Ears

Question 1

Otitis media. How is pain described? What types of middle ear problems occur with this? s/s?

Answer 1

Pain occurs deeper in the ear past the external ear canal

Pain might be described as being behind the ear

Serous effusions, cholesteatoma, acute otitis media with purulent effusion

Question 2

Serous effusion occurs with and usually caused by what?

Answer 2

otitis media w/serous effusion

usually caused by URI - eustachian tube takes on serous fluid and fluid accumulates in the middle ear

Question 3

Symptoms of otitis media w/serous effusion

Answer 3

popping sensation in the ear, fullness in the ear, mild conductive hearing loss, and sometimes pain

Question 4

What is characteristic on examination of otitis media w/serous effusion?

Answer 4

amber fluid behind the eardrum

• a fluid level, a line between air above and amber fluid below, can be seen on either side of the short process
• air bubbles are sometimes present but not always

Question 5

Another form of otitis media often caused by a bacterial infection?

Answer 5

acute otitis media w/purulent effusion

Question 6

Acute otitis media w/purulent effusion s/s? Think bacterial infection
What does this look like on examination?

Answer 6

• s/s: earache, fever, and conductive hearing loss
• the eardrum reddens, loses its landmarks, and bulges laterally, toward the examiner’s eye
• sometimes perforation w/discharge of purulent material

Question 7

Cholesteatoma. What is it? What does it look like? s/s? what would you do?

Answer 7

• Type of chronic otitis media with peeling layers of scaly epithelium
• s/s: painless otorrhea, ear canal filled with keratin debris or granulation tissue, hearing loss, TM perforation around 90% of the time
• REFER TO ENT
• cyst-like mass behind the eardrum caused by proliferation of squamous epithelium
• examination reveals collection of white granulation tissue with perforation of the TM

Question 8

Tug Test

Answer 8

movement of the auricle and tragus is painful in acute otitis externa, but not in otitis media

Question 9

Otitis externa (Swimmer's ear)
What is it? S/S?

Answer 9

• Inflammation or infection of the external auditory canal

- s/s: tenderness at tragus and pinna (outer ear), otorrhea, debris, redness and edema in external canal

Question 10

What dose acute otitis externa look like upon examination

Answer 10

the canal is often swollen, narrowed, moist, pale and tender

might be reddened

Question 11

In chronic otitis externa what does an ear exam look like?

Answer 11

skin of the canal is often thickened, red, and itchy

Question 12

Severe form of otitis externa? What would you do?

Answer 12

Ear wick + IV abx