Ears Flashcards
Viral URI leads to Eustachian tube dysfunction or blockage creating bacterial infection with subsequent buildup of fluid and mucous. Common infants/children.
Acute otitis media
Viruses causing AOM
Strep pneumoniae
H. influenzae
Moraxella cattarhalis
Strep pyogenes
Sxs: Ear pain, ear pressure, hearing impairment
PE: TM erythema and limited motility with pneumotoscopy
Bulging and eventual rupture of TM can occur leading to otorrhea and abruptly decreased pain
Acute otitis media
Treatment AOM
Amoxicillin (first line)
Cephalosporin, TMP-SMX, Azithromycin, Cefaclor, amox-clav
Surgical treatment AOM
Tympanostomy, tympanocentesis, myringotomy
What can occur with inadequate treatment of AOM?
Mastoiditis
Repeated episodes of acute otitis media, trauma, cholesteatoma. Pseudomonas aeruginosa, S. aureus, proteus, anaerobes.
Chronic otitis media
PE: Perforated TM, chronic ear discharge w/o pain; conductive hearing loss
Chronic otitis media
Removal of infected debris, avoidance of water exposure, topical antibiotic drops
Surgery: Tympanic membrane repair/reconstruction
Treatment chronic otitis media
Associated with water exposure, trauma, or exfoliative skin conditions like psoriasis or eczema; “Swimmer’s ear”
Pseudomonas, proteus, fungi
Otitis externa
Patient complains of ear pain esp. with movement of tragus/auricle. Sxs include redness, swelling of ear canal. Purulent exudate.
Otitis externa
Abx drops and avoiding moisture
Aminoglycoside & fluoroquinolone +/- steroid
Otitis externa treatment
Sensation of movement (spinning, tumbling, falling)
Causes of peripheral: labrinthytitis, meniere syndrom (endolymphatic hydrops), benign, paroxysmal positional vertigo, vestibular neuritis
Central: Head injury, tumors, MS, migraines
Vertigo
Dx: Presence and duration of hearing loss, nystagmus, N/V, tinnitis, (Peripheral)
Central usually motor, sensory, cerebellar defects, no auditory symptoms
Vertigo
Diagnosis for benign positional paroxysmal vertigo, patient lays in supine position while provider quickly turns head 90 degrees. Will produce fatiguable nystagmus.
Dix-Hallpike maneuver
If dix-hallpike maneuver is performed and nystagmus is not fatiguable, what could the cause be?
Central vertigo
Therapy based on underlying cause
Diazepam, meclizine for acute sxs
Physical therapy maneuvers
Intervention/surgical therapy
Treatments for vertigo
Acute severe vertigo with hearing loss and vertigo seven days to a week. The vertigo progressively improves over a few weeks, but hearing loss may or may not resolve.
Labrythitis
Abx with fever or associated bx infection
Vestibular suppressants are helpful during initial acute sxs
Treatment for labrynthitis
Rupture will occur from AOM or trauma
Most cases will resolve on their own; surgical repair may be necessary for Tm and ossicular chain w/ persistent hearing loss
Avoid water/moisture in ear to prevent secondary infection
Perforated TM
Causes conductive hearing loss. Caused by overproduction of wax, use of q-tips, creates plug that decreases hearing
PE: Copious cerumen, loss of visibility of TM
Impacted cerumen
Mechanically remove with ear curette/loop. Can use detergent drops, suction, irrigation.
Treatment for impacted cerumen
Most common in kids, can affect speech. Conductive hearing loss. Bottle feeding, smoking, eustachian tube issues. Viral.
Conductive hearing impairment/sleep issues. Nystagmus and vertigo (child will fall over). TM can appear blue and is neutral or retracted Pneumatic otoscopy
Otitis media w/ effusion
3 months or more = audiology referral. If pain or vertigo refer to ENT for tube placement (tympanostomy).
Can cause scarring, hearing loss, perforated TM.
Otitis media w/ effusion treatment
Conductive hearing loss. Abnormal bony growth of the middle ear. Affects both ears. Hearing loss may occur slow at first but continues to get worse. Hearing better in noisy environments than quiet ones.
Dx: Temporal bone CT may be done to rule out other causes of hearing loss
Otosclerosis
Fluoride calcium, vitamin D in early stages - surgery to remove bony overgrowth; hearing aids.
Complications = complete deafness, nerve damage, infection, dizziness, pain, blood clot in ear post surgery
Treatment otosclerosis
Most common etiology of sensorineural hearing loss. Genetic predisposition is strong. Increased risk is highly increased with noise exposure to various medications. Gradual impairment of higher sound frequencies that occurs with increasing age.
Tx: ENT referral for hearing aids, cochlear implant.
Presbycusis
Ringing in the ear
Tx: Instrumental; use other noise to distract ringing, electro-magnetic stimulation therapy, hypnotherapy, acupuncture, pharmacotherapy (lidocaine, antidepressants, sedatives, gabapentin); hearing aids may help
Tinnitus
With conductive loss, the Weber results in lateralization to the ________ ear. Rinne test also shows ______ bone conduction than air conduction on affected side.
AFFECTED
GREATER
With sensorineural hearing loss, the Weber test results in lateralization to the _______ side. The Rinne test will show?
UNAFFECTED
Greater air conduction than bone conduction
New onset of hearing loss in affected ear, ear drainage for 2 weeks, presents as painless (no irritation).
PE: Visualize TM, check for wax and foreign body, white mass behind TM (erosion within membrane) or granulation tissue on retracted TN. Diagnose by clinical suspicion
Cholesteatoma
Sent to ENT - Tube insertion or drain surgically and remove and reconstruct; audiologist for hearing issues; also CT scan to visualize location and size but try to avoid w/ children
Can cause brain infections (meningitis/abscess)
Cholesteatoma treatment
Uncomfortable red bump behind ear, fever, nausea, URI symptoms. School age children often in adults as well.
Risk = recurrent AOM, active AOM
PE: Inflammation of mastoid process, redness, post-auricular lymph nodes causing anterior displacement of pinna
Mastoiditis
Admission to hospital, IV abx (cephlotaxine), urgent ENT consult, drain abscess
Mastoiditis treatment
Inability to equalize barometric pressure in middle ear, associated with eustachian tube dysfunction (congenital narrowing or acquired mucosal edema). Can occur w/ flying, rapid altitude change, or diving underwater.
Presents with ear pain and hearing loss that persists past the inciting event
Barotrauma
Swallowing, yawning, auto inflation (with descent), as well as the use of systemic or topical nasal decongestants (prior to arrival), can be helpful.
Persistent sxs can be treated with decongestants repeated with auto inflation W/ severe pain/hearing loss, myringotomy may be considered!
Barotrauma treatment
Uncontrolled movement of the eyes
Can cause dizziness, visual problems
Tx: None really, case dependent
Nystagmus
Epley maneuver puts crystals back into place
Tx for benign paroxysmal positional vertigo
Endolymphatic hydrops. Sxs related to distention of the inner ear’s endolymphatic compartment.
Sxs: Recurrent vertigo (lasting minutes to hours), w/ lower range hearing loss, tinnitus, one-sided aural pressure. W/ Caloric testing, nystagmus is lost on impaired side
Meniere disease
Low sodium diet and diuretics (acetazolamide). Unresponsive cases can be treated w/ more invasive procedures (intratympanic corticosteroid therapy, surgery).
Meniere disease treatment
Intracranial benign tumor affecting eighth cranial nerve. Unilateral and may present w/ progressive one-sided hearing loss w/ impaired speech discrimination. Hearing loss may also present more acutely.
Other sxs: Vertigo, continuous not episodic
Acoustic neuroma (Vestibular schwannoma)
Consider patient age, health status, tumor size; involve surgery or radiation
Acoustic neuroma (vestibular schwannoma)
Sound is better in one ear than the other
Lateralization
Disorders causing conductive hearing loss
Otitis media with or without pleural effusion
Cerumen impaction
Otosclerosis
Otitis externa
Most common cause of sensorineural hearing loss
Presbycusis
Disorders that cause sensorineural hearing loss
Presbycusis
Meniere disease
Acoustic neuroma
