ENT Flashcards by Trinity Smith

What is the main cause of cerumen impaction?

self-induced due to cleaning

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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

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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

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What is otitis externa?

an infection in the skin of the outer ear

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What are two main causes of otitis externa?

recent water exposure
mechanical damage (scratch)

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What are two common bacteria that cause otitis externa?

*pseudomonas and staphylococcus

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What are two fungi that can cause otitis externa?

*aspergillus and candida

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What populations are more likely to be affected by fungal otitis externa than others?

immunocompromised: elderly, diabetic, recently used Abx, ect…

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What are common symptoms of otitis externa?

otalgia- ear pain
purulence- pus
erythema and edema
hyphae possible
TM will move on otoscopy

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What is the first line Tx of otitis externa?

ear drops for 7-10 days, 5+ drops 3-4x daily

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What are the two most common Abx ear drop treatments for otitis externa caused by bacteria?

neomycin (polymyxin B, hydrocortisone)
ciprodex (ciprofloxacin, dexamethasone)

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What are the two most common ear drop Tx of otitis externa caused by fungi?

clotrimazole (Lotrimin) 1% solution
acetic acid (white vinegar)

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If the ear canal is swollen shut, how can drops to treat otitis externa be administered?

by placing a cotton wick into the canal

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What is the main pathogen that causes malignant otitis externa?

pseudomonas

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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

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When labs are conducted for a pt thought to have malignant otitis externa, what will be elevated?

CRP and SED

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What is the first line Tx of malignant otitis externa in adults?

IV Abx- fluoroqinolones (ciprofloxacine)

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What is the first line Tx of malignant otitis externa in peds?

IV Abx- cephalosporins

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What is pruritis of the outer ear?

itching

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What are the three main causes of pruritis?

too much cleaning
eczema or psoriasis
allergies

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What is the main Tx of pruritis of the external ear?

oil drops
(topical steroids may be used with inflammation but this is atypical)

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What is the main cause of auricular hematoma?

blunt trauma

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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

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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

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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

ENT Flashcards

(108 cards)