pruritus of nose, eyes, mouth
Excess tearing, puffiness around eyes, rhinorrhea, pale or bluish nasal turbinates
Steroid nasal spray, 2 sprays each nostril
Beclomethasone dipropionate (Beconase) twice daily OR Fluticasone propionate (Flonase) 4 times daily
Antihistamine daily
Loratadine 10 mg OR Cetirizine 10 mg OR Fexofenadine 180 mg
Antihistamine nasal sprays each nostril bid
a) Azelastine OR Azelastine/fluticasone OR Montelukast (Singulair)
Acute Bacterial Rhinosinusitis
mucopurulent discharge, nasal obstruction, and facial pain or pressure
Antibiotics for 5-7 days
-Amoxicillin or Augment first choice, Doxycycline or Cephalosporin next
If complicated infection (no improvement in 7 days)
-Increase antibiotics to 10 days
-Switch to Augmentin or Levofloxacin or Doxycycline
Chronic Rhinosinusitis
Nasal steroids are best treatment
Humidifier
Antihistamines
Antibiotics as needed
Pharyngitis
Usually Viral
If bacteria suspected, Amoxicillin is first choice
If tonsils severely swollen, test for strep and consider steroids if strep negative
Influenza
Antivirals must start within 72 hours, <48 hours is best, five days of treatment
Aphtous Ulcers
Sores on inside of lip
Steroid mouthwash
Consider PPIs / GERD eval
Gingivitis
Antibiotics for 10 days, usually cefadroxil or clindamycin
Refer to dental
Group A streptococcus Bacteria pharyngitis
Common presentation of GABHS
Acute-onset sore throat with erythema and tonsillar exudates, Fever, H/A, Tender/enlarged cervical nodes, May have sandpaper rash on torso and petechiae of soft palate, Children may present with N/V and stomach pain
Absence of cough and stuffy nose
Amoxicillin 500 mg tid or 875 mg bid for 10 days or Azithromycin / Cephalosporin
If the tonsils and pharynx are severely swollen, consider prednisone; start with 30 to 50 mg qd and taper over
No school for 24 hours or until fever resolves, throw away toothbrush
Peritonsillar Abscess
fever, chills, and a severe sore throat, muffled voice, foul breath
marked edema and erythema of the peritonsillar tissue
Strep test, immediate refer to ENT for I&D and antibiotics
indications, contraindications, precautions, and patient preparation involved in foreign body removal from the nose.
A child or adult who has a retained nasal foreign body often presents with a foul odor from the nostrils, unilateral purulent rhinorrhea, or persistent epistaxis. More commonly, the patient presents with the request for object removal.
Do not attempt if item cannot be visualize or large
Do not push it further into the nose trying to dislodge into pharynx
Do not irrigate
Coin batteries are an emergent removal
Describe the management for post tooth avulsion or fracture
• If the tooth can be reimplanted, do not dislodge it from the socket.
• Clenching the tooth gently may allow for support of the tooth.
• Avoid talking, drinking, or chewing.
• Seek dental attention as soon as possible.
Identify nasal procedure concerns that warrant emergency evaluation or emergent ear, nose, and throat (ENT) consult.
Epistaxis with hemodynamic instability
Posterior epistaxis
Recurrent bleeding
Epistaxis > 1 hour
Epistaxis despite packing or bilateral packing
Button/Coin batteries in nose or magnets in nose
Identify the indications, contraindications, precautions, and patient preparation involved in nasal packing for epistaxis
This procedure is performed to control nasal hemorrhage that has not been alleviated with firm pressure, in the correct location, immediately distal to the bony portion of the septum for at least 10 to 15 minutes continuously.
Contraindications
Granulocytopenia is present.
Tissue Necrosis
History of stroke, MI
Low PaO2
Severe hypertension
