EENT Precision & Pearls #2 (Ears) Flashcards
Otitis Externa, AKA ______, is MCC by what bacteria? What are some risk factors for this condition?
Symptoms of otitis externa?
Swimmer’s Ear
Pseudomonas Aeruginosa MCC
RF: Water immersion, mechanical trauma (Q tip), Age 7-12
Ear pain, pruritus, hearing loss, pain with traction of tragus, purulent discharge
Treatment for otitis externa
-Protect against moisture (isopropyl alcohol or acetic acid) and remove debris/cerumen
-Topical ABX: Ciprofloxacin-Dexamethasone, Ofloxacin
-Neomycin/Polymyxin B alternative (if no TM rupture)
What should you remember to NOT use if you suspect the TM to be ruptured?
Aminoglycosides (-mycin) as they are ototoxic drugs
Malignant otitis externa is a complication of otitis externa. It is MCC by what bacteria? Risk factors for this condition?
Symptoms of this include
Pseudomonas
Immunocompromised, DM, elderly, HIV, Chemotherapy
Severe preauricular pain, otorrhea, cranial nerve palsies, TMJ pain
Diagnostics for malignant otitis externa
-Otoscopy: edema of EAC, granulation tissue at bony cartilaginous junction of ear on canal floor
CT or MRI to confirm
Treatment for malignant otitis externa
-admission + IV ABX (Ciprofloxacin)
MCC of conductive hearing loss is _______
What is the treatment for this?
Cerumen impaction
Cerumen softening with hydrogen peroxide or carbamide peroxide –> removal with aural toilet or irrigation
What is an auricular hematoma and what are some common causes of this?
Blood collection from external ear trauma (contact sports, wrestling, etc.)
What can an auricular hematoma lead to if not treated and what is the treatment?
Permanent deformity such as a cauliflower ear
Drain and evacuate hematoma (if < 48 hours). Apply pressure dressing
With a foreign body in the ear, what should be removed IMMEDIATELY and what should be done for objects to get them out?
Button batteries can cause necrosis
Mineral oil or lidocaine to kill insects first before removing them. Avoid irrigation if there is a battery in there, as it can cause edema and be harder to get out.
What are risk factors for developing acute otitis media?
What are the common causes (including MC)?
Furthermore, if the patient has AOM with purulent conjunctivitis, what organism should be considered?
Age 6-18 months, not being breastfed, daycare, pacifier use, secondhand smoke in the house
Strep Pneumo (MC), H. Influenzae, Moraxella Catarrhalis, GABHS (Strep Pyogenes)
H. Flu with conjunctivitis
Symptoms of AOM
What if the TM ruptures?
-Otalgia, ear tugging, conductive hearing loss
-Bulging, erythematous TM with effusion
-Decreased TM mobility (most sensitive finding)
TM rupture = rapid relief of pain with bloody otorrhea
What diagnostic is definitive for AOM?
Tympanocentesis with culture
Treatment for AOM
Amoxicillin 80-90 mg/kg/day x 10-14 days
-2nd line: Augmentin or Cefaclor
-PCN Allergy: Azithromycin, Emycin, Bactrim
If AOM is associated with H. Flu, with the purulent conjunctivitis, what should the treatment be?
Augmentin
When should the patient be referred for Tympanostomy tubes for AOM?
If 3 in the last 6 months or 4 in the last 1 year
What is chronic otitis media?
What is the MCC?
Symptoms of this condition?
Recurrent infection of the middle ear with TM perforation > 6 weeks
Pseudomonas MCC
-Persistent purulent otorrhea, painless
-Conductive hearing loss
-Perforated TM on exam
Treatment for chronic otitis media (think Pseudomonas)
-Topical ofloxacin or Ciprofloxacin
-Surgery to remove infected debris and reconstruct the TM
What is serous otitis media with effusion?
What is the treatment?
Middle ear fluid with no signs of infection or inflammation
Observation for most. ENT referral if persistent or language delays, hearing loss, etc.
What is mastoiditis?
It is a complication of what condition?
MCC by what organism?
Infection of mastoid air cells of temporal bone
AOM
Strep Pneumo (same bugs as AOM)
Symptoms of mastoiditis
Diagnostics for this condition
Otalgia, fever, TM signs of AOM
Mastoid (postauricular) tenderness, edema
Protrusion of auricle, fluctuance
CT scan with contrast
Treatment for mastoiditis
-IV ABX and drainage (myringotomy) with/without T tubes
-ENT referral, admission
-IV Vanco + Ceftazidime or Cefepime
-Refractory: mastoidectomy
TM perforation should be considered in a patient with what type of history?
Noise trauma, penetrating trauma
Symptoms of a TM rupture
Treatment?
-Acute ear pain, hearing loss, bloody otto rhea, tinnitus, vertigo
-Most heal spontaneously on their own. Observation for most.
What is a cholesteatoma?
What is it MC from?
Abnormal keratinized collection of desquamated squamous epithelium that leads to mastoid bony erosion
MC from ET dysfunction –> conductive hearing loss
Symptoms of a cholesteatoma?
Painless otorrhea (brown/yellow with strong odor)
Vertigo, dizziness, etc.
Treatment for a cholesteatoma
-Surgical removal and reconstruction of ossicles
What is the MCC of sensorineural hearing loss? Explain the problem here
Presbycusis (normal aging, decreased number of cilia)
Impaired transmission after cochlea
Other causes: noise exposure, Meniere, Labyrinthitis
Explain what happens with the hearing tests in sensorineural hearing loss
Weber (fork on head): lateralizes to normal ear
Rinne (fork near ear): AC > BC (normal)
If unilateral sensorineural hearing loss, what should you be considering as the diagnosis?
Acoustic neuroma
What is the MCC of conductive hearing loss?
Explain the problem here
Cerumen impaction
Impaired transmission to the cochlea
Other causes: otitis media, externa, otosclerosis
Explain what happens with the hearing tests in conductive hearing loss
Weber: lateralizes to the affected ear
Rinne: BC > AC (abnormal)
Barotrauma occurs MC after events such as
Symptoms of this include
What is the best maintenance recommendations for this condition?
Flying, diving, hyperbaric oxygen treatment (due to damage of TM from inadequate pressure equalization)
Ear pain, fullness, hearing loss after event
Avoidance, don’t fly with a cold, autoinsufflation (yawning, chewing, etc.)
When should you give ABX for Barotrauma?
Only if TM ruptured: Ciprofloxacin, Ofloxacin
-Analgesics for pain relief (NSAIDs, Acetominophen)
What is eustachian tube dysfunction? Symptoms include….
Treatment?
Failure of the ET to maintain pressure equalization of middle ear –> negative pressure
Ear fullness, popping, underwater feeling, reduced hearing, auto phony, retracted TM
Treat underlying cause, autoinsufflation, decongestants if needed
Explain peripheral vertigo (symptoms, where problem arises, and causes)
-Problem in labyrinth or CN8
-Symptoms: fatigable horizontal nystagmus, sudden onset, tinnitus
-Causes: BPPV, Meniere, Vestibular Neuritis, Labyrinthitis, Cholesteatoma
Explain central vertigo (symptoms, where problem arises, and causes)
-Problem in brainstem or cerebellum
-Symptoms: nonfatigable vertical nystagmus, gradual onset, progressive
-Causes: Migraines, Tumors, MS
What is BPPV and what is the cause?
Recurrent episodes of sudden peripheral vertigo (lasting 60 seconds or less) and provoked with specific head movements. No hearing loss or tinnitus.
Due to displaced otolith particles in the semicircular canals
What diagnostic test can be done to diagnose a patient with BPPV and what the is the treatment?
Dix Hallpike test to diagnose
Epley Maneuver to reposition otolith particles
What is the difference between vestibular neuritis and labyrinthitis?
VN: inflammation of vestibular portion of CN8
Labyrinthitis: inflammation of both parts of CN8
What symptoms do VN and Labyrinthitis share? What symptoms are specific to labyrinthitis only?
Both: Continuous peripheral vertigo, horizontal nystagmus
Labyrinthitis only: unilateral hearing loss, tinnitus
Treatment for VN and Labyrinthitis
-Glucocorticoids (Pred, Dexa, Cortisone)
-Meclizine for symptoms
-Both self limited
Meniere’s Disease is idiopathic distention of the endolymphatic compartment of inner ear due to excess fluid. What are the symptoms of Meniere’s?
-Episodic peripheral vertigo (minutes to hours)
-Fluctuating sensorineural hearing loss
-Tinnitus, ear fullness
-Horizontal nystagmus
Health maintenance recommendations for a patient with Meniere’s Disease?
Dietary: no salt, chocolate, caffeine, nicotine, alcohol
Meclizine, Benzol, Diuretics
Surgical decompression if needed
An Acoustic Neuroma (also called Schwannoma) is a benign tumor of…..
It arises in the cerebellopontine angle and can compress wha three things?
Schwann cells that causes hearing loss
Compresses CN 5, 7, 8
Symptoms of an acoustic neuroma
What diagnostics can be done, besides audiometry, to diagnose this?
Slowly progressive unilateral sensorineural hearing loss
MRI (DOC)
True or False: Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise?
True! Do audiometry first, then MRI
Name one common medication that can cause tinnitus?
Aspirin at a high dose!
What is otosclerosis and what type of inheritance pattern does it follow?
Abnormal overgrowth of the stapes –> conductive hearing loss
Autosomal dominant
Symptoms of otosclerosis
-Slowly progressive conductive hearing loss (especially at low frequencies)
Treatment for otosclerosis
-Stapedectomy with prosthesis or hearing aid
