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Pulmonology > EENT > Flashcards

EENT Flashcards

1
Q

Benign abnormalities of Outer Ear?

A

Accessory Auricle, aka Skin tag
Microtia/Anotia: abnormal development of auricle creating EAC Stenosis.
Preauricular Pit: cystic tract unclosed from embryologic development.

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2
Q

Concerns of a Preauricular Pit?

A

May develop infection, may become recurrent or abnormally enlarged.

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3
Q

What is an Accessory Auricle and what is the treatment?

A

Aka Skin Tag, a benign skin abnormality.

Tx: simple excision of extra skin.

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4
Q

Treatment for Microtia/Anotia?

A

Cosmetic Surgery

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5
Q

Treatment of a Pre-auricular Pit?

A

Incision and drainage if infected; possibly an excision.

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6
Q

An ENT emergency; also known as cauliflower ear, an accumulation of fluid (usually blood) within sub-perichondrial space of Pinna?

A

Auricular Hematoma

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7
Q

Treatment of an Auricular Hematoma?

A

Incision and Drainage ASAP w/compression bandage to prevent recurrence.

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8
Q

What causes an Auricular Hematoma and what can develop if there is no treatment?

A

Blunt force trauma but arises from decreased blood flow to perichondrial space.

If not drained within 5-7 days of onset, cauliflower ear will develop.

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9
Q

A hydrophobic substance produced within the ear canal creating an acidic environment to protect against infection, trauma, water damage and foreign body?

A

Cerumen or ear wax.

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10
Q

What produces ear wax?

A

Sebaceous and ceruminous glands of the lateral 1/3 of the EAC.

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11
Q

Impaction defined as symptomatic accumulation of cerumen (conductive hearing loss) and how is it treated?

A

Cerumen Impaction treated with an ear lovage or Debrox drops.

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12
Q

Symptoms of a Cerumen Impaction?

A

Hearing loss, otalgia, drainage, dizziness, tinnitus.

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13
Q

Treatment of a foreign body…”pro-tip”?

A

Alligator forceps or curette
More common in kids.
Pro-tip: if the FB is a bug, make sure it is dead; use lidocaine.

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14
Q

Infection/irritation of the skin of the EAC?

A

Acute Otitis Externa (AOE)

Aka “Swimmer’s Ear”

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15
Q

Etiology of AOE?

A

Acute bacterial infection

  • pseudomonas 38%, staph aureus 8%, strep pneumo 6%.
  • can be associated with some derm conditions like eczema or psoriasis.
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16
Q

Risk factors for AOE?

A

Swimming, trauma, DM and other immunodeficient conditions.

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17
Q

Clinical presentation of AOE

A 
Tender pinna/tragus.
Otorrhea
Hearing loss
Erythema, pt’s will say it itches.
EAC edema/swelling
Debris in EAC
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18
Q

How would you treat a mild case of swimmer’s ear?

A

Alcohol/vinegar ear drops.

Treat with Antifungals or Clotrimazole ear drops if a fungal infection.

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19
Q

AKA Herpes Zoster Oticus; presents like zoster - a painful rash, but also with acute facial palsy (CN VII).

A

Ramsey Hunt.

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20
Q

What other CN can be involved with Ramsey Hunt and what can palsy of these CNS lead to?

A

CN VIII, IX, X, XI

Can lead to vertigo, hearing loss, tinnitus, ataxia.

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21
Q

Treatment for Ramsey Hunt?

A

Acyclovir, Steroids, Topical Anesthetic

Steroids typically not used in herpes but because of severe inflammation, Rx it.

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22
Q

How can you orient yourself when looking at the pt’s TM?

A

TM: Tympanic Membrane or ear drum.

The cone of light will point towards the pt’s nose.

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23
Q

Acute illness marked by presence of fluid and inflammation of the mucosa that lines the middle ear space?

A

Acute Otitis Media (AOM)

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24
Q

MCC of AOM?

A

MCC caused by obstruction of the Eustachian Tube causing fluid retention and suppuration of retained secretions.

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25
Q

Clinical presentation and PE of child with AOM?

A 
Tugging ears
Fussy
Fever
Hearing loss (which resolves with resolution of effusion).
Capillary injection and erythema of TM
Bulging TM
Possible purulent fluid
Immobility on bulb insufflation.
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26
Q

Treatment for AOM?

A

MC oral Abx x10 days.
Tylenol PRN for fever.

For adults, consider adding Decongestant (to drain ET) and/or steroid.

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27
Q

First line Abx for AOM?

A

Amoxicillin is 1st line Tx for anything involving the neck up.
*includes amoxicillin/Clavulanate (Augmentin).

  • Macrolides 2nd line if allergy to Amoxicillin.
  • Cephalosporins are 3rd line
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28
Q

ASOM?

A

Acute Serous Otitis Media

A collection of non-infected fluid in the middle ear space (fluid is clear and serous).

29
Q

Etiology of ASOM?

A

Usually from ET obstruction from URI of nasopharynx (Viral, Sinusitis, Allergy).

30
Q

ASOM Management?

A

Usually self-limiting.

  • Bulb suction, saline, steam.
  • Nasal decongestant (Afrin) and/or steroids for adults.
  • Antihistamine if due to Allergies.
  • Nasal Steroid.
  • If >3 months, myringotomy and tube insertion should be done to prevent long-term standing trauma and hearing loss.
31
Q

Chronic inflammation (usually >3 months) of the middle ear and/or mastoid cavity, which presents with recurrent ear discharges or otorrhea through tympanic perforation?

A

Chronic Otitis Media

32
Q

Treatment for Chronic Otitis Media in children and criteria?

A

Bilateral Myringotomy and tube indication (BMT): serous otitis >3 months, 6 AOM in 6 months or 7 in 1 year.

33
Q

Clinical Pearl for Chronic Otitis Media in adults?

A

If unilateral otitis media not responding to medication, ALWAYS CONSIDER NASOPHARYNGEAL MASS and refer!

34
Q

Tympanic Membrane Perforation

A

Excess pressure within middle ear causes the tympanic membrane to perforate - will see a hole in the TM.

35
Q

Sx and presentation of TM perforation?

A

Sx: Otalgia, hearing loss, otorrhea, possibly 2/2 otitis externa.

Presentation: pt states intense ear pain, a pop and then resolution of pain w/drainage and decreased hearing.

36
Q

Treatment of TM perforation?

A

Typically, self-resolving within 4 weeks. Avoid swimming, baths, submersion.

May need referral if present >6 wks, can be repaired surgically.

If caused by Otitis Media, may need Otic Drop Abx: FQs not macrolides; avoid “-mycin” - otototoxic!

37
Q

Complication of severe acute/chronic otitis media with spreading of fluid and infection refractory to mastoid cavity; MC in kids? Sx?

A

Mastoiditis - true ENT emergency.

Sx: fever, pain atop mastoid bone, erythema, protrusion of auricle.

38
Q

Work up for Mastoiditis?

A

CT Temporal Bone, anytime mastoiditis is expected; if +, refer to ENT.

39
Q

Treatment for Mastoiditis?

A

IV Cephalosporins and/or Mastoidectomy.

40
Q

Keratinized, desquamated epithelial collection growing rapidly in the middle ear space usually 2/2 to TM perforation?

*can occur as complication of deep retraction pocket from Chronic ETD (ET dysfunction).

A

Choesteatoma

41
Q

Presentation and evaluation of Cholesteatoma?

A

MC seen in kids.

Chronic otorrhea refractory to Tx, CHL (conductive hearing loss), may see dull with debris, which is usually visible in retraction pocket.

Binocular exam, audiometry, temporal bone CT; may need ENT referral for middle ear surgery.

42
Q

TMJD?

A

Temporomandibular Joint Disorder

MC reason for otalgia.

43
Q

Classic Sx of TMJD?

A

Otalgia w/o evidence of otitis media or externa.
Worsened with jaw movement, eating.
Tender to palpation atop TMJ.

44
Q

Treatment for TMJD?

A

NSAIDS, rest, heat, PT, referral to Oromaxillofacial (OMF) specialist.

45
Q

Hardening (sclero-) of the ossicular chain of the middle ear, MC the stapes causing slowly progressing hearing loss, usually starting in early 20s?

A

Otosclerosis

46
Q

Presentation and management of Otosclerosis?

A

Presentation: CHL but TM is mobile, dizziness, tinnitus. Often worsens with pregnancy.

Eval: audiometry, Temporal bone CT.

Mgmt: surgical detachment of stapes from oval window (stapedectomy). Hearing amplification.

47
Q

Noise or ringing in the ears?

A

Tinnitus

Affects 1/5, it is a Sx not a disorder.

48
Q

Types of Tinnitus?

A

Ringing - MC, typically caused by SNHL from high frequency; noise-induced, trauma, cerumen, ARS/ETD, Ménière’s disease.

Pulsation - sudden onset tinnitus; think HTN, carotid bruit, AV malformation, atherosclerosis, vascular neoplasm, ETD.

Clicking - caused by muscle spasm or ossicular changes.

49
Q

Treatment for Tinnitus?

A

None. Can consider distraction (white noise) and amplification (hearing aids).

Look at a pt’s medications!
-common too toxic meds include loop diuretics, cancer meds (cisplatin, aminoglycosides), ASA.

50
Q

What is the most important thing to do with any patient that complains of being dizzy?

A

Distinguish between dizziness or vertigo & establish if it is PERIPHERAL or CENTRAL

Dizziness: off-balance, lightheaded, “woozy” feeling, disequilibrium.
Vertigo: room spinning OR spinning sensation.

51
Q

Function of the Cochlea?

A

Converts mechanical vibrations to nerve impulses interpreted by the brain as hearing.

52
Q

Function of the Semicircular canals?

A

Sense position of head in space for input into balance formula, also allows the eyes to track objects.

53
Q

CENTRAL Vertigo vs PERIPHERAL vertigo?

A

CENTRAL: gradual onset, no hearing loss, vertical nystagmus.

PERIPHERAL: sudden onset, changing hearing, horizontal nystagmus.

**If syncope cause is CENTRAL - it is NEVER related to inner ear problems.

54
Q

MC cause of peripheral vertigo?

A

Benign Paroxysmal Positional Vertigo (BPPV)

*intermittent episodes of room spinning with positional changes lasting <60 seconds.

Classic: pt wakes up, stands and immediately start spinning.

55
Q

Causes of BPPB and exam to evaluate?

A

Otolith deposits break from Celia within the semicircular canals causing disruption of brain’s interpretation of position in space.

Exam: Dix-Hallpike Maneuver, VNG (videonystagmography).

56
Q

Treatment for BPPV?

A

Eply maneuver, vestibular therapy, meclizine, proprioception, stable gaze.

57
Q

Inflammatory or post-infectious process of the inner ear causing aural fullness, vertigo, tinnitus, and N/V?

A

Labrynthitis or Vestibular Neuritis.

58
Q

Cause of Labrynthitis, signs, Tx?

A

Often after URI, 1-2 weeks after; MC viral, rarely bacterial.

Signs: rotational nystagmus.

Tx: usually self-limiting, vertiginous episodes last 10-30 sec. Steroids, antiemetics.

59
Q

Abnormal fluctuations of endolymph fluid within the inner ear causing a change of pressure and resultant Sx??

A

Meniere’s Disease (aka Endolymphatic hydrops).

60
Q

What is the triad of Meniere’s Disease?

A

Tinnitus, hearing loss and vertigo.

Vertigo will last longer, maybe hours, with resolution on its own.

61
Q

Evaluation and mgmt of Meniere’s Disease?

A

Evaluation: audiometry, (VNG) that measure response to inner ear stimulation.

Mgmt: vestibular therapy/balance therapy, meclizine, anxiolytics (Valium), diuretics, steroids, low salt diet.

Most severe cases may require labyrinthectomy.

62
Q

Cause of Central Vertigo?

A

Acoustic Neuroma

63
Q

What does an Acoustic Neuroma mimic?

A

Meniere’s Disease; S/Sx include the triad of MD - hearing loss, vertigo, tinnitus.

64
Q

Classifications of Hearing Loss?

A

Conductive Hearing Loss (CHL)
-problem w/EAC, TM, or ossicles; problem conduction vibrations from the TM to the cochlea.

Sensorineural Hearing Loss (SNHL)
-permanent loss in cochlea’s ability to generate nerve impulses.

Mixed
-presbycusis w/cerumen impaction.

65
Q

Rinne and Weber test?

A

Rinne test for bone conduction or conductive loss.

Weber test for sensorineural loss.

66
Q

Progressive Sensorineural Hearing loss?

A

Presbycusis, noise-induced, congenital, trauma, iatrogenic, idiopathic.

67
Q

Sudden sensorineural hearing loss?

A

EMERGENCY!

  • start high-dose steroids within 14 days of onset.
  • recheck audiogram post-Tx, consider MRI IAC if no improvement.
  • Approx. 1/3 will improve/resolve, 1/3 no better, 1/3 worsen.
68
Q

Hearing loss in the elderly?

A

Presbycusis

Majority of age-related hearing loss is sensorineural.
Hx will be gradual loss, NOT sudden.
Bilateral, assoc. with Tinnitus.
Difficulty w/speech discrimination.

Pulmonology (5 decks)

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