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GW Clinical Medicine I > EENT > Flashcards

EENT Flashcards

1
Q

oscillopsia

A

visual distortion

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2
Q

air conduction

A

gain from tympanum to oval window about 18 fold

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3
Q

bone conduction

A

temporal bone conduction has 60-dB loss

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4
Q

hair cells in ear

A

tonotopically organized on cochlear basilar membrane detect vib on membrane

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5
Q

Tympanosclerosis

A

calcification or scaring of TM and middle ear from inflammation

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6
Q

myringosclerosis

A

calcification of TM from OME and AOM, rarely hearing loss unless “porcelain eardrum”

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7
Q

myringosclerosis vs middle ear mass

A

pneumatic otoscopy shows diff as plaque moves with TM during insufflation

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8
Q

retraction pocket

A

invagination of pars tensa or pars flaccida from chronic inflamm and neg prssure in middle ear (atrophy, atelectaisis of TM)

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9
Q

adhesive otitis

A

continued inflammation between retracted TM and ossicles creating cholestetoma or fixation and erosion of ossicles

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10
Q

cholestetoma

A

pearly white mass seen in retraction pocket/ perforation… purulent drainage or granulation tissue/ polyps… SMELLS bad! keratinizing squamous epithelium in the middle ear and/or mastoid process

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11
Q

perforation from AOM: time frame, drug, limitations of patients behavior

A

heals within 2 wks, ototopical antibiotics for 10-14days referred to an otolarygologist 2-3 wks after rupture for hearing eval limit water activities/ use ear mold

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12
Q

tympanoplasty

A

repar eardrum after 7 when Eustachian tube reaches adult orientation

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13
Q

facial nerve

A

encased in temporal bone to stylomastoid foramen through middle ear

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14
Q

facial nerve paralysis…

A

not idiopathic Bell palsy until everything else excluded.

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15
Q

myringotomy

A

perforate TM to release fluid in middle ear with facial nerve paralysis, place tube

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16
Q

if cholesteatoma or mastoiditis is suspected

A

CT is indicated.

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17
Q

OME vs AOM

A

OM w/ effusion: fluid in the middle ear without inflammation, before/after an infection (few days - many weeks/ mths after AOM) common in young children.

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18
Q

tool to clear cerumen

A

ear curette or irrigation for hard/ flaky can add cerumen softener (H2O2)

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19
Q

tympanometry

A

measures TM compliance and volume of ear canal, displays as a graph, shows if perforated or intact TM

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20
Q

226 Hz tympanometry for kids older than 6 mths

A

1000hz for younger

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21
Q

chronic supperative OM (CSOM)

A

ongoing purulent ear drainage, TM perforation or tympanostomy tube …can be assoc. with cholesteatoma, chronic mucosal edema, ulceration, granulation tissue, polyp formation

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22
Q

risk factors for CSOM

A

history of OM, crowded living, day care, lg fam, P.aeruginosa, S. aureus, Proteus sp. Klebsiela penuoniae, diptheroids

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23
Q

key to Mgmt

A

determine cause, cleaning drainage, topical antimicrobial

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24
Q

possible causes of CSOM

A

foreign body, neoplasm, landerhans cell histiocytosis, TB, granulomatosis, fungal infection, petrositis (bone probs)

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25
Q

immediate referral to an otolaryngologist

A

facial palsy, vertigo, CNS signs

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26
Q

supperative OM

A

labrynthitis can be sequelae bony obliteration of inner ear, including cochlea–> hearing loss

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27
Q

mastoiditis

A

AOM present, postauricular pain and erythema (later ear protrusion) infection spreads from middle ear space to mastoid part of temporal bone–> abcess possible 60% >2yrs old

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28
Q

symptoms / signs of mastoiditis

A

mastoid red/indurated, swollen and fluctuant, pinna pushed forward from postauricular swelling, narrowed ear canal. except in younger pts swelling is superior, an pushes ear down vs out

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29
Q

incidence of mastoiditis in patients on antibiotics

A

2/100,000 person years U.S. vs. 4.2 in Netherlands where only 31% get antibiotics

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30
Q

diff diagnosis for mastitis

A

lymphadentitis, parotitis, trauma, tumor, histiocytosis, OE, furncle

31
Q

complications of mastoiditis

A

meningitis when with high fever, stiff neck, severe headache… lumbar puncture for diagnosis. facial palsy, sigmoid sinus thrombosis, epidural abcess, cavernosu sinus thrombosis, thrombophlebitis

32
Q

if no improvement after 48 hrs

A

surgical intervention: tympanostomy tube, with cultures taken. if subperiosteal abscess: incision and drainage preformed…culture directed antibiotic for 2-3wks.

33
Q

how is a tympanostomy tube maintained

A

with continued otic drops until drainage abates.

34
Q

4 types of conductive hearing loss

A

(1) obstruction (cerumen impaction),
(2) mass loading (eg, middle ear effusion),
(3) stiffness effect (eg, otosclerosis), and
(4) discontinuity (eg, ossicular disruption)

35
Q

sensory hearing loss can be caused by …

A

can be from presbycusis, acoustic trauma, or acoustic neuroma, mumps, meningitis, head trauma, or ototoxic medications (ASA, erythromycin, quinine), or congenital (rubella, maternal diabetes, prematurity, hypoxia, genetics))

symptoms include tinnitis,

36
Q

presbyacusis

A

advancing age… associated with sensory hearing loss

deterioration of the cochlea, from loss of organ of Corti (hairs) progressive, high-frequency loss because all sounds hit the area that processes high pitches (so they get more wear and tear through the years)

37
Q

sudden sensory hearing loss

A

may respond to corticosteroids if delivered within several wks of onset

38
Q

diseases of auricle

A

traumatic auricular hematoma,

skin cancer,

canal blockage from dissolution of cartilage,

cellulitis,

relapsing polychondritis (rheumatologic) (treat wit corticosteroids)

39
Q

disease of ear canal

A

cerumen impaction, foreign bodies

40
Q

avoid vestibular caloric response

A

use body temp water to avoid dizziness, aim at posterior ear canal wall near cerumen plug **only when TM intact!!

COWS : Cold opposite directed nystagmus, warm water causes nystagmus toward the same side

41
Q

cerumen impaction

A

self induced releaved with drops, mechanical removal, suction, irrigation

42
Q

foreign bodies

A

dont use water to flush, causes swelling. use microscopic guidance

43
Q

Treatment for eustachian tube

A

systemic and intranasal decongestants (eg, pseudoephedrine, 60 mg orally every 4 hours; oxymetazoline, 0.05% spray every 8–12 hours) combined with autoinflation by forced exhalation against closed nostrils may hasten relief.

44
Q

patulous eustachian tube

A

own breathing too loud, aural pressure hypofunction eustachian tube. can see excursions of TM during heavy breathing

45
Q

serous OM

A

usually only in adults after an upper respiratory tract infection, with barotrauma, or with chronic allergic rhinitis. or nasopharyngeal carcinoma

46
Q

treatment for serous OM

A

oral corticosteroids (eg, prednisone, 40 mg/day for 7 days) & oral antibiotics (eg, amoxicillin, 250 mg three times daily for 7 days)— or a combination of the two.

47
Q

barotrauma

A

Oral decongestants (eg, pseudoephedrine, 60–120 mg) should be taken several hours before anticipated arrival time so that they will be maximally effective during descent. Topical decongestants such as 1% phenylephrine nasal spray should be administered 1 hour before arrival.

48
Q

dive slowly to avoid…

A

hearing loss and acute vertigo…avoid the development of severely negative pressures in the tympanum that may result in hemorrhage (hemotympanum) or perilymphatic fistula. In the latter, the oval or round window ruptures

49
Q

cant go diving

A

when upper respiratory tract infection or nasal allergy, or TM rupture, never dive. unbalanced thermal stimulus to the semicircular canals and may experience vertigo, disorientation, and even emesis.

50
Q

Otosclerosis

A

Lesions involving the footplate of the stapes producing conductive hearing loss.–> hearing aid/ stapedectomy

51
Q

Meniere’s Disease etiology

A

Excess accumulation of endolymph in membranous labyrinth causing distension of ductis.

6 subtypes (classic, cochlear- not dizzy, vestibular- no auditory, bilateral, subclinical, post-traumatic)

52
Q

presentation of Meniere’s disease

A

tinnitus, aural fullness, vertigo can last minutes to days

can cause progressive unilateral hearing loss especially lower pitch.

53
Q

acoustic trauma tx

A
54
Q

eustachian tube dysfunction

A

tube fails to open and stays closed

common with kids since horizontal position

55
Q

causes of Eustation Tube Dysfunction (ETD)

A

inability of hair cells to remove fluid and infection

narrow eustachian tube

adenoid tissue blocking ET

swollen nasal tissue or secretions (rhinorrhea)

nasopharyngeal tumor in adults

56
Q

associated dysfunction with ETD

A

otitis media

barotrauma

cholesteatoma if IM burst (see on physical exam as pearl on TM) (can also lead to facial paralysis if compresses CN, destruction of the middle ear, labyrinth, mastoid air cells)

57
Q

Presentation of ETD

A

ear pain, pressure

stuffiness

hearingloss/ tinnitis

rectracted TM

58
Q

treatment of ETD

A

nasal decongestant

nasal steroid

possible tube placement to equalize pressure (myringotomy)

59
Q

risk factor for Tinnitis and Treatment

A

male, old, smoking, CVD, noise exposure

Tx: oral steroids, chronic can be treated with masking (white noise), and minimize noise exposure

60
Q

otosclerosis risk factors

A

female, caucasian

young adults to middle age

genetic predisposition

61
Q

etiology for otosclerosis

A

abnormal spongy bone growth on oval window (by stapes)

62
Q

presentation and Dx of otosclerosis

A

(type of conductive hearing loss which can progress to sensorineural)

worsening hearing loss over time as it growth ossifies, tinnitis

Dx: conductive hearing loss on audio exam, normal physical findings, may have absent cone of light

Dx with temporal bone CT or exploratory surgery

63
Q

Other conductive hearing loss

A

cerumen impaction, OM, OE, TM perf, mastoiditis, foreign body, cholesteatoma, myringosclerosis, and tympanosclerosis

64
Q

acoustic neuroma and risk factors for it

A

vestibular schwann cells growing a benign tumor

no symptoms until larger

risk factors: neurofibromatosis Type 2, (with cafe au lait spots), and ionized radiation

65
Q

presentation of acoustic neuroma

A

unilateral hearing loss and tinnitus

headache, dizziness

facial numbness/ weakness

symptoms worsen over time

66
Q

Dx Acoustic neuroma

A

audiogram shows a unilateral sensorineural hearing loss

speech discrimination harder than expected

brainstem response can be normal while tumor is small

get MRI

*Monitor with imaging and audiometry every 6 mths/ refer to ENT for surgery

67
Q

Peripheral Vertigo vs. Central vertigo

A

peripheral has fast beating nystagmus which is suppressed by fixation,

central is slow onset and is NOT suppressed by fixation

68
Q

Dx of vertigo

A

history and physical

Audiometry

Video/electronystagmography

calorics with COWS

auditory brainstem response

MRI

Electrocochelography (fluid pressure in ear to Diagnose Meniere’s or endolymphatic hydrops)

69
Q

Tx Vertigo

A

Benzosdiazapine (Valium and Xanax to calm nervous system)

Meclizine

Transdermal scopolamine

oral steroid

salt/ caffeine restriction

vestibular rehab

interventional and surgical

70
Q

BPPV

A

1 cause of vertigo (associated with head movement)

positional vertigo from crystalline structures becoming dislodged from hair cells from trauma or idiopathic

hearing INTACT

diagnose with Dix-Hallpike maneuver (nystagmus with supine, posterior/ 90degree head turn),

treat with Epley maneuver

71
Q

vestibular neuritis presentation

(labrytinthitis)

A

suddent VIOLENT vertigo with nausea

lasts hours to days

with or with out hearing loss

usually after a viral upper respiratory infection

ototoxic meds

72
Q

tx for labrytinthitis

A

steroid

benzos

meclizine

73
Q
A

GW Clinical Medicine I (4 decks)

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