EENT Flashcards
Acute Otitis Media
Infection of the middle ear made evident by infected fluid and inflammation of the mucosa lining
Presentation:
- Otalgia, bulging of tympanic membrane, marked erythema, fever
Diagnosis:
- Bulging tympanic membrane
Treatment:
- Amoxicillin 45mg/kg BID x5-7 days in 2 years and older without history of recurrent AOM or antibiotics use in the last 30 days (<2 years, recurrent AOM or if TM is perforated, treat with antibiotics x 10 days)
- Augmentin or Ceftriaxone if recent AOM, recent antibiotic use or treatment failure.
Acute Otitis Externa
Inflammation of the external auditory canal
- Also referred to as “swimmers ear”
Presentation:
- External otalgia, discharge, pruritus and possible hearing loss if sufficient pus present
Treatment:
- Polymyxin B-Neomycin-Hydrocortisone suspension drops QID x7 days AND.OR ofloxacin Otic drops BID x 7 days.
- NO neomycin, gentamycin, tobramycin (ototoxic) if the tympanic membranes intaqctness is not able to be confirmed.
Hearing loss
The problem may be with outer, middle or inner ear
- All hearing loss associated with outer and middle ear results in conductive hearing loss
- All hearing loss associated with the inner ear results in sensorineural hearing loss
Conductive hearing loss:
- Caused by something that stops the sound from getting through the outer or middle ear
- Example: Cerumen impaction
Sensorineural hearing loss:
- Occurs when there is damage to the ear’s inner structure
- Example: Ménière’s disease, acoustic neuroma, labyrinthitis
Weber and Rinne Hearing tests
Used to determine if conductive or sensorineural hearing loss present
WEBER: Tuning fork placed midline/forehead
- Sensorineural hearing loss: Sound localizes to unaffected ear
- Conductive hearing loss: Sound localizes to affected ear
RINNE:
- Normal: Air conduction > Bone conduction
- Abnormal: Bone conduction > Air conduction
Presbycusis: Progressive, symmetric hearing loss over years in the elderly
- Concern with loss of cognitive function due to hearing loss
Conjunctivitis
Inflammation of the conjunctiva, typically benign or self limiting
- Can be infectious (bacterial or viral) or allergic in nature
- Very contagious and spreads through direct contact (secretions or contaminated objects)
Presentation:
- Pruritic red eyes with discharge
- Bacterial conjunctivitis: Purulent discharge (yellow, white or green)
- Allergic conjunctivitis: Itchy eyes
- Viral conjunctivitis: Viral Prodrome with profuse tearing
Treatments:
- Antibiotics should be reserved for bacterial infection/contact lens wearers
- Fluoroquinolones are first in line with contact lens wearers due to the high incidence of pseudomonas infection
Subconjunctival Hemorrhage
Bright red blood, sharply demarcated area of the eyeball surrounded by normal conjunctiva
Risk factors:
- Anticoagulation therapy, trauma, history of coughing or vomiting, hypertension and diabetes
Treatment:
- Does not require treatment, blood reabsorbs in 2 to 3 weeks
Hordeolum
Acute inflammation of the eyelid
Presentation:
- Presents with painful swelling or a nodule
- May be internal (caused by inflammation of the meibomian gland) or external (eye lash follicle)
Treatment:
- Generally resolves spontaneously in 1 to 2 weeks
- Warm/moist compress for 5-10 minutes BID to QID
- Discontinue eye makeup during recovery
Chalazion
Slow growing inflammation of the eyelid
Presentation:
- Painless localized eyelid swelling
- Not infectious
- Caused by obstruction of a sebaceous gland
- Hordeola may evolve into a chalazion after acute inflammation resolves
Treatment:
- May take several weeks to months to resolve
- Warm/moist compress for 5-10 minutes BID to QID
- Refer to ophthalmologist for possible I&D if lesions persist >2 months
Hordeolum HURT… Chalazion is CHILL
Blepharitis
- Common chronic inflammation of the eyelid
- Classified as anterior or posterior blepharitis
- Posterior: More common, affects the inner part of the eyelid
- Anterior: Occurs at the base of the eye lashes
Presentation:
- Erythema, swollen, pruritic eyelid(s), crusting, blurred vision that can be blinked away
Treatment:
- Warm compresses to lid for 5-10 minutes at a time, 2-4. Times a day
- Lid massage
- Artificial tears
- Bacitracin or erythromycin ophthalmic ointment up to 4x a day for 1 month
Corneal Abrasion
