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ear txs > Ear txs > Flashcards

Ear txs Flashcards

1
Q

Sensorineural Hearing Loss :

A

NOT correctable with medical or surgical therapy but can prevented, stabilized, or amplified

**Primary goal in sensory hearing loss is prevention of further loss and functional improvement with amplification **

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2
Q

SUDDEN SDHL Tx:

A

-High dose oral corticosteroids

if oral tx fails:
-intratympanic corticosteroids

Exception to SDHL → corticosteroids fast of onset to recover hearing

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3
Q

when do we detect Congenital or genetic SNHL?

screenings?

A

-Early detection (by 6 months)
Neonatal hearing-screening (OAE and ABR);

  • Early intervention prevents speech delay, improves language development, social and emotional development

Management:
Torch, hearing aid, preventative strategies, genetic eval

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4
Q

SNHL
-Presbycusis

-Noise trauma SNHL=

A

P: hearing aids (amplification)

N: hearing protection, hearing aid

**Primary goal in sensory hearing loss is prevention of further loss and functional improvement with amplification **

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5
Q

SNHL
Noise Trauma Tx:

A

-hearing protection, hearing aids

**Primary goal in sensory hearing loss is prevention of further loss and functional improvement with amplification **

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6
Q

SNHL Otoxicity meds and avoid:

A

-Aminoglycosides
-Loops Diuretics
-Platinum based antineoplastic agents
-NSAIDS/ASA

avoid these drugs and find other alternatives

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7
Q

Conductive Hearing Loss:

A

medical surgery

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8
Q

Otosclerosis:

A

-hearing aid
-surgery of stapedectomy

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9
Q

Tinnitus:

A

Goal is to lessen tinnitus and impact on quality of life.

Assessment of Medications:
-ASA, NSAIDs,
- alcohol
-Smoking and caffeine cessation
- Hearing aids
-CBT (most effective)

Sound therapy: decrease the strength of the tinnitus

Oral antidepressants: bc associated with depression

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10
Q

Vestibular neuronitis and Labrythitis:

if only vertigo tx:

persistant tx:

A

-Primary Treatment:
Bacteria: Antibiotics

Viral: Supportive care
Methylprednisolone

if only vertigo tx:
-Vestibular suppressants (eg, diazepam or meclizine)

-Antiemetics (promethazine)

-IV hydration if needed

persistant tx:

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11
Q

Meniere’s Dx:

A

Dietary Restrictions (avoid fluid shifts):
-Low Salt Diet + avoidance of triggers (caffeine, sugar, MSG, alcohol)

-Diuretics:
Hydrochlorothiazide/triamterene 25/37.5 mg daily (HCTZ)
Furosemide 20 mg daily
Acetazolamide 250-500 mg twice daily

-Allergy management and stress reduction

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12
Q

Benign Paroxysmal positional vertigo

A

-Epley maneuvers (Canalith Repositioning): movements of the head to rearrange displaced particles (success rate > 95% w/ 1-2 sessions)

-Watchful waiting:

-Vestibulo suppressant medications: minimal relief

-Vestibular rehabilitation: takes time and repeated stimulation of vertigo (Pts can do at home exercises)

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13
Q

Vestibular Schwannoma aka Acoustic Neuroma:

A

-1st: Surgery: surgical removal remains the treatment of choice for tumor eradication

-Stereotactic radiation therapy: uses radiation delivered to a precise point to target tissue but
does not eliminate the tumor/ higher trigeminal injury

-Observation: elderly, small tumors, high risk medical conditions

-Additional: Bevacizumab (VEG-F blocker) has shown promise for treatment of tumors in neurofibromatosis type

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14
Q

EAC Neoplasm:

A
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15
Q

Cholesteatoma:

A

Refer to ENT!!! for surgical removal with tympanomastoidectomy

-Potential complications: brain abscess, meningitis

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16
Q

Mastoiditis:

A
  • IV Antibiotics + middle ear drainage + tympanostomy tube (van + ceftazidimine or piperacillin)

-mastoidectomy

-Complications: brain abscess, septic lateral sinus thrombosis

17
Q

EAC Foreign Bodies:

A

-Remove FB (unless round or smooth). Refer to ENT if you can’t get it

-Immobilize live insects before removal with Lidocaine

-Avoid irrigation for organic FB such as beans/insects -> they can swell

18
Q

Cerumen Impaction:

A

Mechanical removal
Loop or cerumen spoon/Suction
Low pressure irrigation (no perforation) with body temperature water

-Cerumen softening agents:
Peroxide (50% strength)
Mineral oil
Debrox (OTC)

-PREVENTION!!

19
Q

Perforated TM:

A

Dry the ear

-If perforation is secondary to AOM, oral and topical otic (Ex: ofloxacin)

antibiotics are typically prescribed (if TM is perforated or unable to be visualized)

!!!! avoid ototoxic ear drops such as aminoglycosides: neomycin, gentamicin, or tobramycin)

20
Q

Barotrauma:

A

Avoidance of trauma

-TRY Swallowing, Yawning, Auto-insufflating during descent

-Air travel:
Oral decongestants (pseudoephedrine) several hours before

Topical decongestants (1% phenylephrine) 1 hour before arrival

21
Q

Acute Otitis Media:

A

-Oral Abx with intact TM (1st line): Amoxicillin

if PCN allergy:
- Cefdinir
(Azithromycin or Clindamycin [not as great])

-Oral Abx + topical Abx for AOM with TM perforation: -
Amoxicillin + Ciprofloxacin/ Dexamthasone/Ofloxacin (cheaper)

-F/u in 1 week if not improved.

!!!!Do not document true clinical failure of therapy until at least 3 days of treatment with high-dose amoxicillin

22
Q

Serous Otitis Media:

A

-resolves without ABX, NOT an INFX(observation x 3 months)

-Auto insufflation

-Adult with moderate OME due to acute seasonal allergic rhinitis, short-term treatment (≤ 12 weeks):
-Antihistamines
-Systemic decongestants
-Nasal corticosteroids

if all fails and >12 weeks:
-Myringotomy

23
Q

Chronic Otitis Media:

A

-Difficult** REFER ENT

-Removal of infected debris

-Meds: 1ST LINE= USE BOTH
Topical antibiotic drops (Ofloxacin 0.3% or Ciprofloxacin Dexamethasone for exacerbations)

-Oral Ciprofloxacin (active against Pseudomonas) for 1–6 weeks

  • Definitive treatment is surgical
    Mastoidectomy, myringoplasty, and tympanoplasty
24
Q

Otitis Externa: swimmers ear

A
25
Q

Malignant otitis externa:

A

1st: -Culture and biopsy of granulation tissue

-Meds:
IV anti-pseudomonal antibiotics x 6–8 weeks :
Fluoroquinolone or penicillin or cephalosporin (piperacillin or cefepime)

-Antibiotic/steroid (ciprofloxacin/dexamethasone)

26
Q

ETD:

A

Systemic/intranasal decongestants (pseudoephedrine, oxymetazoline spray)

-Auto inflation

-Allergic patients: intranasal corticosteroids (fluticasone propionate)

-Balloon dilation of the eustachian tube

27
Q

Traumatic Auricular hematoma:

A

-Must be drained to prevent significant cosmetic deformity) or canal blockage. Do not leave an auricular hematoma undrained unless the injury is older than 7 days (refer to ENT >7 days → granulation tissue)

-Apply a compression dressing sutured in place

-Daily follow-up ear examinations

28
Q

EAC Neoplasm

A

-Refer to ENT

-Temporal bone resection (total or subtotal)

Parotidectomy with suspected clinical

radiological invasion
Radiation therapy is used often

ear txs (2 decks)

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