Ears Flashcards
Conductive Hearing Loss
Cerumen impaction Eustachian tube dysfunction Otosclerosis Foreign body
TX: clear ear canal
Sensorineural
- Deterioration of the cochlea
- Presbyacusis (age-related)
- Noise exposure
- Ototoxicity (drugs)
- Trauma
- Neural: lesions of CNVIII/auditory cortex/neuroma/MS
Sudden sensorineural hearing loss
- Idiopathic
- Autoimmune
- Loud noise exposure
- Vascular infarc
TX: Oral steroids within 24hrs.
Acoustic Neuroma
UNILATERAL
Non-malignant tumor of CN VIII due to Schwann cells surrounding nerve (compresses nerve)
MRI/CT
TX: surgery, radiology, or close monitoring if small tumor
Tinnitus
High-pitched ringing in ears
Normal = several minutes of mild/high pitched noises
Abnormal = interferes with sleep/concentration/psychological distress
Limbic System (emotions/mood) activated with tinnitus, so other symptoms accompany.
- Increased HR
- Sweating
- Insomnia
TX: Ear protection, avoid loud noises, avoid ototoxic drugs (gentomyacin)
Anti-depressants used in management/treatment of symptoms
Hematoma of External Ear
“Cauliflower Ear”
Shearing force that causes perichondrium to separate from chondrium (cartilage) = Swollen auricle due to lot of vasculature in perichondrium
Can lead to permanent deformation of the auricle
TX: evacuate blood, reapproximate perichondrium to cartilage
Foreign Bodies
Foreign Bodies in Ears
Children>Adults
TX:
- NO H2O for organics (will swell in ear canal)
- Lidocaine for insects
- Do not displace objects closer to TM
- Use loop or hook to remove
Otitis Externa
“Swimmer’s Ear”
Sx: otalgia, pruritis, discharge, hearing loss, edema, erythema, pain in ear with tugging
Bacterial (most common)
Fungal (otomycosis)
TX:
- remove debris/liquid
- control pain (anti-inflammatory)
- control infection:
- ABX=fluorquinolone or aminoglycoside
- Fungal = FlucanAZOLE
Contact Dermatitis
Erythema and pruritus of external auditory canal, most often meatus
Usually caused by Neomycin (Neosporin) or earrings
TX: mineral oil, topical steroids
External Auditory Canal Carcinoma
SX: Bloody otorrhea, facial paralysis, mild pain, lesions in ear canal with pus, hearing loss.
TX: surgery, radiology
Osteomas/Exostoses
Bony overgrowths of ear canal, usually from overexposure to cold water
TX: surgical removal
Eustachian Tube Dysfunction
Pt reports sense of fullness in ear, mild-to-moderate impairment of hearing, reports
- “plugged ear”
- Yawning/swallowing cause popping or cracking
Causes: Swelling of the tube lining from allergies or viral URI causes air to be trapped –> Negative Pressure which will cause a retracted TM (will see bony landmarks)
TX:
- Oral/Nasal decongestants for URI - SUDAFED
- Nasal Corticosteroids for allergies - FLONASE
Otitis Serous
Prolonged blockage of Eustachian Tube. Constant negative pressure leads to –> collection of transudative fluid in middle ear
Causes:
- URI *occurs after otitis media
- Barotrauma
- Allergies
You will see BUBBLES or fluid behind TM. Hypomobile.
TX:
- Oral/Nasal decongestants for URI - SUDAFED
- Nasal Corticosteroids for allergies - FLONASE
- Tubes (if recurrring)
Barotrauma
Caused by inability to equalize the barometric stress exertedon the middle ear by air travel, changes in elevation, or diving.
SX: Otalgia, Tinnitus, Pressure in ear, Hearing loss
Exam: Hemotympanum, red/retracted ear drum
TX:
- Valsalva (autoinflate ears during descents)
- Decongestant: SUDAFED
Acute Otitis Media
SX: SUDDEN onset of otalgia, hearing loss, vertigo, fever, irritability, apathoy, anorexia, diarrhea (kids).
Causes: virus or bacteria travels up eustachian tube to middle ear
- Bacterial: Shake (Strep) My (Moraxella) Head (Heamophilus)
- Viral –> most common!
Clinical: Bulging, Air/Fluid behind TM, Red
TX: limit abx tx to patiens <6mos old or pts with severe disease
- Amoxicillin
- Augmentin
- Degongestants = SUDAFED
- Pain relievers = Antinflammatories
Acute Mastoiditis
Inflammation of mastoid air cells of the temporal bone
Causes: otitis media
Sx: fevers, post-auricular erythema, tenderness, AOM on otoscopy
CT! CBC!
TX:
- hospitalization
- IV abx
- Surgical
Choesteatoma
Squamous epithelium lined-sac sucked in to middle ear area due to negative pressure. Fills with keratin and skin debris. Can cause obstruction, damage to ossicles, and infection.
TX: Abx for infx. Surgical to remove sac.
Chronic Suppurative Otitis Media
Chronic infection of middle ear, usually due to lots of AOM. Often have ruptured TM and leak PUSS.
- Purulent ear discharge that increases with URI or H2O exposure
- Conductive hearing loss
- Painless
- PUSS behind TM
Causes: bacterial
TX:
- remove debris
- Quinolon = CIPRO,
- can require sx repair of tM
Nystagmus
Rhythmic oscillation of the eyes from vestibular and optokinetic stimulation.
Pathologic: occurs when semicircular canals are stimulated while head is NOT in motion.
Overview of Positional Vertigo
Certain positions or head movements cause predictable, usually brief, episodes of vertigo.
Crystals in utricle or sacule come loose and enter the semicircular canals where they cause receptors to depolarize and send rotational signals to the brain. “Canalithiasis”
DX: Dix-Hallpike
TX:
- Epley Maneuver
- Antihistamine
- Anticholinergic (anti-parasympathetic)
- Sedative/hypnotic
- Antiemetic
Benign Positional Vertigo
RECURRENT spells of BRIEF vertigo, associated with changes in head position. NO HEARING LOSS. Most common positional vertigo.
DX: Dix-Hallpike that results in horizontal nystagmus
TX:
- Epley Maneuver
- Antihistamine
- Anticholinergic (anti-parasympathetic)
- Sedative/hypnotic
- Antiemetic
Traumatic Vertigo
Traumatic peripheral vestibular injury
SX: Worse after trauma
- Vertigo
- Nausea
- Vomiting
- Imbalance
TX: same as other vertigo
Vestibular Neuronitis
SINGLE EPISODE, acute onset, lasts for days.
Causes: often follows URI
Neuritis: inflammation of vestibular nerve –>NO hearing changes.
Labyrinthitis: inflammation of the labyrinth. Results in hearing changes as well as dizziness or vertigo. –>YES hearing changes.
TX: abx if pt is febrile or has sx of bacterial infx.
Meniere’s Syndrome
Excess endolymphatic fluid pressure. –> More fluid in semi-circular canals, cochlea and vestibule (inner ear).
SX: spontaneous onset, RECURRING, LASTING 20min to many hrs.
Causes: syphillis and head trauma
TX:
- Low salt diet
- Diuretics: HCTZ
- Intratympanic steroid injections or sac decompression
Cervical Vertigo
Vertigo from disturbed neck sensors.
Causes: Cervical trauma or hyperextension.
Can be confused with migraine-associated vertigo.
