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Foundations II > Ears > Flashcards

Ears Flashcards

1
Q

cerumen impaction etiology, presentation, diag, Tx

A

Cerumen protects ear.
Etiology: self induced
PE: Hearing loss, earache, fullness, itchiness, reflex cough (vagus) Dizziness, tinnitus
Tx: detergent ear drops, mechanical removal, irrigation with body temp water, dry canal.
HnP: Q-tip
Pt education: no Q-tips, refer if unruly pt or cerumen wont break up.

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2
Q

Foreign body etiology, presentation, diag, Tx, complications

A

Children> adults
PE: Asymptomatic, decreased hearing, otaglia, drainage, chronic cough/ hiccups
Tx: Urgent if button battery, live insect, penetrating FB. Firm = irrigate and loop, organic, immobilize and loop.
Complications: TM or canal lacerations. Check other ear and nostrils

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3
Q

Otitis Externa etiology, presentation, Epidemiology, diag, Ddx, Tx, Prevention

A

Swimmer’s ear: Allergies, dermatologic conditions, infection (Pseudomonas, S. epidermidis, S. aureus, Fungi
PE: Swelling, erythema, discharge, otaglia, puritis, hearing loss, Hx of water exposure, tender tragas, TM moves with pneumatic otoscope
Epidemiology: Warm humid climate, psoriasis, trauma, occlusive devices.
Ddx: Otitis media, contact dermititis, psoriasis, herpes zoster, squamous cell carcinoma, Chronic suppurative otitis media, radiation.
Diag: Clinical diag on HnP
Tx: Aminoglycoside, fluoroquinolones if TM ruptured + corticosteroids, PLace wick, remove debris, refer to ENT.
Prevent: No Q-tips or swimming

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4
Q

Hematoma of External ear etiology, presentation, Tx

A

Trauma to auricular (hemoragge). Tx: prompt drainage

Complication: cauliflower ear.

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5
Q

AOM etiology, risk factors, presentation, Epi, diag, Tx

A

Risk factors: Age, inflammation, congenital malformation, Fx, day care, lack of breastfeeding, pacifier use, tobacco/air pollution
Etiology: Bacterial (HMSSS) URI predictor EDT obstructed, accumulates fluid allows 2nd infection, Allergies, 2nd hand smoke
Epi: children in the winter (4-24 months).
PE: otaglia, pressure, hearing loss, fever, URI symptoms, TM immobile with erythema and bulge (mycoplasma). TM may rupture
Ddx: OM with effusion, ETD, Herpes zoster, head/neck infection
Tx: 1st line: Amoxi 80-90 divided, PCN resistant = cephalo, doxy, macrolides. 2nd line = amoxi-clavulanate and 2nd-3rd gen cephalosporin. Ofloxin for TM rupture
improve within 48-72 hrs

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6
Q

Chronic Otitis media etiology, presentation, diag, Tx

A

Etiology: recurrent AOM
PE: chronic otorreah, Perforated TM, Conductive hearing loss (BC>AC)
Tx: remove debris, earplugs, topical or oral antibiotics, Surgery to repair TM.

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7
Q

Serious Otitis Media etiology, Epi, presentation, diag, Tx

A

Etiology: eustachian tube prolonged blocked, negative pressure.
Epi: Kids = narrow and horizontal EDT. Adults after URI, barotrauma, chronic allergies
PE: No inflammation, conductive hearing loss, fullness, TM is dull hypomobile, bubbles visible,

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8
Q

Cholesteatoma etiology, presentation, diag, Tx, complications

A

Specific type of chronic otitis media.
Etiology: prolonged ETD (most common cause), Chronic negative pressure pulls TM, creates lined sac - squamous epithelium, keratin: pseudomonas Proteus (always behind TM).
PE: Asympt or hearing loss, Chronic infection, otorreah, TM pocket, perforating exudating debris.
Tx: antibiotics drops, surgical.
Complications: Erosion into inner ear, facial nerve, brain abscess.

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9
Q

Eustachian Tube dysfunc. etiology, presentation, diag, Tx, management, & complications

A

Middle ear to Nasopharyx. Ventilate and drain middle ear. Usually closed unless swallowing & yawn.
Etiology: Tube lining edema, trapped air in middle ear = negative pressure. VURI, allergies
PE: fullness, fluctuating hear, otaglia, pressure change, popping or crackling sensation. retracted TM with decreased mobility.
Management: Avoid air travel and scuba diving.
Tx: decongestants (topical/oral), Autoinflation, desensitize to allergies, Intranasal contricosteroids, surgery, Complication: serous otitis media, cholesteatoma

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10
Q

Otic Barotrauma etiology, presentation, diag, Tx, Pt ed

A

Cant equilize pressure in middle ear during: air travel, rapid altitude change, underwater diving.
Etiology: Mucosal edema, congenital narrowing.
PE: otaglia during descent
Tx: enhance Eustachian tube with decongestant (systemic before fly, nasal before descent)
Pt ed: swallow, yawn, autoinflate in planes - inhibit negative pressure. Hemotympanum, perilymphatic fistula = ruptured oval window, sensory heaing loss, acute vertigo, vomit.

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11
Q

TM perforation etiology, presentation, diag, Tx

A

Small rupture (25% autorepair), larger require tympanoplasty, No water in canal until TM closed. Avoid ototoxic ear drops (aminoglycoside) use quinolones

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12
Q

AOM Complications and Tx

A

Labyrinthitis, Hearing loss, Mastoiditis
Tx: with antibiotics or mastoidectomy.
Resistance = IV antibotics , check resistances.
Tympanostomy (PE tubes)

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13
Q

Otic barotrauma complications

A

TM ruptured, middle ear infection. Persistant pressure after landing. Decongestant, autoinflate, mydringotomy for immediate relief, Ventilating PE tubes

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14
Q

Ramsey Hunt Syndrome

A

HSV, facial palsy. Outer ear canal

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15
Q

weber test results

A

BC> AC, crummy ear

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16
Q

cough reflex

A

vagus nerve, hiccups too

17
Q

place wick why?

A

in OE due to inflammation

18
Q

malignant otitis externa

Dx, Tx

A

AKA necrotizing otitis externa: osteomyolitis of temporal bone. Foul smalling, granualtions, deep otaglia, cranial nerve palsies.
Dx: CT
Tx: IV quinolones, surgery

19
Q

3 signs of Chronic otitis media

A

Chronic ottorhea, conductive hearing loss, perforated TM

20
Q

types of Hearing loss

A

Acute vs Gradual, Conductive vs sensorineural. Mostly in older patients

21
Q

Tinnitus, Hx, Dx, Tx

A

ringing, buzzing.
Sensory-neural hearing loss association. Affects 50 million people, more in men.
Hx: HTN, ASCVD, depression, insomnia
Dx: MRI, idiopathic
Tx: Pt edu, stop ototoxic Rx, avoid loud sounds, music can mask it.

22
Q

Labyrinthitis Etiology, PE, Tx, Pt edu

A

Inflamed CN 8, post-viral infection.
PE: acute onset continuous, sever vertigo, hearing loss, tinnitus, N/V gait impairment.
Tx: Antibiotics, antihistamine, benzos, Anti-emetics, corticosteroid.
Pt edu: self limiting, gradual recovery, vestibular rehab.

23
Q

Meniere disease, PE, Dx, Tx

A

Endolymphatic Hydrops
Vertigo syndrome due to peripheral lesion. Endolymph pressure changes.
PE: episodic vertigo 20 mins, sensorineural hearing loss, tinnitus (low tone)
Vertigo + hearing loss + tinnitis
Dx: Referral to ENT
Tx: diuretics low salt diet

24
Q

vestibular schwannoma

Dx, PE, Tx

A

acoustic neuroma, common intracranial tumors, benign tumor, CN 8 compressed (pons and hydrocephalus) Unilateral
Dx: Audiometry, MRI
PE: unilateral hearing loss, Continuous dysequilibrium, Tinnitus
Tx: Observation, surgical, radiotherapy.

25
Q

vertigo disease and types

A

no definition, vestibular disease. Central (nystagmus vertical) or peripheral (nystagmus horiz)

26
Q

Conductive hearing loss & mechanisms. Causes

A

dysfuntion of external or middle ear, not transmitted to cochlea.
Mech: obstructive, mass effect, stiffness effect, discontinuity.
causes: otitis media or externa, TM rupture, trauma, otosclerosis

27
Q

Sensorineural hearing loss

Mech, Etiology

A

dysfunction or cochlea or hair cells (CN 8).

Etiology presbycusis, loud noise trauma, meniere’s disease, head trauma, systemic inflammation, acoustic neuroma, MS

28
Q

Menieres disease

A

disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. unilateral. Cant hear Low pitched

29
Q

Sjogrens syndrome

A

test to eval hearing loss (autoantibody test)

30
Q

hearing Dx tests

A

pure-tone (audiogram), speech audiometry. Electrocochleargraphy: ilicit brainstem responce.

31
Q

forms of tinnitus

A

Pulsating/ vascular = hear heart beat. (angiogram or bone CT)
Staccato: rapid series of pops or clicks = middle ear spasm.

32
Q

Dizziness Dx, PE

A

Dx: history.
PE: vitals/orthostatic, N/V

33
Q

Vertigo

Dx:

A

BPPV most common is Posterior canal = horizontal nystagmus

Dx: DIx-hallpike maneuver, ENG/VNG = measure nystagnus. Vestibular disorder: BPPV, labyrinthitis, meniere disease

34
Q

Peripheral causes of vertigo. PE

A

LAMO
vestibular neuritis/labyrinthitis, meinere disease, alcohol, otitis barotrauma, semicircular canal dehiscence. Sudden onset,
PE: Acute severe sympt N/V Tinnitis, hearing loss, horizontal nystagmus with rotation. Eye motion in response to head turning. Fatiguable

35
Q

Central causes of vertigo. PE

A

Seizure, MS, Wernicke encephalopathy, chiari malformation, cerebral ataxia.
PE: Gradual onset, gait and posture issues, nystagmus in any direction no latency, no suppression. No auditory syndrome. Non-Fatiguable, no auditory symptoms

36
Q

Central & Peripheral causes of vertigo

A

Migraine, stroke, vestibular schwannoma, meningioma, infection (Lyme, syphilis), hypothyroidism

37
Q

BPPV & Tx:

A

benign paroxysmal positional vertigo. otoliths, otoconia. 10-15 latency period. Brief duration, often recurrent.
Tx: Epley maneuver, PT/OT, bed rest. Fall risk

Foundations II (6 decks)

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