ENT Flashcards
What is the main cause for ear squeeze
inability of eustachian tube/ear drum to equalize
what is the cause for ear squeeze
changes in pressure low or high could be because of pre-existing condition infection PE tubes Iatrogenic
How does someone with ear squeeze present to you upon examination
They may have ear pain, rupture, hemorrhage
damage to ossicles or round window
there is tinnitus (immediate or delayed)
If they have vertigo they will have severe damage
If someone presents with ear squeeze what type of tests would you want to order/preform to confirm the diagnosis
Check hearing and balance
check the mobility of the Tympanic Membrane
See if there is bleeding or rupture of the Tym. Mem
How would you treat someone with Ear squeeze
If they have a mild condition- decongestant (oxymetazalone, psedophedrine)
moderate cinditions- steroid and antibiotics as well as decongestants
Severe condition- myringotomy, pain control and ENT follow up as well as decongestant and antibiotic
What is a myringotomy
it is a tiny incision that is made into the ear to relieve the pressure of excess fluid build up in the middle ear
What causes sinus squeeze
changes in air pressue
pre-existing condition such as polyps, allergies, previous surgery
Chronic inflammation
sinus squeeze
What tests/exam would you do to check to see if someone was having sinus squeeze
transilluminate sinus
palpate the sinus with your hands
how will a patient present in your office with sinus squeeze
they may have blood vessel ruptures
pain from pressure/ blood and epistaxis
How do you treat a patient with sinus squeeze
hyperbaric chamber
decongestants, pain control
oxymetazalone (afrin)
ENT follow up
What causes tooth squeeze
Air that get trapped between a tooth filling
How will a patient with tooth squeeze present to you
pain or pressure in their tooth
What test/exam would you check to see if they had tooth squeeze
use a tongue depressor to apply pressure on the tooth and also check for possible tooth infection
How would you treat a patient with tooth squeeze
use a hyperbaric chamber
What causes a Tympanic membrane perforation
Infection, trauma, iatrogenic, irrigation, PE tube
How will a patient with Tym Mem perforation present to you
They will have hearing loss
Pain and sounds with equalization they will hear a whistling noise
What test/exam would to perform to see if they had an ear drum perforation
Otoscopy
Bubble test
How would you treat a patient with a Tym Mem perforation
antibiotic for perforation
often self healing
surgical repair
What causes an external hematoma
Trauma to the ear lobe
The auricular perichondrium and cartilage separate
Very common in wrestlers
How will a patient with External hematoma present to you in the office
The outer helix of the ear will be inflamed there is blood accumulation in the helix
can cause the ear to become deformed or get cauliflower ear
How do you treat a patient with an external hematoma
Incision and Drainage then wrap the ear properly
What is the cause for someone who has conductive hearing loss
they have some blockage of the external canal because of cerumen impaction
They could have inflammation of the external ear (OM)
Middle ear fluid collection
otosclerosis
eustachian tube dysfunction
Foreign Body in ear
What test/exam would you want to preform on a patient who you think has conductive hearing loss
Hearing test (bedside) finger rub Weber test Rinne test tympanometry
How will a patient present who has conductive hearing loss
they will have better hearing in the blocked ear
How do you treat a patient who has a conductive hearing loss
Hearing aids, removal of cerumen
cochlear implants and surgical removal of cholesteotoma
What is the etiology of a sensorineural hearing loss?
loss of hearing from the inner ear to the brain
auditory
cranial nerve
What causes a sensorioneural hearing loss
Most common is presbyacusis associated with aging chronic noise exposure menieres disease ototoxicity neoplasms vascular disease demyleniating, infections and trauma
What is presbyacusis
it is an age related hearing loss that is usually symmetric loss. People with this tend to lose their quality of hearing. Usually starts with high frequency and the affects all frequencies of hearing
What causes Menieres disease
starts in the 5th decade of life intermittent hearing loss it is associated with vertigo
Tx: low sodium diet, thiazide diuretic, short course of steroids
What causes Menieres disease
starts in the 5th decade of life intermittent hearing loss it is associated with vertigo
Tx: low sodium diet, thiazide diuretic, short course of steroids
what is ototoxicity
hearing loss that is caused by medications which damages the hair cells of the organ of corti
what is ototoxicity
hearing loss that is caused by medications which damages the hair cells of the organ of corti
What meds have an increased risk of ototoxicity
salicylates(NSAID, Asprin) Quinine Aminoglycosides loop diuretics cisplatin
What meds have an increased risk of ototoxicity
salicylates(NSAID, Asprin) Quinine Aminoglycosides loop diuretics cisplatin
What is an acoustic neuroma (schwanoma)
brain tumor affecting auditory pathway if this is the case most patients will present with unilateral hearing loss
What is an acoustic neuroma (schwanoma)
brain tumor affecting auditory pathway if this is the case most patients will present with unilateral hearing loss
what is the cause of tinnitus
associated hearing loss can be first symptoms of serious conditions (schwanoma) acoustic trauma vascular tumor If caught early enough can use steroids
What is the underlying problem with someone who suffers from a acoustic neuroma
issues with cranial nerve 8
- acoustic
- vestibular where this tumor arises from schwann cells of the myelin sheath of the nerve cell
What causes mixed hearing loss
from trauma to neoplasm which causes a combination of conductive and sensorineural loss
What causes mixed hearing loss
from trauma to neoplasm which causes a combination of conductive and sensorineural loss
How to test for mixed hearing loss
finger rub test or whispered word in each ear
How to test for mixed hearing loss
finger rub test or whispered word in each ear
What is tinnitus
perception of sound when there is no sound.
they will hear the sound of buzzing or ringing
what is the cause of tinnitus
associated hearing loss can be first symptoms of serious conditions (schwanoma) acoustic trauma vascular tumor If caught early enough can use steroids
What is the underlying problem with someone who suffers from a acoustic neuroma
issues with cranial nerve 8
Where does this tumor arise in the brain
at the cerebellopontine angle in the posterior fossa of the brain near CN7
How will a patient with a acoustic neuroma
they will have asymmetric sensorineural hearing loss or unilateral tinnitis. They wont have true vertigo. They will also have unilateral facial weakness (bells palsy)
How do you treat a patient with acoustic neuroma
send patient for a consult with a neuro for tumor removal. The CN 8 gets sacrificed and they are very careful to spare the CN7
What is vertigo
is it a pathology of the cochlea, middle ear and the acoustic portion of the CN8
How will a patient present with vertigo?
they will have a false sense of movement. The environment will be spinning to them. They may be nauseous and vomit. They can also have ataxia
What is the treatment for a patient with vertigo
Bed rest, IV fluids, antihistamine, benzodiazapine and vestibular exercises. The CNS will adjust itself
What is the etiology of peripheral vertigo
pathology of the cochlea, middle ear, and the acoustic portion of the CN8
How does a person with peripheral vertigo present
they will have hearing loss, tinnitus and unidirectional nystagmus
What is the etiology of a person suffering from central vertigo
it affects their brainstem or cerebellum
How will a patient with central vertigo present
rarely causes hearing loss and tinnitus.
Diplopia (double vision), homonymous hemianopsia, facial weakness/numbness. They will have sensory complaints. The will have dysarthria (trouble speaking)/swallowing. Ataxia and they will have persistent multidirectional nystagmus after vertigo resolves
How does benign paroxsmal positional vertigo (BBPV) start
Most common form of vertigo and most recurrent. Onset of vertigo seconds after assumption of certain head position. Usually lying supine
How do you diagnosis a person with BBPV
you will do the dix-hallpike maneuver. The pt sit on the exam table and turn head 45 degrees to right. The examiner brings patient to the supine position on the table with head extended over the table at 30 degree. look for nystagmus
With BPPV there with be a fatigue ability of the vertigo symptoms
How will a patient present with movement related vertigo
they will have vertigo in almost any position. There is no latency period and there is not fatigue ability
How will a patient present with meniere’s disease
recurrent episodes of vertigo, hearing loss, tinnitus, aural fullness, typically all symptoms are present with each episode. Attacks last 30min-24hr
How will a patient present acute peripheral vestibulopathy
gradual onset of peripheral vertigo attacks, incapacitating form. mild ataxia toward side of lesion
What is the cause of presyncope
CV problems with neurological symptoms,
causes-hypertventilation syndrom, anxiety, othrostatic hypertension, hypoglycemia
what type of test would want to do for a person with presyncope
reproduce with hyperventilation and use an EKG
How will presyncope present in patients
lightheadness will occur while pt is standing. It will accompanying sudden pain or strong emotion. More likely in a hot crowded room. premonition of syncope, yawing, diaphoresis, pallor can be associated symptoms. Occurs in young health people
how do you treat someone with presyncope
adjust medication, slow postural changes, elastic stockings, avoidance of precipitants
what causes disequilibrium
visual impairment, vetibulopathy, medication, slow growing neoplasm of posterior fossa, peripheral neuropathy in lower extremities
How will a patient present with disequilibrium?
more common in the elderly, dizziness is more constant and maximized with standing or ambulation (walking), they complain of feeling off balance or unsteady
How do you treat a person who has disequalibrium
dopamine agents, vp shunt, cane, vestibular exercises
What is the cause of ceruminosis
debris off of canal which is normal shedding. Q tips can cause it to get worse
How do you treat a patient with pericondritis
systemic antibiotics, I&D
What is the cause of otitis externa
inflammation of the skin of the external ear canal and surrounding soft tissue
What causes Auricular cellulitis
infection of skin overlying the external ear mostly caused by S. aureus, strepococci
How will a person with auricular cellulitis present
tenderness, erythema, swelling, and warmth of external ear, no involvement of inner ear of canal rubor, calor, dolor, tumor
How do you treat a person with auricular cellulitis
warm compress, oral antibiotics, IV antibiotics
What is pericondritis
it is an infection of the perichondrium of the auricular cartilage due to local trauma, ear piercing, burns, or lacerations. caused by S aureus
how will a person with otitis media present
history of acute onset signs and symtpoms of middle ear inflammation and middle ear effusion
bulging and limited mobility of air/ fluid behind T M or otorrhea and a fever
How do you treat a patient with pericondritis
systemic antibiotics, I&D
What is the cause of otitis externa
inflammation of the skin of the external ear canal and surrounding soft tissue
What is the pathogen that causes otitis externa
S aureus, P aeruginosa
How will a patient with otitis externa present
maceration from loss of protective function of cerument and increase moisture, increased pH in the canal, trauma, ear plugs, contact dermatitis, secondary infection with MC perforation
How would you treat a patient with OE
otic drops (fluoroquinolone, neosporin, steroids) Ear wicks, moist heat, Can be prevented with one footed dance, 1:1 white wine and 70% ethyl alcohol, 2% acetic acid drops
how to treat a person with eustachian tube dysfunction
PE tubes MEE >4months, hearing impairment
How would you test/ examine a pt with OM
otoscopy to check for red bulging T M, see if cerumen needs to be removed
How would you treat a patient with patient with a cholesteotoma
surgical repair of the Tympanic membrane (tympanoplasty, myringoplasty, mastoidectomy
how will a person with eustachian tube dysfunction present
middle ear fills with serous fluid which is caused by Eustachian tubes that don’t drain properly
How would you check to see if someone had eustachian tube problems
pneumatic otoscopy, tympanometry, toynbee test, MRI/CT/ET cath, nasopharyngoscopy
What are risk factors for eustachian tube dysfunction
younger than 6yo, tobacco, suction, obesity
how to treat a person with eustachian tube dysfunction
PE tubes MEE >4months, hearing impairment
what is the cause of foreign bodies in children
present in children >9mo
food particles, organic material, small toys, beads pencils erasers, rocks
how to remove foreign bodies from ears
reduce swelling, vasoconstriction meds, suction/glue, forceps immobilize insects, positive pressure
How would you treat a patient with patient with a cholesteotoma
surgical repair of the Tympanic membrane (tympanoplasty, myringoplasty, mastoidectomy
What causes mastoiditis
inflammation of the mastoid periosteum to bony destruction of the mastoid air system