Ears Flashcards
What would you suspect from these issues?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
Auricular Hematoma
How would dress this?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
A dental roll or a firm sterile pledget can then be placed over the restored site with through-and-through sutures connected to a similar bolster on the
opposite side.
How would you treat this?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
- Local anesthesia
- Semicircular incision (using sterile technique) should be made through the skin with caution not to violate the underlying perichondrium
- Irrigations
True/False
A auricular hematoma pt needs prophylactic oral antibiotics
False
Patient DOES NOT need prophylactic oral antibiotics
What antibiotics would you give for this after draining the hematoma?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
Neomycin-bacitracin-polymyxin B (Neosporin)
Apply one application twice daily
What is the goal of treatment for this after removing the fluid collection?
(1) History of auricular trauma
(2) Edematous, fluctuant, and ecchymotic pinna with loss of normal cartilaginous
landmarks
maintain pressure in the area for several days to prevent reaccumulation of fluid.
What are the instruments of choice for removal of a foreign body in the ear
Cerumen loops/scoops,
right angle hook,
alligator forceps
IF there is a live object in the ear canal what do you do?
Live objects should be drowned with a 2% lidocaine solution or viscous lidocaine
Why are live objects drowned in 2% lidocaine or viscous lidocaine?
this immediately paralyzes the offending insects and provides modest topical anesthesia.
Although some patients with cerumen impaction may present with a c/c totally unrelated to the ears, the majority of patients will report decrease in what and/or what?
hearing, and/or a
sensation of pressure or fullness
If irrigation fails for a cerumen impaction, then the next step would be to use WHAT?
Carbamide Peroxide (Debrox) – cerumenolytic Instill 2-5 drops in affected ear BID for a max of 4 days.
True/False Carbamide Peroxide (Debrox) is indicated for perforated TM
FALSE
Contraindicated
What would you suspect?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
Otitis Media
What antibiotic therapy would you give for this?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
(a) Amoxicillin 1000mg TID x 5-7 days
OR
(b) Amoxicillin/Clavulanate (Augementin) 2000mg/125mg PO BID x 5-7 days
What antibiotic therapy would you give for this IF your patient has a PCN allergy?
1) Otalgia, aural pressure, decreased hearing, and often fever and history of
an upper respiratory tract infection.
(2) Erythema and hypomobility of tympanic membrane.
(3) Severe: Tympanic membrane bulging (rupture is imminent), mastoid tenderness
(presence of pus within the mastoid air cells).
1) Ceftriaxone 1-gram IM one dose
OR
2) Doxycycline 100mg PO BID x10 days
F/u and initial care for Otitis media
(1) Follow up in 1 week to be reevaluated
(2) Consult to ENT as needed
(3) Refer for sudden worsening with fever or marked swelling.
What the complications for otitis media?
(1) Cholesteatoma
(2) Mastoiditis
(3) Central Nervous system infection
PT has these issues what would you suspect?
(1) Severe Ear Pain
(2) Fullness or “under water sensation”.
(3) Hearing loss or “muffled hearing”
(4) Tinnitus
(5) “Popping or snapping noises”
Eustachian Tube Dysfunction
Differential Diagnosis for ETD
(1) Tympanic membrane perforation
(2) Barotrauma
(3) Meniere disease
What are some med options for ETD
(a) Pseudoephedrine 60mg q4-6h PRN
(b) Oxymetazoline 1-2 sprays each nostril q12h PRN (limit use to 3 days)
(c) Fluticasone propionate (Flonase) 1-2 sprays each nostril daily PRN
(d) Cetirizine (Zyrtec) 5-10mg PO daily PRN
(e) Fexofenadine (Allegra) 60mg PO BID PRN
When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the ______, usually anteriorly or inferiorly
Pars tensa
pt has these issues what would you suspect?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
TM Perf
pt has these issues how would you TREAT this?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
Foreign material is suspected to remain in the canal or in the middle ear so place on systemic antibiotics.
(a) Augmentin 875 mg PO BID x 7 days OR
(b) Doxycycline 100mg PO BID x 7 days
DDX for TM perf
(1) Barotraumas
(2) Otitis Media
(3) Foreign bodies
If there is a TM perf secondary to penetrating trauma what must be done within 24 hours?
Refer to an otolaryngologist
What would you suspect?
PT has an hx of prolonged eustachian tube dysfunction
Otoscopic examination revealed an epitympanic retraction pocket or a marginal tympanic membrane perforation that exudes keratin debris, or granulation tissue.
Cholesteatoma
How is this treated?
Surgical marsupialization of the sac or its complete removal
What are complications of Cholesteatoma
(1) Bone erosion
(2) Inner ear erosion with facial nerve and intracranial involvement
(3) Death
What is the most frequent etiology for barotrauma?
flying
Your patient has these issues what would you suspect?
Symptoms
(1) Middle ear pain
(2) Hearing loss due to deformation of tympanic membrane that can hinder membrane mobility
(3) Specific MOI to include sx associated with changes in inner ear pressure (relevant hx)
(4) SEVERE cases: Sensorineural hearing loss and vertigo due to inner ear damage (perilymphatic fistula)
Physical Findings:
(a) Positive Conductive hearing loss.
(b) Possible TM Perforation from acute pressure changes.
(c) TM Bulging appearance.
(d) May have fluid in the ear canal.
(e) Severe findings:
1) Vertigo
2) Sensorineural hearing loss
Barotrauma
What are some DDx for Barotrauma?
(1) Tympanic membrane perforation
(2) Acute otitis media
What meds would you use to treat barotrauma?
- Pseudoephedrine:
- Immediate release: 60 mg every 4 to 6 hours
- Extended release: 120 mg every 12 hours or 240 mg every 24 hours
- MAX 240mg per day
- Oxymetazoline (Afrin).
- Antihistamines as needed for symptomatic relief.-
Sudden hearing loss (3 days or less) and is divided into what?
- Conductive hearing loss
- Sensory hearing loss
Common sources of injurious noise are what?
industrial machinery,
weapons
excessively loud music
Treatment for Noise induced hearing loss
(1) Remove the member from further exposure.
(2) Educate member on wearing earplugs.
(3) Refer to ENT specialist for further evaluation as necessary.
Patient has thee issues what would you suspect?
(1) “Ringing Noise”
(2) Conductive hearing loss/changes
(3) Headache
(4) Noise intolerance
(5) Vertigo
(6) TMJ dysfunction
Tinnitus
What labs would you run for Tinnitus?
(1) CBC
(2) TSH
(3) HIV
(4) RPR/autoimmune panel
What type of imaging would you get for tinnitus if any
(5) MRI with or without contrast
(6) CT scan for pulsatile tinnitus
When would you order a CT scan for Tinnitus?
pulsatile tinnitus
What is the patient education for tinnitus?
Help patients understand the relatively benign nature of tinnitus and importance of PPE for noised induced areas.
