ENT Flashcards
1
Q
Meds that affect hearing…
A
- Aminoglycosides
- Aminoglycosides can cause hearing loss, specifically gentamicin
- Aspirin
- NSAIDs
- Quinine
- Furosemide
2
Q
Concerning/Common S&S EARS
A
- Hearing loss: may be congenital, from single-gene mutations
- Distinguish between conductive and sensorineural loss
- Otalgia (earache)
- Otorrhea (discharge)
- Cerumen (wax) normally found in ear
- Tend to be yellowish-dark brown color
- Consistency: sticky
- Falls out of ear on its own or removed w/ washing
- Can build up ⇒ blocks ear canal (wax blockage)
- One of most common causes of hearing loss
- East Asians or Native Americans → usually drier and whitish gray
- Cerumen (wax) normally found in ear
- Tinnitus: common Sx that increases in frequency w/ age
- When associated w/ hearing loss and vertigo ⇒ suggests Meniere Disease
- Vertigo: perception that pt or environment is rotating or spinning
3
Q
Concerning/Common S&S NOSE
A
- Rhinorrhea (runny nose):
- Sneezing, watery eyes, throat discomfort, itchy eyes/nose/throat
- Can be worsened w/ excessive use of decongestants ⇒ causes vasomotor rhinitis
- Environmental triggers or seasonal association ⇒ suggests allergic rhinitis
- Congestion: If pt’s nasal congestion limited to one side ⇒ consider deviated nasal septum, foreign body, or tumor
- Epistaxis (bloody nose):
- Assess if pt on anticoagulation therapy or aspirin bc ⇒ they interfere w/ clotting
- Nasal sprays, if overused ⇒ can contribute to rebound effect ⇒ causing inflammation and congestion
- Change in smell: Loss of smell and taste ⇒ associated w/ COVID-19 infection
4
Q
Concerning/Common S&S THROAT
A
- Hoarseness: Acute hoarseness might be caused by voice overuse or acute viral laryngitis
- Sore tongue: Note findings under tongue– aphthous ulcers or atrophic glossitis
- Bleeding gums: Most often caused by gingivitis: inflammation of gingiva
5
Q
Weber Test
A
- tests lateralization
- Norm: sound is heard equal bilaterally
- In conductive hearing loss ⇒ sound lateralizes to impaired ear
- In unilateral sensorineural hearing loss ⇒ sound heard in good ear
- Restricted to pts w/ unilateral hearing loss bc pts w/ normal hearing may lateralize (hear sound on 1 side) and pts w/ bilateral conductive or sensorineural deficits won’t lateralize
- Steps: place base of lightly vibrating tuning fork on top of pt’s head or mid-forehead → ask where pt hears sound → normally sound heard midline or equally in both ears
6
Q
Rinne Test
A
- compares air and bone conduction
- Norm: air conduction lasts longer than bone conduction (AC > BC)
- In conductive hearing loss ⇒ sound heard thru bone as long as or longer than it is through air (BC = AC or BC > AC)
- In sensorineural hearing loss ⇒ sound heard longer thru air than bone (AC > BC)
- Hearing is decreased in both hearing losses
- Steps: place base of lightly vibrating tuning fork on mastoid bone, behind ear and lvl w/ canal → when pt can’t hear sound anymore place fork close to ear canal → ask pt if vibration is heard
7
Q
Tonsil Grading
A
- 1: tonsils visible
- 2: tonsils between tonsillar pillars and uvula
- 3: tonsils touching uvula
- 4: tonsils touching each other
8
Q
Gag Reflex CN IX and X Test
A
- Tests: gag reflex of CN IX (glossopharyngeal) and X (vagus)
- Steps: palpate palatal arches w/ tongue depressor one at time and wait for normal gag reflex
Abnormal results: - If no gag reflex ⇒ indicates one side of IX glossopharyngeal nerve is damaged
- Soft palate doesn’t rise and uvula deviates to opposite side away from lesion ⇒ indicates damaged X vagus nerve
9
Q
4 MAIN TYPES OF DESCRIBED DIZZINESS
A
- Vertigo
- Strong sense of motion or spinning
- Can be peripheral or central
- Disequilibrium
- Common: pts have it temporarily or infrequently
- Feeling off-balance
- Unsteady / Wobbly
- Lightheadedness
- Woozy
- Disconnected from environment
- Presyncope
- Feeling of losing consciousness
- About to faint
10
Q
Peripheral Vertigo General Info
A
- Onset: Sudden
- Intermittent w/ severe Sxs
- Affected by head position and movement
- NV more frequent
- Motor function, coordination, gait intact
- Causes: less severe
11
Q
Central Vertigo General Info
A
- Onset: Gradual
- Constant w/ milder Sxs
- Unaffected by head position and movement
- NV less frequent
- Motor function, loss of coordination, gait instability frequent
- Causes: more severe
- Duration: variable but rarely continuous
- Hearing: unaffected
- Tinnitus: absent
- Additional features: usually w/ other brainstem deficits– dysarthria, ataxia, crossed motor and sensory deficits
12
Q
Peripheral Vertigo: Meniere Disease
A
- Onset: sudden
- Duration: several hrs – ≥1 day
- Hearing: sensorineural hearing loss– recurs, eventually progresses
- Tinnitus: present, fluctuating
- Additional features: pressure or fullness in affected ear, NV, nystagmus
13
Q
Otitis Media (what, cause, common in, identified during which tests)
A
- What: inflammation of middle ear (Classified as primary otalgia (ear pain))
- Cause: bacterial infection
- More common in children than adults
- Tested/Identified during:
- Conductive vs. neurosensory hearing loss w/ Tuning Fork Test
- This is unilateral conductive hearing loss → sound heard in/lateralized to impaired ear
- Palpation of Tragus and Pinna
- Pt feels pain during palpation
- Conductive vs. neurosensory hearing loss w/ Tuning Fork Test
14
Q
Otitis Media S&S
A
- Serous effusion, thickened drum, purulent otitis media ⇒ can decrease mobility
- With any perforation ⇒ there’ll be no mobility
- Tenderness behind hear
- Might see distorted light reflex
- Can’t see landmarks of ossicles bc tympanic membrane or eardrum is bulging
- Bulges laterally toward examiner’s eye
- Red bulging drum ⇒ indicates purulent otitis media
- May have drainage behind eardrum
- Dilated blood vessels can be seen in all segments of drum
- Diffuse redness of entire eardrum may follow w/ discharge of purulent material to ear canal
- Earache
- Fever
- Hearing loss
15
Q
Otitis Externa / “Swimmer’s Ear”
A
- What: inflammation of ear canal/outer ear (Classified as primary otalgia (ear pain))
- Cause: frequent submersion of ear in water
- Tested/Identified during: External Meatus Patency when pulling ear up to look at canal → painful for pt
- S&S:
- Ear canal is swollen, tender, narrowed, moist, pale, and/or reddened
- If chronic, skin canal thickened, red, itchy
- Pt feels pain if you put otoscope in or if you pull ear up
- Hearing loss
- Drainage
- Swelling
- Edema
- Erythema
- Pain
16
Q
Allergic Rhinitis
A
- What: runny nose due to allergies / inflammation of nose when IS reacts to environmental allergens that body doesn’t recognize (atopic disease)
- S&S:
- Mucosa pale, bluish, red
- Nasal discharge and congestion, post nasal drip (may cause sore throat)
- Sneezing
- Watery, itchy eyes
- Fatigue
- Pale and boggy turbinates (curving bony structures, covered by highly vascular mucous membrane protrude into nasal cavity)
- Allergic shiners (little black eye on inferior aspect of eye or below lid)
17
Q
Sore throat: Viral
A
- Onset: gradual
- Cough
- Mild, if at all: fever, chills, and/or headaches
18
Q
Sore throat: Strep
A
- Cause: A B hemolytic strep
- Can lead to future problems w/ heart/kidney infections
- Common in: school-aged kids or adults
- Onset: abrupt
- Dysphagia
- Red, swollen tonsils and throat
- Pus in back of throat
- White spots on tongue
- Swollen lymph nodes in neck
- Fever chills, and/or headaches
19
Q
Candidas Albicans / “Oral Thrush”
A
- What: overgrowth of yeast fungi on tongue
- S&S:
- Painful, esp if you scrape it w/ tongue depressor
- White patches or raised white spots on tongue
- Cause: fungal infection
- Common in: infants but still need to be treated bc it can impact baby’s ability to eat
- In breastfeeding infants → treat mom bc they can keep passing thrush between baby and breast (normal but still need treatment)
- Uncommon in older children and adults ⇒ suspect immunocompromised states, HIV, immunosuppressive meds, etc.
20
Q
red flag for throat
A
Thrush in older children and adults bc they shouldn’t have it ⇒ means they’re immunocompromised, have HIV, take immunosuppressive meds
21
Q
age-related considerations EARS
A
- Infants
- Hearing assessments before newborns go home because it’s important for development ⇒ any congenital hearing deficits needs to be addressed and/or any hearing conditions to be corrected
- Look for auricle/ear lobe for formation, flexibility
- Look at auditory canal and tympanic membrane
- Children: During otoscopic exam: pull earlobes down instead of up if they’re < 3 yo
- Older Adults
- Hearing changes w/ age
- Increase in cerumen impact: cerumen increases ⇒ earwax dries ⇒ impacts hearing and makes it difficult to see tympanic membrane to assess for issues
- Hearing loss in later yrs isn’t just from noise exposure, also from presbycusis: age-associated hearing loss
- Pregnant Women: Bulging or Retraction of tympanic membrane due to fluid imbalance
22
Q
age-related considerations NOSE
A
- Infants: Inspect nares if they can breathe through nose
- Children: Frontal sinuses don’t develop until age 7+ ⇒ kids shouldn’t be having sinus infections then
- Older Adults: Drying mucosa
- Pregnant Women: Sinus congestion
23
Q
age-related considerations THROAT
A
- Infants: Should be assessed for cleft palate by running finger on roof of mouth
- Older Adults: Drying mucosa
- Saliva cleanses and lubricates mouth but many meds reduce salivary flow ⇒ increases risk for tooth decay, mucositis, gum disease from xerostomia (dryness of mouth)
- Pregnant Women: Hypertrophy of gums (swelling)
24
Q
Conductive Loss (what, causes, usual age of onset)
A
- External or middle ear disorder ⇒ impairs sound conduction to inner ear
- Causes:
- Foreign body
- Otitis media
- Perforated eardrum
- Otosclerosis of ossicles
- Usual age of onset: childhood + young adults up to age 40
25
Q
conductive hearing loss (ear canal and drum effects)
A
- Abnormality usually visible
- Hearing seems to improve in noisy environment
- Voice becomes soft bc inner ear and cochlear nerve intact
26
Q
conductive hearing loss in weber test
A
- Sound lateralizes to impaired ear ⇒ room noise not well heard ⇒ detection of vibrations improves
27
Q
conductive hearing loss in rinne test
A
- Bone conduction longer than or equal to air conduction (BC ≥ AC)
28
Q
sensorineural loss (what, causes, usual age of onset)
A
- Inner ear disorder involves cochlear nerve and neuronal impulse transmission to brain
- Causes:
- Loud noise exposure
- Inner ear infections
- Trauma
- Tremors
- Congenital and familial disorders
- Aging
- usual age of onset: Middle or Later yrs
29
Q
sensorineural loss ear canal and drum effects
A
- Problem not visible
- Higher registers lost ⇒ sound distorted
- Hearing worsens in noisy environment
- Loud voice bc hearing difficult
30
Q
sensorineural loss in weber test
A
- Sound lateralizes to good ear bc inner ear or cochlear nerve damage impairs transmission to affected ear
31
Q
sensorineural loss in rinne test
A
- Air conduction longer than bone conduction (AC > BC)
- Inner ear or cochlear nerve less able to transmit impulses regardless of how vibrations reach cochlea ⇒ normal pattern prevails
