EENT #6 (Ears) Flashcards by Tyler Cichowski

Tympanic membrane rupture MC occurs due to ________ and MC occurs at what location?

Penetrating or noise trauma

Pars tensa

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Symptoms of TM perforation

Acute ear pain, hearing loss
Sudden pain relief with bloody otorrhea
Tinnitus and vertigo

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Although most TM perforations heal spontaneously, what should always be remembered if prescribing antibiotics for the ear?

Do not give aminoglycosides or water. They are ototoxic

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What is a cholesteatoma

-Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid

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What is a cholesteatoma MC from?

Chronic middle ear disease or Eustachian tube dysfunction

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Symptoms of a cholesteatoma

Painless otorrhea (brown or yellow discharge with a strong odor)
May develop peripheral vertigo, tinnitus, dizziness, or cranial nerve palsies

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What is seen on otoscopy of a patient with a cholesteatoma?

-Granulation tissue (cellular debris) and may have TM perforation

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True or False: A patient with a cholesteatoma will have conductive hearing loss?

True

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Management of a cholesteatoma

-Surgical excision of debris and cholesteatoma with reconstruction of the ossicles

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What is otosclerosis?

Abnormal bony overgrowth of the footplate of the stapes leading to conductive hearing loss

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Otosclerosis is what type of genetic inheritance pattern?

Autosomal dominant (may have family history of conductive hearing loss)

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Symptoms of otosclerosis

Slowly progressive conductive hearing loss (especially low frequencies)
Tinnitus
Vertigo is UNCOMMON

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Although conductive hearing loss is one way to diagnose otosclerosis, what is the most USEFUL?

Tone audiometry

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Management for otosclerosis

Stapedectomy with prosthesis or hearing amplification (hearing aid)
Cochlear implantation if severe

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What is the difference in nystagmus with peripheral vertigo vs central vertigo?

Peripheral: Horizontal nystagmus (beats away from affected side, fatiguable)
Central: Vertical nystagmus (nonfatiguable and continuous)

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What are some causes of peripheral vertigo?

BPPV (MC)
Meniere
Vestibular Neuritis
Labyrinthitis
Cholesteatoma

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Nausea and vomiting is caused by sensory conflict mediated by which neurotransmitters (5)

GABA
Acetylcholine
Histamine
Dopamine
Serotonin

What is the first line medication for vertigo?

Meclizine
Scopolamine
Dimenhydrinate
Diphenhydramine

Contraindications for antihistamines/anticholinergics such as Meclizine and Scopolamine?

Acute narrow angle glaucoma, BPH with urinary retention

What is the mechanism of action of ondansetron and granisetron?

Blocks serotonin receptors both centrally and peripherally in the medulla (suppressing the vomiting center)

Benign Paroxysmal Positional Vertigo is a type of peripheral vertigo that most commonly is due to _______

displaced otolith particles (calcium crystals) within the semicircular canals of the inner ear (Canalithiasis)

MCC of peripheral vertigo

BPPV

Symptoms of BPPV

Recurrent episodes of sudden, episodic peripheral vertigo (lasting 60 seconds or less) and provoked with specific head movements
Nausea, vomiting
NO HEARING LOSS, TINNITUS, or ATAXIA

How do you diagnose BPPV?

Dix Hallpike (Nylen Barany) Test: produces fatiguable nystagmus

How do you manage a patient with BPPV?

-Canalith repositioning treatment of choice (Epley Maneuver) or Semont Maneuver

What is vestibular neuritis?

Inflammation of the vestibular portion of Cranial Nerve VIII (8)

On the contrary, what is labyrinthitis?

Inflammation of the vestibular and cochlear portion of CNVIII (8)

Although the etiologies of vestibular neuritis and labyrinthitis are idiopathic, what may it be associated with?

Viral or postviral inflammation

Symptoms of both vestibular neuritis and labyrinthitis

Continuous peripheral vertigo Dizziness, nausea, vomiting, gait disturbances Horizontal and rotary nystagmus (away from affected side in fast phase)

What does labyrinthitis only have?

Unilateral hearing loss, tinnitus

Management of vestibular neuritis and labyrinthitis

- Glucocorticoids are first line - Antihistamines (Meclisine) or anticholinergics for symptoms - Both are self-limited and resolve within weeks

What is Meniere's Disease?

Idiopathic distention of the endolymphatic compartment of the inner ear due to excess fluid

Meniere Disease is characterized by four findings. What are they?

- Episodic peripheral vertigo (lasting minutes-hours) - Fluctuating sensorineural hearing loss - Tinnitus - Ear Fullness -Other symptoms: Horizontal nystagmus, nausea, vomiting

Management of Meniere Disease

- Initial: Dietary modification: avoidance of salt, caffeine, nicotine, chocolate, and alcohol - Medical: antihistamines (Meclizine) and diuretics (Hydrochlorothiazide) to reduce pressure are options

If the case of Meniere's Disease is refractory, what treatments can be pursued

``` Surgical decompression (T tube) Labyrinthectomy Intraaural Gentamicin ```

What is an acoustic CNVII neuroma?

Vestibular schwannoma--benign tumor involving Schwann cells which produce myelin sheath

Where does an acoustic neuroma arise?

Cerebellopontine angle and can compress structures (CNVIII, VII, and V)

Symptoms of an acoustic neuroma

- Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise - Tinnitus - Facial numbness - Facial paresis - Ataxia - Headache

What is the imaging study of choice for an acoustic neuroma

MRI

However, what is the laboratory study of choice for an acoustic neuroma?

-Audiometry

Treatment for an acoustic neuroma

-Surgery or focused radiation therapy