Ears/Nose Flashcards
Cholesteatoma presentation
Unilateral hearing loss Purulent, foul discharge Perforated TM Cauliflower-like/ pearly-white mass H/o recurrent OM
Cholesteatoma treatment
Antibiotics
Refer to ENT for surgical excision
Conductive hearing loss PE
Lateralization to “bad” ear
BC > AC
Sensorineural hearing loss PE
Lateralization to “good” ear
AC > BC
Auricular Hematoma Presentation
Blunt trauma to ear
Bleeding in cartilage
If not drained can result in cauliflower ear
Acoustic Neuroma CN VIII (Vestibular Schwannoma) presentation
Asians 50-60s Lasting 3-4 years Unilateral sensorineural hearing loss Tinnitus Unsteady gait Possible facial nerve involvement CNVII
Acoustic Neuroma treatment
Refer to neurologist
Battle sign presentation
Adult that fell/assaulted/MVA Parietal bone linear fracture Blue/purple color of TM Otorrhea/rhinorrhea After 1-3 days: - Raccoon eyes - Mastoid bruising
Battle sign treatment
Refer to ED
Tympanogram Normal vs Abnormal Result
Normal = peaked line Abnormal = straight line (as seen in OM)
AOM Presentation
Child Ear pain Popping noises Muffled hearing Recent cold/allergic rhinitis Low-grade fever TM may be ruptured (blood/pus discharge)
Bullous Mygrinitis presentation
Type of AOM more painful Blisters on TM Red bulging or retracting TM Conductive hearing loss
AOM abx treatment
If no abx in last 30 days 1. Amoxicillin 500 mg tid x 5-10 days If no response in 48-72 hours 2. Amox-clav, cefdinir, cefprozil bid OR levofloxacin, moxifloxacin qd x 5 days
How long can MEEs last after AOM is treated?
8 weeks
Acute Bacterial Rhino-sinusitis presentation
Recent cold/allergic rhinitis Facial pain Nasal congestion >10 days Purulent nasal drip Hyposmia Postnasal drip cough No relief from OTC decongestants
Acute Bacterial Rhino-sinusitis PE
Dark yellow/green nasal discharge Maxillary and frontal sinuses TTP Boggy nasal turbinates Transillumination dull on affected side Possible fever
Acute Bacterial Rhino-sinusitis and AOM symptomatic treatment
Pain relief Hydration Pseudoephedrine/Guaifenesin Afrin (3 days max) Saline nasal spray q 2-3 hrs
Acute Bacterial Rhino-sinusitis abx treatment
- Amox-clav 1-2k mg bid x 5-7 days
- Cefdinir, cefpodoxime, cefuroxime
- Levofloxacin, doxycycline
When to initiate antibiotics for Acute Bacterial Rhino-sinusitis?
- high fever
- nasal discharge >3 days
- sxs > 10 days
- maxillary toothache
- unilateral facial pain
- bad odor in nose
- rebound sxs
- ## immunocompromised
Recurrent Acute Bacterial Rhino-sinusitis treatment
Refer to ENT
Meningitis presentation
Acute onset High fever Stuff neck Severe headache Photophobia \+ brudzinski or kernig signs
Cavernous sinus thrombosis presentation
Acute onset Severe headache Reduced sleep Confusion Fever Abnormal neuro exam
EOM/SOM PE
TM not red
fluid bubbles seen behind TM
EOM/SOM treatment
Oral decongestants
Steroid nasal spray
Saline nasal spray
+ Zyrtec if c/b allergic rhinitis
Otitis Externa (swimmer’s ear) presentation
External and canal ear pain Swelling Purulent green discharge Itching Conductive hearing loss Recent swimming
Otitis Externa (swimmer’s ear) abx treatment
Corticosporin 4 gtt qid x 7 days
Ofloxacin, ciprofloxacin gtt bid x 7 days
Add oral abx if immunocompromised
Otitis Externa (swimmer’s ear) recurrent treatment prophylaxis
Otic domeboro (boric) Alcohol and vinegar (VoSol)
Mono presentation
15-24 year olds Fever Pharyngitis Lymphadenopathy (posterior cervical) \+ Fatigue Tonsillar exudate Abdominal pain (HSM) Recent kissing
Mono labs
CBC - repeat until normal
LFTs
Monospot antibody
Abdominal US if HSM - repeat in 4 weeks
Mono treatment plan
No physical activity for 4 weeks
Symptomatic treatment
Avoid sharing saliva
Do not give amoxicillin
Ménière’s presentation
Recurrent vertigo
Tinnitus
Unilateral hearing loss
N/V
Ménière’s treatment
Salt restriction Avoid nicotine, caffeine, alcohol Vestibular suppressant PRN Antiemetic PRN Refer to ENT if persistent
BPPV presentation
50-70s
Brief vertigo episodes c/b sudden head movements and position changes
Induced by trauma, aerobics, mtn biking
BPPV diagnosis
Dix hall pike = gold standard
BPPV treatment
Epley Meclizine (avoid in elderly) Avoid sleeping on affected side x 1 wk
Ceruminosis treatment
OTC carbamide peroxide (debrox)
Allergic Rhinitis presentation
H/o asthma, eczema Chronic or seasonal nasal congestion Clear mucus rhinorrhea Postnasal drip w/ cough Nasal itch Sneezing Palatal click
Allergic Rhinitis PE
Boggy turbinates Allergic salute in children Cobblestoning Posterior pharynx with mucus Under eye “circles”
Allergic rhinitis treatment
eliminate allergen
- Nasal steroid - fluticasone, triamcinolone
- Azelastine
- Cromolyn sodium
- Decongestants PRN
- Second gen antihistamine PRN
Rhinitis medicamentosa treatment
Stop nasal decongestants
Nasal saline spray
Epistaxis causes
Trauma (nose picking)
Cocaine use
Anticoags/NSAIDs
Severe HTN
Epistaxis treatment
Apply direct pressure
Afrin to help shrink tissue
Refer to ENT if recurrent for cauterization
