Ears Flashcards
History taking for otalgia.Name 8 questions
1- When did it start? (Onset)
2- Associated symptoms? (Vertigo, fever
3- Hx of Trauma?
4- Worse with chewing?
5- Hearing loss?
6-Uni or bilateral?
7- Upper respiratory tract infection?
8- CV risk/heavy smoker?
Additional questions if young child with otalgia (3)
1- Daycare/sick contacts?
2- Bottle or breastfed?
3- Immunizations UTD?
Describe physical exam for otalgia. (6)
1- Look outside of ear
2- Look inside of ear. (Note ear canal + tympanic membrane)
3- check for cervical adenopathy. (Palpate lymph nodes)
4- Check inside mouth.
5- Palpate for otitis external or temporomandibular joint.
6- Neuro exam PRN.
Considerations for serous otitis media…. In child…? (3)
1- could need tubes (tympanostomy)
2- Referral to ORL if recurrent otitis
3- Screen for hearing impairment.
1- What would postauricular tenderness, swelling and erythema indicate in a AOM context?
2- What do you do with it?
1- Acute mastoiditis.
2- Urgent referral to ORL. ER!!!
Name causes of Otorrhea. (5)
1- Otitis externa
2- Acute otitis media with perforated tympanic membrane
3- Cerebrospinal fluid leak
4- Trauma
5- Osteomyelitis
1- Counselling and 2- Follow-up for someone who’s had a perforated tympanic membrane?
1- No swimming/water, plugs in shower.
2- FU in 6 weeks to ensure healed. If not, refer to ENT.
External otitis symptoms? (4)
1- Hyperemic ear canal
2- Swollen ear canal (Narrow)
3- Otorrhea (green)
4- Ear is tender (palpate)
How to treat external otitis?
Cipro-dex drops x 7 days.
1-What to consider for unilateral otalgia and diabetes and immunocompromized patients.
2- What do you do with it?
1- Malignant necrotizing external otitis
2- ER for ENT stat.
Name some questions to ask for history taking in tinnitus (7)
1- Description of tinnitus (Episodic vs constant. Pulsatile or not. Quality of sound, high pitch or no?)
2- How it affects quality of life/sleep/depression?
3- Ask about medication (Ototoxic)
4- Uni or bilateral?
5- Associated hearing loss?
6- Vertigo?
7- Change of intensity with motion or body position?
What do you include in physical examination in the case of tinnitus? (6)
1- Neuro exam, to rule out neuro cause.
2- Observe tympanic membrane. To rule out cerumen impaction, perforation, infection tumor.
3- Weber, Rinne, Whisper test.
4- Observe balance and gait.
5- Head and neck exam (like all ear issues)
6- If pulsatile, auscultation over neck for carotid bruits.
What do you ask if someone complains of hearing loss? (5)
1- Presence of tinnitus or vertigo?
2- unilateral or bilateral Hearing loss?
3- Inciting factor such as trauma, surgery or medication?
4- How it started?
5- Occupation/hobbies? (Loud noises could cause acoustic trauma)
Name common causes of
1- Conductive hearing loss. (4)
2- Sensorineural hearing loss (4)
1- Otitis, foreign body, cerumen impaction, TM perforation
2- Noise induced traumatic loss, presbyacusis, Miniere’s disease, acoustic neuroma
Name red flags for hearing loss. (2)
1- Sudden unilateral hearing loss (Acoustic neuroma)
2- Abnormal neurological findings (Tumor, brainstem infarction, cerebrovascular accident)
(2) Counselling and (2) Pharmacological interventions for idiopathic tinnitus.
1- Background noise
2- Cognitive behavior therapy
3- Antidepressants.
4- Melatonin or trazadone for sleep
Rinne test: air>bone
Weber test: equal at midline.
What does it man?
No hearing loss.
Rinne test: Air>bone
Weber test: Louder in normal ear or better hearing ear
What does it mean?
Sensorineural hearing loss
Rinne test: Bone>air
Weber test: Louder in affected ear
What does it mean?
Conductive hearing loss.
Intervention plan for an adult with serous otitis. (4)
1- Nasal hygiene
2- Intermittent auto inflation (chew gum, yawn)
3- No flying/scuba diving (anything that could cause barotrauma)
4- Could use 2nd line decongestants
Name 3 tests that can be performed in house for hearing loss. And what do they do?
1 intervention outside of clinic
1- Weber test (symmetric vs asymmetric)
2- Rinne test (condudtive vs sensorineural)
3- Whisper test (high frequency loss)
4- Refer to audiology
1- What do you do with serous otitis in a child?
2- When do you refer to ENT?
1- Watchful waiting x 3 months
2- if speech/learning/language is at risk, and if not resolved in 3 months.
Ear effusion without hyperemia is what?
Serous Otitis media
Why do you inspect head and neck when checking ears?
Checking for masses or lymphadenitis which would indicate cancer or infection.
Name 7 Ddx for conductive hearing loss.
1- Cholesteatoma
2- Polyp/cyst/tumor
3- Foreign body
4- Cerumen impaction
5- Otosclerosis
6- Otitis externa
7- Middle ear effusion
