ENT Flashcards
What is the main cause of cerumen impaction?
self-induced due to cleaning
What are the three main Tx of cerumen impaction?
ear drops
irrigation (warm water directed towards posterior canal w/ TM visible and dry after)
suction- refer to ENT
What is the mainTx of a foreign body in EAC?
remove with hook
if an insect, utilize lidocaine or mineral oil
don’t use water for organic materials
What is otitis externa?
an infection in the skin of the outer ear
What are two main causes of otitis externa?
recent water exposure
mechanical damage (scratch)
What are two common bacteria that cause otitis externa?
*pseudomonas and staphylococcus
What are two fungi that can cause otitis externa?
*aspergillus and candida
What populations are more likely to be affected by fungal otitis externa than others?
immunocompromised: elderly, diabetic, recently used Abx, ect…
What are common symptoms of otitis externa?
otalgia- ear pain
purulence- pus
erythema and edema
hyphae possible
TM will move on otoscopy
What is the first line Tx of otitis externa?
ear drops for 7-10 days, 5+ drops 3-4x daily
What are the two most common Abx ear drop treatments for otitis externa caused by bacteria?
neomycin (polymyxin B, hydrocortisone)
ciprodex (ciprofloxacin, dexamethasone)
What are the two most common ear drop Tx of otitis externa caused by fungi?
clotrimazole (Lotrimin) 1% solution
acetic acid (white vinegar)
If the ear canal is swollen shut, how can drops to treat otitis externa be administered?
by placing a cotton wick into the canal
What is the main pathogen that causes malignant otitis externa?
pseudomonas
What are 3 unique findings of malignant otitis externa?
osteomyelitis
granulation tissue at junction of bone and cartilage
CN impact- 6,7,9,10,11,12
When labs are conducted for a pt thought to have malignant otitis externa, what will be elevated?
CRP and SED
What is the first line Tx of malignant otitis externa in adults?
IV Abx- fluoroqinolones (ciprofloxacine)
What is the first line Tx of malignant otitis externa in peds?
IV Abx- cephalosporins
What is pruritis of the outer ear?
itching
What are the three main causes of pruritis?
too much cleaning
eczema or psoriasis
allergies
What is the main Tx of pruritis of the external ear?
oil drops
(topical steroids may be used with inflammation but this is atypical)
What is the main cause of auricular hematoma?
blunt trauma
What are some of the main causes of TMJ?
malocculsion
displacement of condylar head
bruxism- grinding of teeth
acute synovitis- swelling of joint
trauma
arthritis
dental caries or abscess
herpes zoster- shingles
What are some of the main symptoms of TMJ?
pain on opening and closing mouth (worse in morning)
radiating pain- ear, jaw, neck
restricted jaw function
noise, popping, clicking or crepitus- NOT a marker of worsening or improvement
What are some of the main conservative measures of TMJ Tx?
*NSAIDs x 10-15 days
avoid chewing gum or fingernails
soft food diet
avoid grinding teeth
massage, heating pad
What are some of the Tx measures for chronic TMJ pain/ bruxism
muscle relaxers (combo w/ NSAIDs)
neuropathic pain meds (TCA: nortriptyline or amitriptyline; gabapentin)
corticosteroids
CBT
PT
acupuncture
What is cholesteamtoma?
when the middle ear (behind TM) develops a cyst
What is the MC cause of cholesteamtoma?
prolonged eustachian tube dysfunction
This type of cholesteatoma is less common and thought to result from embryonal epithelial tissue in the middle ear
congenital
This type of cholesteatoma is associated with chornic or recurrent otitis media and tympanic membrane rupture
acquired
What are some of the symptoms of cholesteatoma?
*otalgia
headache
hearing loss
otorrhea
What are signs of cholesteatoma?
middle ear deafness
*pearly gray-white middle ear mass of debris behind TM
What are two common diagnostic measures of cholesteatoma?
non-contrast CT of temporal bone (boney erosion, mastoid process with air cell opacification)
audiology
What are two treatments of cholesteatoma?
surgery- mastoidectomy
ABx steroid drops to reduce inflammation and granulation (refer to ENT)
What are the three types of otitis media?
acute otitis media
chronic otitis media
otitis media with effusion
What is the main cause of AOM?
viral URI- causes eustachian tube dysfunction
What are the most common pathogens associated with AOM?
*streptococcus pneumoniae
*haemophilus influenzae
streptococcus pyogenes
moraxella catarrhalis
What are 4 common symptoms of AOM?
otalgia
aural pressure
decreased hearing
fever
What are common PE findings with AOM?
erythema of TM
bulging of TM
decreased mobility of TM
bullae possible
Secondary conditions of AOM may include…
effusion
acute mastoiditis (cefazolin and myringotomy)
myringitis
labyrinthitis
What is first line Tx of AOM in adults?
amoxicillin
What are some alternative Abx to amoxicillin in AOM Tx in adults?
amoxicillin- clavulanate
cefuroxime
cefpodoxime
What are 2 Tx for recurrent AOM in adults?
long-term abx prophylaxis (sulfamethoxazole or amoxicillin)
tubes
What are some risk factors for AOM in children?
FH
atopy- allergies, asthma, eczema
URI
low SES
smoke exposure
daycare
short breast feeding, prematurity
adenoid hypertrophy
craniofacial anomaly
AOM symptoms in children include what?
ear tugging
irritability
difficulty sleeping or eating
change in behavior
otorrhea
What defines recurrent AOM?
3 or more documented separate AOM episodes in past 6 months
four or more episodes in past 12 months with at least 1 in past 6 months
What measures transfer of acoustic energy as a function of ear canal pressure?
tympanometry
What indicates impaired TM vibration due to middle ear fluid on tympanometry?
flat tracing
What would you use for AOM pain management in children?
tylenol and ibuprofen (if older than 6 months)
Abx are typically indicated for what children with AOM?
infants less than 6 months old and children w/ increased risk for complications
6-24 months w/ bilateral AOM
any child w/ 1 or more: moderate or severe otalgia, otaliga> 48hrs, temp> 39C (102.2F)
What 3 Abx are used for children with AOM?
amoxicillin (if haven’t received in 30 days)
amoxicillin-clavulanate- amox in past 30 days, concurrent purulent conjuctivitis, recuurent AOM
cephalosporin (cefdinir, ceftriaxone)- PCN allergy
What children receive 10 days of Abx Tx for AOM?
children younger than 2
those with severe symptoms
What children receive 7 days of Abx Tx for AOM?
2-5 yrs
those with mild or moderate AOM
What children receive 5-7 days of Abx Tx for AOM?
children 6 yrs or older
mild or moderate AOM
Tx for children with recurrent AOM includes what?
tympanostomy tubes and adenoidectomy
(prophylactic abx not recommended)
Prevention of AOM in children includes what?
PCV vaccine
influenza vaccine
avoid smoke exposure
tympanostomy tubes
encourage breastfeeding
What is the MC cause of chronic OM?
recurrent AOM
What are the most common pathogens of chronic OM?
p aeruginosa
proteus species
staphylococcus aureus
mixes anaerobic infections
What is the most common symptom of chronic OM?
otorrhea- intermittent or continuous
pain uncommon except in acute exacerbations
What will an otoscopy of a pt w/ chronic OM show?
TM perforation and middle ear inflammation with otorrhea
What is first line tx of chronic OM?
topical otic abx (w/ dexamethasone)
ofloxacin or ciprofloxacin
What is the second line tx of chronic OM?
systemic abx
oral ciprofloxacin
What are three tx of chronic OM besides abx?
maintain dry ear
aural toilet
surgery- tympanoplasty/ mastoidectomy
What is the most common cause of hearing impairment in children?
OM with effusion
This is a chronic inflammatory condition with fluid in the middle ear w/o acute signs or symptoms
OM with effusion
What are three causes of OME?
poor eustachian tube function
URI
nasal allergies
OME risk factors include….
genetics
allergies
cigarette smoke
GERD
obesity
What will OME show on otoscopy?
dull TM with impaired mobility
air-fluid level or bubbles
What will OME show on tympanometry?
wide or flattened tracing with low peak height
Tx pathways for OME include…
auto inflation for 1-3mo
surgery- typanostomy
children with no risk- watchful waiting and re-eval every 3-6mo
What is the MC cause of eustachian tube dysfunction?
diseases associated with edema of tubal lining: viral URI, allergies
What are 3 symptoms of eustachian tube dysfunction?
sense of fullness
hearing impairment (mild-mod)
swallowing or yawning may elicit a sound (if partially blocked)
What is the tx for eustachian tube dysfunction following viral illness?
systemic and intranasal decongestants combined with autoinsufflation
pseudoephedrine; oxymetazoline
What is the tx of eustachian tube dysfunction for pts with allergies?
intranasal corticosteroids- beclomethason dipropionate
This ear condition is a result of pressure change and is associated with sudden eustachian tube dysfunction.
barotrauma
What are common signs/ symptoms of barotrauma?
otalgia
aural pressure
vertigo
otorrhea- blood or fluid
hearing loss
need to “pop” ears
What are the three common tx/ preventions of barotrauma?
pop ears frequently
OTC decongestants
topical decongestants
What OTC decongestant should be taken several hours before arrival time to help combat barotrauma?
pseudoephedrine
What topical decongestant should be administered 1 hour before arrival time to help combat barotrauma?
phenylephrine or oxymetazoline spray
What are three common causes of TM perforation?
infection
trauma
iatrogenic
Symptoms of TM perforations may include…
otalgia
otorrhea
hearing loss
whistling sound when blowing nose
Does a TM perforation result in movement of the TM upon pneumatic otoscopy?
no, the TM should not move
What is the Tx for TM perforation?
monitor and keep ear dry
spontaneous healing often occurs
What are three causes of hemotympanum?
infection
barotrauma
skull trauma
What is hemotympanum?
blood behind the TM
What is the MC cause of inner ear fistula?
trauma (pressure, straining, cleaning)
Symptoms of an inner ear fistula may include…
vertigo
acute onset hearing loss
disequilibrium
What is the definitive diagnosis of an inner ear fistula?
surgical exploration
What are 3 conservative tx of inner ear fistula?
BR w/ elevated HOB
stool softeners
oral corticosteroids
What are 2 non-conservative tx of inner ear fistula?
middle ear exploration
tympanotomy
This is boney overgrowth of the stapes which blocks conduction
otosclerosis
What are two ways to manage otosclerosis?
hearing aids
stapedectomy
this type of HL can be caused by age, noise, or ototoxic medications and is damage to the cochlea or nerve pathways to the brain
SNHL
this type of SNHL is age related. It is typically progressive, bilateral, and includes high frequency HL.
presbycusis
this type of SNHL is usually bilateral (not always) and shows a cookie bite deformity on audiogram
noise trauma
this type of SNHL is usually unilateral, occurs within a 72 hr window, impacts at least 3 frequencies and is a decrease greater than 30 dB.
sudden SNHL
this type of SNHL symptoms include unilateral HL, tinnitus, continuous vertigo, headache, and facial paresis
vestibular schwannoma
this cause of vertigo is sudden onset, severe, includes horizontal nystagmus, is worsened by positioning, and has no associated neurological signs
peripheral
this cause of vertigo is gradual or sudden onset, includes non-fatiguable vertical nystagmus, is unaffected by positioning, and is associated with other neurological symptoms
central
5 types of peripheral vertigo
BPPV
Meniere’s Disease
Labyrinthitis
Vestibular Neuronitis
Vestibular Schwannoma
Peripheral Vertigo:
cause- positioning of head
vertigo 10-60 sec
BPPV
what are the Dx and Tx of BPPV?
Dx- Dix-Hallpike test
Tx- Epley maneuver
Peripheral Vertigo:
episodic vertigo 20 min- hours
low frequency SNHL, blowing tinnitus, unilateral ear pressure
Meniere’s Disease
Tx of Meniere’s Disease
low sodium diet
diuretics (acetazolamide)
Peripheral Vertigo:
acute onset of severe, continuous vertigo lasting days- a week
HL and tinnitus common
labyrinthitis
Tx of labyrinthitis
abx if signs of infection
acute attacks- meclizine or valium
Peripheral Vertigo:
single attack of vertigo lasting days- a week
no auditory impairment
nystagmus may be present
vestibular nerutonitis
vestibular neuronitis Tx
acute phases- valium or meclizine
