Ears Flashcards
What are the indications to remove cerumen clinically?
- EVERYTHING!
What is ceruminosis?
- excessive buildup of cerumen
What treatments soften the cereumen?
- H2O2/glycerin
- docusate sodium (laxative)
What are the mechanincal type treatments for cerumen?
- curreting
- irrigation
- suctioning
_________ complicated by _________ can lead to pericondritis.
- auricular hematoma (cauliflower ear)
- infection
What should be in the ddx list for pericondritis and how do you r/o?
- auricular cellulitis
- lobe is less involved with pericondritis
What are the treatments for pericondritis?
- systemic abx
- I&D
What is otitis externa?
- inflammation of the skin of the external ear canal & surrounding soft tissues
What are some enviornmental causes of otitis externa?
- maceration from loss of cerumen & increased moisture
- increased pH
- trauma
- ear plugs
- contact dermatitis (neomycin)
- infection s/p OM with perforation
What are the most common bug causes of otitis externa?
- S. aureus
- P. aerunginosa
- yeast is rare
What can occur with otitis externa?
- facial cellulitis
What is the treatment for otitis externa?
- otic drops
- ear wicks
- moist heat
- avoid water in the ear
How can otitis externa be prevented?
- one footed dance
- 1:1 sol’n vinegar/70% ethyl ETOH before and after water exposure
- 2% acetic acid drops
What are the classifications of otitis media?
- acute (AOM)
- with effusion (OME)
- chronic suppurative
What is AOM?
- acute otitis media
- acute onset of middle ear inflammation AND middle ear effusion (MEE)
How is a MEE determined?
- bulging TM
- limited or absent mobility of the TM
- air-fluid level behind the TM
- otorrhea
Define otorrhea
- fluid leaking from a hole in the TM
What are signs and symptoms of middle ear infection?
- TM erythema
- otalgia
- bluging TM 2ndary to crying
How does OM present?
- fever with otalgia
- disrupted sleep/activity
What is the exam for OM?
- pneumatic otoscopy (insuflation)
- cerumen removal
- tympanometry
What are complications from OM?
- typanosclerosis
- cholesteatoma
- TM perforation
- chronic suppurative OM
- mastoiditis
- facial n. paralysis
What is the treatment for OM?
- pain management/analgesia
- watchful waiting
- abx (1st: amoxicillian 2nd: augmentin)
- typanocentesis
What is the toynbee test?
- closed nose swallowing to generated (-) middle ear pressure
- pressure changes if TM is intact
What is serous otitis media?
- prolonged eustachian tube dysfunction causing (-) pressure builds up transudate in middle ear
What is the treatment for serous otitis media?
- PE tubes if MEE lasts longer than 4mo or (B) hearing impairment of 20dB+
What are the two types of cholesteatomas?
- central TM perf
- peripheral TM perf
What is a central TM perf?
- drainage of purulent fluid from middle ear
What is a peripheral TM perf?
- squamous epithelium from auditory canal invade middle ear through perf
- keratinaceous debris (tumor) forms at site
- bony errosion
What is congenital cholesteotoma and when is it found?
- squamous epithelium trapped in the temporal bone during embryogenesis
- discovered 6mo-5y/o
What is primary acquired cholesteotoma?
- pars flaccida of TM retracts medially over ossicles with their desctuction
- may erode into the mastoid or lateral semicircular canal
What can 2nd type of primary acquired cholesteatomas lead to?
- facial n. exposure
What is secondary acquired cholesteotoma?
- occurs 2ndary to TM injury
- squamous epithelium implants in middle ear
What are complications from cholesteotomas?
- menigitis
- brain abscess
- facial n. paralysis
What is the treatment for cholesteotoma?
- refer to ENT for mastoidectomy, myringoplasty, tympanoplasty
What is mastoiditis?
- spectrum ranging from mastoid periostium inflammation to bony destruction
- complication of OM
How does mastoiditis present?
- postauricular pain
- down or outwardly displaced pinna
- sore
What is the treatment for mastoiditis?
- IMMEDIATE ENT REFERRAL
- myringotomy w/ or w/o PT tubes
- IV abx
- cortical mastoidectomy
What are common foreign bodies found in adults v. children?
- adults: insects (i.e. cockroaches)
- children: food and small inorganic objects
When do children start putting foreign bodies in their ear and why?
- after 9 mo
- pincer grip
What are techniques to remove foreign bodies in the ear?
- mechanical extraction/curetting
- irrigation
- suction
When is irrigation contraindicated for removal of a foreign body in the ear?
- when the item might swell (organic matter)
