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PANCE 2.0 > EENT #5 (Ears) > Flashcards

EENT #5 (Ears) Flashcards

1
Q

What are some risk factors for otitis externa?

A
  • Water immersion (swimmer’s ear)
  • Local mechanical trauma (use of Q tips)
  • Age 7-12 years
  • Aberrant ear wax (too much or too little)
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2
Q

MC bacterial etiology of otitis externa?

A

Pseudomonas aeruginosa

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3
Q

Other causes of otitis externa

A
  • Staph A
  • Staph Epidermidis
  • GABHS
  • Aspergillus
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4
Q

Symptoms of otitis externa

A
  • Ear pain
  • Pruritus in ear canal (may have recent activity of swimming)
  • Auricular discharge
  • Ear pressure/fullness
  • Hearing loss
  • Pain on traction of canal or tragus
  • Purulent auricular discharge
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5
Q

How do you diagnose otitis externa?

A

Otoscopy: edema of external auditory canal with erythema, debris, and discharge

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6
Q

How do you manage otitis externa?

A
  • Protect ear against moisture (isopropyl alcohol and acetic acid)
  • Removal of debris or cerumen
  • Topical ABX: Ciprofloxacin-Dexamethasone, Ofloxacin
  • -Aminoglycoside combination: Neomycin/Polymyxin B/Hydrocortisone
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7
Q

Why would you NOT use aminoglycosides for topical antibiotics for otitis externa if TM perforation is suspected?

A

They are ototoxic

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8
Q

What is malignant (necrotizing) otitis externa?

A

Invasive infection of external auditory canal and skull base

–Complication of acute otitis externa

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9
Q

MC etiology of malignant otitis externa

A

Pseudomonas Aeruginosa

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10
Q

Risk factors for malignant otitis externa

A
  • Immunocompromised (Elderly diabetics MC)
  • High dose glucocorticoid therapy
  • Chemotherapy
  • Advanced HIV
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11
Q

Symptoms of malignant otitis externa

A
  • Severe auricular pain
  • Otorrhea
  • Cranial nerve palsies (CNVII)
  • May radiate to TMJ pain with chewing
  • Severe auricular pain with movement of tragus or ear canal
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12
Q

How do you initially diagnose malignant otitis externa?

A
  • Otoscopy: edema or external auditory canal, discharge, erythema
  • -Granulation tissue at bony cartilaginous junction of ear canal floor
  • -Frank necrosis of the ear canal skin
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13
Q

What are the diagnostics that A) confirm malignant otitis externa and B) is the definitive diagnostic?

A

Confirm: CT or MRI

Biopsy is definitive and most accurate

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14
Q

How do you manage malignant otitis externa?

A

-Admission + IV ABX (IV Ciprofloxacin is first line)

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15
Q

Mastoiditis, an infection of ____________, is largely a disease of ________

A

Mastoid air cells of the temporal bone

Childhood (especially under 2 years old)

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16
Q

Symptoms of mastoiditis

A
  • Usually a complication of acute otitis media
  • -Otalgia, Fever, bulging and erythematous TM
  • -Mastoid (post auricular) tenderness, edema, erythema
  • -Protrusion of auricle
  • -Narrowed auditory canal
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17
Q

What is the first-line diagnostic test for mastoiditis?

A

CT Scan with contrast

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18
Q

How do you manage a patient with mastoiditis?

A
  • IV ABX + middle ear or mastoid drainage (myringotomy) with or without tympanovstomy tube placement
  • Tympanocentesis can be performed to get cultures

IV Vanco + Ceftazidime, Cefepime, or Piperacillin-Tazobactam

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19
Q

What ABX are best used for mastoiditis?

A

-IV Vanco + Ceftazidime or Cefepime or Piperacillin-Tazobactam

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20
Q

If the mastoiditis is refractory or complicated, what treatment should be done?

A

Mastoidectomy

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21
Q

What is chronic otitis media?

A

Recurrent or persistent infection of the middle ear and/or mastoid cell system in the presence of TM perforation > 6 weeks

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22
Q

MC etiology of chronic otitis media

A

Pseudomonas Aeruginosa

23
Q

True or False: Chronic otitis media can become worse after a URI or after water enters the ear?

A

True

24
Q

Symptoms of chronic otitis media

A
  • Perforated TM membrane + persistent or recurrent purulent otorrhea (painless)
  • Conductive hearing loss
  • Ear fullness
25
Q

How do you manage a patient with chronic otitis media?

A
  • removal of infected debris + Topical ABX drops (Cipro or Ofloxacin)
  • Avoid water, moisture, and topical aminoglycosides if TM rupture
26
Q

Risk factors for Acute otitis media

A 
Age 6-18 months
Day Care
pacifier or bottle use
Second hand smoke
Not being breastfed
27
Q

4 MC organisms seen in acute otitis media

A

A…SMH

Strep Pneumoniae (MC)
H. Influenzae
M. Catarrhalis
Group A Strep

28
Q

What is the pathophysiology of acute otitis media (AOM)

A

Most commonly preceded by viral URI

Leading to blockage of Eustachian tube

29
Q

Symptoms of AOM

A
  • Fever
  • Otalgia
  • Ear tugging in infants
  • Conductive hearing loss
30
Q

However, if the TM ruptures, what symptoms would you expect?

A

-Rapid relief of pain + Otorrhea (usually heals in 1-2 days)

31
Q

What is seen on physical exam of a patient with AOM?

A
  • Bulging and erythematous TM with effusion
  • Loss of landmarks
  • Decreased TM mobility (MOST SENSITIVE FINDING)
32
Q

Although AOM is a clinical diagnosis, what can be done?

A

Tympanocentesis for culture is definitive

33
Q

Management for AOM

A
  • Children over 2 receive ABX
  • -Amoxicillin is first line
  • -Second line: Amoxicillin-Clavulanic acid, Cefuroxime, Cefdinir, Cefpodoxime
34
Q

If the child has a PCN allergy, what medications are options for AOM

A

Azithromycin, Clarithromycin, Erythromycin-Sulfisoxazole, Trimethoprim-Sulfamethoxazole

35
Q

If the AOM is severe or recurrent, what should be done?

A

Myringotomy (surgical drainage) with tympanostomy tube insertion

36
Q

In children with recurrent otitis media, they may need _________ and _______

A

Iron deficiency workup and CT scan

37
Q

What is serous otitis media with effusion?

A

Middle ear fluid + no signs or symptoms of acute inflammation (no fever, no pain, no erythema, no bulging of TM)

38
Q

What is seen on otoscopy of a patient with serous otitis media with effusion?

A

Effusion with TM that is retracted or flat

39
Q

Management for serous otitis media with effusion

A

Observation in most cases (spontaneously resolves)

40
Q

Symptoms of eustachian tube dysfunction

A
  • ear fullness or pressure
  • popping of the ears
  • underwater feeling
  • tinnitus
  • conductive hearing loss that fluctuates
41
Q

Management for eustachian tube dysfunction

A
  • Treat underlying cause is the mainstay of treatment
  • Autoinsufflation (swallowing, yawning, blowing against slightly pinched nostril)
  • Decongestants for congestive symptoms
42
Q

What is barotrauma?

A

Damage to TM can occur with sudden pressure changes (flying, diving, hyperbaric oxygen, decompression)

43
Q

Symptoms of barotrauma

A

-Ear pain, fullness, hearing loss that persists after etiologic event

44
Q

What is seen on physical exam of a patient that has undergone barotrauma?

A

May have bloody auricular discharge if traumatic

TM visualization may reveal petechiae or rupture

45
Q

How do you manage a patient with barotrauma?

A
  • Avoidance is best treatment (do not fly with a cold)

- Autoinsufflation: yawning, swallowing, chewing gum

46
Q

cerumen impaction may lead to _______ and _____

A

Conductive hearing loss and ear fullness

47
Q

Conductive hearing loss pattern with cerumen impaction

A

Lateralization to affected ear on Weber testing

-Bone conduction > air conduction

48
Q

What is used to soften the cerumen?

A

Hydrogen Peroxide or Carbamide Peroxide

49
Q

If softening the cerumen doesn’t work what other treatment can be done for cerumen impaction?

A

-Aural toilet: irrigation, curette removal of cerumen, suction

50
Q

MCC of sensorineural hearing loss

A

Presbycusis (normal gradual aging hearing loss)

51
Q

MCC of conductive hearing loss

A

Cerumen impaction

52
Q

A weber hearing test is assessed with a tuning fork placed at the top of the head. Normal results are no lateralization. What occurs with conductive hearing loss? With sensorineural hearing loss?

A

Conductive: lateralizes to affected ear
Sensorineural: lateralizes to normal ear

53
Q

A Rinne hearing test is assessed with a tuning fork placed on the mastoid by the ear. Normal results are air conduction > bone conduction. However, what occurs in conductive hearing loss? In sensorineural hearing loss?

A

Conductive: BC > AC (negative)
Sensorineural: Normal AC > BC

PANCE 2.0 (62 decks)

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