EENT Ears Flashcards
On Weber testing, what will be present with cerumen impaction?
Lateralization to affected ear (bone conduction > air conduction
-Conductive hearing loss
Name two solvents that work to soften the cerumen in an impaction.
Hydrogen peroxide
Carbamide peroxide
What else can be done if softening the cerumen does not work to solve the problem?
Irrigation, curette, suction
MCC of otitis externa
Pseudomonas aeruginosa
Symptoms of otitis externa
- Pain
- Pruritus
- Pain with movement of tragus or auricle
- Purulent auricular discharge
Topical ABX for otitis externa
-Ciprofloxacin-dexamethasone
-Ofloxacin
For about 7 days
What is osteomyelitis of the temporal bone called and who does it normally occur in?
Malignant Otitis Externa
Immunocompromised states; elderly diabetes MC, high dose glucocorticoid therapy, chemo, HIV
What cranial nerve palsies can malignant otitis externa lead to?
Cranial Nerves 6, 7, 10, 11, 12
Treatment for malignant otitis externa
Admission + IV Ciprofloxacin
Diagnostic for malignant otitis externa
CT or MRI
But, biopsy is most accurate
Cauliflower ear is a result of _________
Blunt trauma that creates a hematoma. The hematoma creates avascular necrosis of the ear. Happens in wrestlers that do not wear helmets.
MCC of acute otitis media
Staph Pneumoniae
Symptoms and exam findings of a patient with acute otitis media
- Preceded by viral URI
- Otalgia
- Bulging and erythematous TM with effusion
- Decreased TM mobility (most sensitive)
Risk factors for AOM
- Bottle feeding or pacifier
- Second hand smoke
- 6-18 months old
Treatment for AOM
- Pain killers (Ibuprofen or Tylenol)
- Amoxicillin first line for 10 days
- Second line: Amoxicillin-Clavulanic acid, Cefdinir, Cefpodoxime
If the patient has a penicillin allergy, what is the treatment for AOM?
-Azithromycin, Clarithromycin, Bactrim
What is chronic otitis media?
-Recurrent infection of middle ear in presence of TM perforation > 6 weeks
MCC of Chronic otitis media
Pseudomonas
-Staph A, Mycoplasma
Symptoms of chronic otitis media
-Recurrent purulent otorrhea (painless)
Treatment for chronic otitis media
-Removal of infected debris + Ofloxacin/Ciprofloxacin
What is a cholesteatoma?
Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid
Symptoms of a cholesteatoma
-Painless otorrhea (brown or yellow with a strong odor)
Treatment for cholesteatoma
Surgical excision of debris and reconstruction of ossicles
What two things should you avoid if you suspect a TM rupture?
Topical aminoglycosides (Gentamicin, Tobramycin, Amikacin) Water
What is an acoustic neuroma/vestibular schwannoma?
Benign tumor involving Schwann cells, which produce myelin sheath
- Arises in the cerebellopontine angle and can compress cranial nerves 5, 7, 8
- MC intracranial tumors
Symptoms of acoustic neuroma
- Sudden onset of unilateral sensorineural hearing loss (partial) that slowly worsens
- Tinnitus, facial numbness (5), facial paresis (7)
How do you confirm an acoustic neuroma with imaging? What do you perform for the laboratory of choice for this?
MRI
Audiometry
Treatment for barotrauma
- Prevention
- Do not fly with a cold
- Autoinsufflation: swallowing, yawning, chewing gum, decongestants
Symptoms of narrowed Eustachian Tubes
- Fullness in the ears
- Retraction of TM or decreased mobility
- Popping or cracking with yawning or swallowing
- Decreased hearing
Treatment for narrowed Eustachian Tubes
Decongestants (Pseudoephedrine, Oxymetazoline)
Surgical insertion of T tube
Symptoms of overly patent Eustachian Tubes
- Exaggerated ability to hear yourself breathe or speak
- Feel better during a URI
