Ears

Question 1

Tophi

Answer 1

uric acid crystals, hard & painless

Question 2

Hematoma

Answer 2

trauma or blood dyscrasia. can become cauliflower ear if not drained - tender blue mass

Question 3

Keloid

Answer 3

piercing scars

Question 4

Infection

Answer 4

cellulitis. treated with Cephalexin or diclox 500mg 2-4 x daily for 7-10 days

Question 5

Dry skin

Answer 5

eczema, seborrhea, esp. in ear fold

Question 6

Cerumen impaction

Answer 6

Caused by excessive production, narrow canal, obstruction
C/O discomfort, decreased hearing, dizziness
OTC wax softener; remove with curette or H2O pik

Question 7

Otitis externa

Answer 7

(swimmers ear)
Pruritis and discomfort, drainage, decreased hearing
Pseudomonas, Staph, Candida
Canal filled with white exudate, inflammed and erythematous
Remove debris, acidify canal (50:50 white vinegar & H2O)
Antimicrobial: Cipro HC,Cortisporin otic, Floxin otic, Zoto-HC, Lotrimin gtt
Culture if recurrent. Refer malignant OE

Question 8

Hearing loss

Answer 8

Hx to reveal occupational risks, FH, ototoxic meds
Sudden or gradual; unilateral or bilateral; associated sxs & dx
Conductive vs. sensorineural—Weber & Rinne tests
Examine to id external blockage, normal TM
Refer for audiometry and to ENT (labs and CT?)

Question 9

Conductive loss

Answer 9

Mechanical - obstruction from cerumen, infection, cholesteatoma, tumor

BC>AC

Question 10

Sensorineural

Answer 10

Problem with cochlea and auditory nerve (acoustic neuroma, autoimmune dx, infection, meniere’s, trauma)

AC>BC

Question 11

Otitis Media

Answer 11

Bacterial, fungal, viral infection of middle ear
Acute OM or chronic OM with effusion (OME)
Eustachian tube dysfunction accumulation of secretions microbial overgrowth
Most common cause: Strep pneum & H. flu
Causes pain, sensation of ear fullness, related URI sxs
TM is bright red, bulging, decreased landmarks. Bullae with mycoplasma

Question 12

Management of AOM

Answer 12

Do not give antibiotics for effusion
AOM antibiotic regimes:
Amoxicillin 250mg TID for 7-10 days
Augmentin 500mg BID
Cephalosporin 2nd or 3rd generation
Zpak
Bactrim DS
Decongestants, analgesics (Auralgan gtts)
Perforations:  Refer to ENT, avoid water in ear canal

Question 13

Effusion and scarring appear as ______ on TM?

Answer 13

White /dull TM

Question 14

Benign Positional Vertigo

Answer 14

Episodes of vertigo without hearing loss
Associated with specific head movements
Usually self-limiting over several months
Cupulolithiasis—Baranay (Dix-Hallpike) test to diagnose, Epley maneuvers to treat
Meclizine; slow position changes

Question 15

Labyrinthitis

Answer 15

Sudden onset of vertigo, N & V
A/W recent URI
Self-limiting, resolves within 2-3 weeks

Question 16

Acoustic Neuroma

Answer 16

Benign tumor of 8th cranial nerve (schwannoma)
Present with unilateral hearing loss, tinnitus, mild positional vertigo
Can have ataxia, decreased corneal reflex
Confirm with MRI
Surgery

Question 17

Tinnitus

Answer 17

Chronic ringing, buzzing, roaring in ears; benign or sign of serious disease (pulsatile, unilateral)
Risk factors: advancing age, male, history of military service or noise exposure, smoking, HTN
Etiology:
Otologic: hearing loss, presbycusis, Menieres dx, otosclerosis
Neurologic: MS, acoustic neuroma
Ototoxic drugs: ASA, gentamycin , furosemide ,valproate, antineoplastic
Metabolic: thyroid dx, DM, zinc deficiency, anemia
Mechanical: head/neck injury, TMJ disorder, infection, cerumen
Vascular: aortic/carotid stenosis, AV fistula malformation, tumor, ,

Question 18

Tinnitus: Assessment

Answer 18

Subjective: meds, hx of noise exposure, onset and character, associated symptoms
PE: inspect for obstruction, infection, bruit, TMJ problem, thyroid, cranial nerves
Plan: imaging to R/O vascular lesion if indicated, audiogram, labs to R/O thyroid dx, anemia, DM, zinc deficiency

Question 19

Treatment of Tinnitus

Answer 19

Most causes are irreversible and 25% will worsen over time.
Avoid noise above 80 decibels over the course of an eight-hour day
Wear ear plugs or muffs to prevent stimulus and worsening tinnitus
ENT and/or audiology referral recommended
Amplification (Hearing Aids), masking,
Tinnitus Retraining Therapy (TRT); Cognitive Behavior Therapy (CBT)
White noise machine at night time
No evidence that benzodiazepenes, antidepressants, gababetin, herbals, or acupuncture are helpful.