Ears- General and External Flashcards

1
Q

what are the 3 types of hearing loss?

A

conductive: problems that limit movement of sound wave through external & middle ear
sensorineural: damage to hair cells or nerve
mixed: combo of both

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2
Q

what is conductive hearing loss caused by?

A
  • obstructed ear canal
  • perforated tympanic membrane
  • dislocated ossicle
  • OM or SOM
  • OE
  • otosclerosis or ossicular chain fixation
  • congenital
  • cholesteatoma
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3
Q

what is sensorineural hearing loss caused by?

A
  • acoustic trauma
  • barotrauma
  • head trauma
  • ototoxic drugs (diuretics, antibiotics, etc)
  • infection
  • aging
  • acoustic neuroma
  • sudden SNHL, microvascular
  • meniere dz
  • vascular dz
  • MS
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4
Q

what is tinnitus?

A

perception of sound in absence of acoustic stimulus

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5
Q

what are the 2 types of tinnitus?

A
  • subjective:audible only to pt, high frequency, damage to hair cells
  • objective:rare, can be heard by doc
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6
Q

what can cause subjective tinnitus?

A
  • acoustic trauma
  • barotrauma
  • CNS tumors
  • infections
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7
Q

what can cause objective tinnitus?

A
  • turbulent flow in carotid A or jugular V

- vascular middle ear tumor

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8
Q

what is the work-up for tinnitus?

A
  • history: description of sound, noise of exposure, head trauma, hearing problems, loss of balance, recent dental work, etc.
  • PE: ototscopic exam, CN VIII fxn & hearing, check for carotid artery bruits, HTN
  • audiology, angiography
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9
Q

what is vertigo?

A
  • nonspecific term describing altered spatial orientation

- most often vestibular, visual or proprioceptive dysfunction

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10
Q

what are the two TYPES of vertigo?

A
  • subjective:pt is moving w/in surroundings

- objective: surroundings are moving around pt

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11
Q

what are the two CLASSIFICATIONS of vertigo?

A
  • true vertigo: sensation of movement

- non-true vertigo: syncope, fainting or sensation of impending fainting

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12
Q

what is true vertigo due to?

A

most common, asymmetry in vestibular sys (CN8, inner ear, cerebellum)

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13
Q

what are sxs of true vertigo?

A
  • either subjective or objective
  • postural instability
  • n/v, sweating
  • worse when moving head
  • nystagmus common
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14
Q

what are further classifications within true vertigo?

A

peripheral: CN8 or labyrinth
central: cerebellum or vestibular cortex in temporal lobe

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15
Q

how does nystagmus present in peripheral vertigo?central?

A

peripheral: unidirectional w/fast component towards normal ear, horizontal with rotation
central: any direction, sometimes changes direction

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16
Q

are there other neuro signs in peripheral? central vertigo?

A

peripheral: absent
central: often, ataxic gait,diplopia, slurred speech, numbness

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17
Q

how is postural stability in peripheral vertigo? central?

A

peripheral: unidirectional stability, walking preserved
central: severe instability, pt can fall while walking

18
Q

is there hearing loss in peripheral vertigo? central?

A

peripheral: may be present
central: absent

19
Q

what are some causes of central vertigo? what does it include?

A

lightheadedness: ‘graying out’, suggests hypoperfusion of brain
disequilibrium: w/standing or walking, unsteady w/o dizziness, source may be cerebellum, frontal lobe tumor, etc
miscellaneous: chronic hyperventilation syndrome, new eyeware

20
Q

work-up or vertigo?

A
  • history: onset sudden or gradual, duration
  • PE: general exam, otological exam, extraocular movements, hearing tests, sensory exam to test proprioception, vestibular imbalance
  • extra testing for true vertigo: caloric testing (water in ear) & nylene barany maneuver
  • extra testing for non-vertigo: orthostatic hypotension, carotid sinus massage, proprioception testing, hyperventilation
21
Q

sudden onset and vivid memory of episodes are usu due to dz where?

A

-inner-ear dz

22
Q

gradual and ill-defined vertigo originates from where?

A

-CNS, cardiac, & systemic dzs

23
Q

how long does epidsodic true vertigo last?

A

-lasts for secs, associated w/head or body position change (BPPV)

24
Q

vertigo that lasts for minutes can be due to what?

A

-brain or vascular dz

25
Q

vertigo that lasts for hours or days can be due to what?

A

-meniere dz or vestibular neuronitis

26
Q

what are red flag sxs associated with vertigo?

A

head or neck pain, ataxia, loss of consciousness, focal neurological deficit

27
Q

what are causes of otalgia?

A
  • external ear: impacted cerumen or foreign body, OE, local trauma
  • middle ear: eustacian tube obstruction, OM, neoplasms
  • referred pain from TMJ, wisdom teeth
  • local infxns: tonsilitis, peritonsillar abscess
  • atlas/axis subluxation
  • tumor in pharynx, tonsils, etc
  • neuralgia
  • colds, allergies, cold wind
28
Q

what are red flags of otalgia?

A

-diabetes or immunocompromised pts, redness/pain over mastoid, severe swelling of canal meatus, chronic pain w/head/neck sxs

29
Q

what can cause acute otorrhea?

A
  • acute OM w/TM perforation
  • post t-tube
  • CSF leak from head trauma
  • OE: infection or allergy
30
Q

what can cause chronic otorrhea?

A
  • cancer of ear canal
  • cholesteatoma
  • chronic purulent OM
  • foreign body
  • mastoiditis
31
Q

what are red flags of otorrhea?

A

head trauma, CN dysfunction, fever, erythema of ear, diabetes or immunocompromised

32
Q

what can cause obstruction of the external ear?

A
  • cermumen, may cause itching, pain, conductive hearing loss

- foreign body- children

33
Q

what can cause AOE?

A
  • infection
  • ‘swimmer’s ear’
  • forceful cleaning of ear
  • trauma
34
Q

what are SSxs of AOE?

A

itching, pain, discharge possible, loss of hearing if becomes swollen or filled with purulent debris

35
Q

PE findings of AOE?

A
  • pinna & tragus painful when pressed or tugged
  • external canal red
  • TM normal pearly gray
  • pseudomonas produces green/yellow otorrhea
  • aspergillus looks like fine white mat topped with black spheres
  • fever, swollen lymph nodes possibly
36
Q

what causes COE?

A
  • follows psoriasis, seborrheic dermatitis, eczema

- allergies or fungal infxn

37
Q

SSxs of COE?

A

-pruritis, redness, discharge

38
Q

PE findings of COE?

A
  • pinna & tragus less likely to be painful
  • external canal appears irritated, perhaps dry, flaking tissue
  • TM not usually affected
  • may get secondarily infected, increased pain & swelling
39
Q

what is perichondritis caused by and what does it cause?

A

trauma, insect bites lead to decreased blood to cartilage= avascular necrosis/deformity

40
Q

what are the 3 forms of tumors of the external ear?

A
  • sebaceous cysts, osteomas (occlude ear canal)
  • gouty deposits (tophi)
  • basal or squamous cell carcinoma (sun exposure)