Ear txs Flashcards
Sensorineural Hearing Loss :
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 **
SUDDEN SDHL Tx:
-High dose oral corticosteroids
if oral tx fails:
-intratympanic corticosteroids
Exception to SDHL → corticosteroids fast of onset to recover hearing
when do we detect Congenital or genetic SNHL?
screenings?
-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
SNHL
-Presbycusis
-Noise trauma SNHL=
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 **
SNHL
Noise Trauma Tx:
-hearing protection, hearing aids
**Primary goal in sensory hearing loss is prevention of further loss and functional improvement with amplification **
SNHL Otoxicity meds and avoid:
-Aminoglycosides
-Loops Diuretics
-Platinum based antineoplastic agents
-NSAIDS/ASA
avoid these drugs and find other alternatives
Conductive Hearing Loss:
medical surgery
Otosclerosis:
-hearing aid
-surgery of stapedectomy
Tinnitus:
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
Vestibular neuronitis and Labrythitis:
if only vertigo tx:
persistant tx:
-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:
Meniere’s Dx:
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
Benign Paroxysmal positional vertigo
-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)
Vestibular Schwannoma aka Acoustic Neuroma:
-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
EAC Neoplasm:
Cholesteatoma:
Refer to ENT!!! for surgical removal with tympanomastoidectomy
-Potential complications: brain abscess, meningitis
Mastoiditis:
- IV Antibiotics + middle ear drainage + tympanostomy tube (van + ceftazidimine or piperacillin)
-mastoidectomy
-Complications: brain abscess, septic lateral sinus thrombosis
EAC Foreign Bodies:
-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
Cerumen Impaction:
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!!
Perforated TM:
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)
Barotrauma:
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
Acute Otitis Media:
-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
Serous Otitis Media:
-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
Chronic Otitis Media:
-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
Otitis Externa: swimmers ear
Malignant otitis externa:
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)
ETD:
Systemic/intranasal decongestants (pseudoephedrine, oxymetazoline spray)
-Auto inflation
-Allergic patients: intranasal corticosteroids (fluticasone propionate)
-Balloon dilation of the eustachian tube
Traumatic Auricular hematoma:
-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
EAC Neoplasm
-Refer to ENT
-Temporal bone resection (total or subtotal)
Parotidectomy with suspected clinical
radiological invasion
Radiation therapy is used often
