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ENT Flashcards

1
Q

Inflammation of the external auditory canal

A

Otitis Externa

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2
Q

Risk Factors for Otitis Externa

A

water immersion

local mechanical trauma

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3
Q

MC etiologies of OE

A

Pseudomonas aureginosa + Staphylococcus

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4
Q

ear pain
pruritis
tragal or ear canal pain with contact
purulent auricular discharge

A

Otitis Externa

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5
Q

Diagnosis of OE

A

clinical + otoscopy –

EAC edema with erythema, debris, or discharge

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6
Q

Management of OE

A

Avoid moisture / use drying agents
Removal debris + cerumen
Topical antibiotics

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7
Q

Topical Antibiotics for Otitis Externa

A

Ciprofloxacin-dexamethasone, ofloxacin
Alt:: Neomycin/Polymyxin-B/Hydrocortisone otic
– DO not use if TM is perforated or cannot be visualized

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8
Q

invasive infection of the external auditory canal and skull base

A

Malignant (necrotizing) otitis externa

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9
Q

Most common cause of

A

Pseudomonas aeruginosa

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10
Q

Risk Factors for malignant OE

A

immunocompromised states

Elderly diabetics

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11
Q

Severe auricular pain (esp with canal or tragal manipulation)
Otorrhea
Cranial Nerve Palsies (eg. CN VII)

A

Malignant (necrotizing) otitis externa

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12
Q

Malignant (necrotizing) otitis externa Otoscopic Finding

A

granulation tissue at the bony cartilaginous junction of the ear canal floor

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13
Q

Diagnostic Confirmation of Malignant (necrotizing) otitis externa

A

CT or MRI

Biopsy is most accurate test

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14
Q

Malignant (necrotizing) otitis externa Management

A

Admission + IV ciprofloxacin

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15
Q

Etiologies of Mastoiditis

A

complication of acute otitis media

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16
Q

Deep ear pain (worse at night), fever, postauricular tenderness, edema & erythema
Auricular protrusion

A

Mastoiditis

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17
Q

Diagnostic Study of Mastoiditis

A

CT scan w/ contrast

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18
Q

Mastoiditis management

A

IV Vancomycin + Ceftazidime || Cefepime or Piperacillin-tazobactam
+ middle ear or mastoid drainage
+/- Tympanostomy tube placement

Mastoidectomy for refractory or complications

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19
Q

recurrent or persistent infection of the middle ear plus TM perforation

A

Chronic otitis media

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20
Q

MC cause of Chronic Otitis Media

A

pseudomonas

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21
Q

Perforated TM + persistent or recurrent purulent otorrhea (often painless)
+/- conductive hearing loss

A

Chronic Otitis Media

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22
Q

Management of Chronic Otitis Media

A

Debris Removal
Ciprofloxacin or Ofloxacin
If TM rupture – avoid water, moisture, & topical aminoglycosides

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23
Q

Infection of middle ear, temporal bone, and mastoid air cells

A

Acute otitis media

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24
Q

MC bacterial causes of Acute otitis media

A

Streptococcus pneumoniae
H. influenzae
Moraxella catarrhalis
Group A Streptococcus

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25
MC cause of AOM
viral URI -> Eustachian tube blockage
26
Fever, Otalgia, Ear Tugging, maybe pop w/ pain relief
Acute otitis media
27
Otoscopic Findings: Bulging & erythematous TM w/ effusion Decreased TM mobility
Acute otitis media
28
Antibiotic Treatment of Acute otitis media
Amoxicillin | 2nd: Augmentin, Cefdinir
29
Middle ear fluid + no signs of acute inflammation
Serous otitis media with effusion
30
Otoscopic Findings: | retracted or flat TM with fluid behind
Serous otitis media with effusion
31
Management of Serous otitis media with effusion
Observation | +/- tympanostomy tube for drainage
32
Popping of the ears + underwater feeling
Eustachian Tube dysfunction
33
Management of ETD
``` Autoinsufflation (swallowing, yawning, etc) Intranasal corticosteroids (flonase) ```
34
Damage to the tympanic membrane can occur with sudden pressure changes
Barotrauma
35
Ear pain, fullness, & hearing loss that persists after the etiologic event.
Barotrauma
36
Barotrauma Management
Avoidance is the best treatment: • Avoidance of flying with a cold. • Autoinsufflation (eg, swallowing, yawning, chewing gum)
37
conductive hearing loss & ear fullness. Weber lateralizes to the affected ear Rinne: Bone > air conduction
cerumen impaction
38
Management of TM perforation
Most heal spontaneously +/- Ofloxacin Avoid water & aminoglycosides
39
abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid
Choelsteatoma
40
``` painless otorrhea (brown or yellow discharge with a strong odor) +/- vertigo, tinnitus, dizziness, or cranial nerve palsies ```
Cholesteatoma
41
Otoscopic Finding: granulation tissue (cellular debris) +/- perforated TM Conductive Hearing Loss
Cholesteatoma
42
Management of Cholesteatoma
surgical excision of the debris & cholesteatoma with reconstruction of the ossicles
43
abnormal bony overgrowth of the footplate of the stapes bone leading to conductive hearing lost Autosomal dominant disorder (+/- FamHx of conductive hearing loss)
Otosclerosis
44
Conductive hearing loss esp at low frequencies, tinnitus | Vertigo is uncommon
Otosclerosis
45
Most useful test for Otosclerosis
Tone Audiometry
46
Management of Otosclerosis
Stapedectomy w/ prosthesis or hearing amplification (hearing aid) If severe, cochlear implantation
47
False sense of motion (or exaggerated sense of motion)
Vertigo
48
Location of peripheral vertigo
Labyrinth or Vestibular nerve (CN VIII)
49
Location of central vertigo
brainstem or cerebellar
50
Etiologies of Peripheral Vertigo
``` Benign Positional Vertigo (MC) Meniere Vestibular Neuritis Labyrinthitis Cholesteatoma ```
51
Episodic Vertigo w/o hearing loss
Benign paroxysmal positional vertigo
52
Episodic vertigo + hearing loss
Meniere disease
53
Continuous vertigo w/o hearing loss
Vestibular neuritis
54
Continuous vertigo + hearing loss
Labyrinthitis
55
Etiologies of Central Vertigo
``` Cerebellopontine tumors Migraine Cerebral Vascular Disease Multiple Sclerosis Vestibular Neuroma ```
56
``` Horizontal nystagmus (beating away from the affected side) Fatigable ``` Sudden tinnitus & hearing loss
Peripheral Vertigo
57
Vertical nystagmus Nonfaigable (continuous) Gradual onset Positive CNS signs Gait issues more severe
Central Vertigo
58
Cause of N & V related to vertigo
Neurotransmitters GABA, Acetylcholine, histamine, dopamine, & serotonin
59
How do antiemetics prevent N & V related to vertigo?
blocking the related neurotransmitters (GABA, acetylcholine, histamine, dopamine, & serotonin)
60
What 4 classes can be used to manage N/V related to vertigo
Antihistamines/anticholinergics Dopamine Blockers Benzodiazepines Serotonin Antagonists
61
Which Antihistamines/Anticholinergics can be used for N & V related to vertigo?
Meclizine Scopolamine (anticholinergic) Dimenhydrinate Diphenhydramine
62
MOA of Antihsitamiens/anticholinergics [N & V w/ vertigo]
acts on the brain's control center for N, V, & D
63
What are the 1st line meds for Vertigo (N/V) & motion sickness
``` Antihistamines/Anticholinergics -- Meclizine Scopolamine (anticholinergic) Dimenhydrinate Diphenhydramine ```
64
Side Effects of Antihistamines/Anticholinergics when related to vertigo (N/V)
Anticholinergic Effects -- - blurred vision (dilated pupils) - urinary retention - dry mouth - constipation - dry skin - flushing - tachycardia - fever - delirium
65
What are the dopamine blockers that can be used with N/V in vertigo?
Prochlorperazine Promethazine Metoclopramide
66
What is the MOA of dopamine blockers? Prochlorperazine Promethazine Metoclopramide
blocks CNS dopamine receptors (D1, D2) in the brain's vomiting center

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