ENT Flashcards
What are the two types of hearing loss?
Conductive
Sensorineural
Conductive Hearing Loss Consists of
External or middle ear
What are some causes of Conductive Hearing Loss?
Cerumen Impaction
TM perf
Fluid accumulation
Tympanosclerosis (hardening of the tissues of the middle ear)
Sensorineural Hearing Loss Consists of
Inner ear or damaged 8th Cranial Nerve
Causes of Sensorineural Hearing Loss
Acoustic neuroma Meniere’s Dz Ototoxic drugs Injury form noise Viral (after mumps)
Presbycusis
Hearing loss due to aging
Any sudden hearing loss is
an emergency
Diagnostic tests for hearing loss
- Weber
2. Rinne
Rinne Test Normal Finding
AC (air conduction) > BC (bone conduction)
Rinne Conductive Hearing Loss
BC>AC
Tone heard louder in the affected ear
(CB—conductive bad)
Rinne Sensorineural Hearing Loss
AC>BC or AC=BC
Hearing loss can cause _________ in children
delayed speech
Hearing loss treatment
Remove cerumen impaction with Debrox or Murine
Abx to treat OM
Decongestants for serous otitis
Refer to ENT if conductive hearing loss does not improve w/ Tx
Otitis Externa
Aka Swimmer’s ears
Extremely painful to touch
Treatment for Otitis Externa
Ciprofloxin & Hydrocortisone (intact TM): 3 gtts BID x 7 days (>1 year)
Ofloxiacin Otic drops 5 gtts affected ear qdx 7 days (6 mos-13 years); Adults 10 gtts qd x7 days
Neomycin sulfate 3.5mg, polymixinb sulfate 1000 units & hydrocortisone 10mg/ ml (Adults 4gtts qid, 2-16 years 3 gtts tid Max 10 days)
2 % Acetic acid (50/50 mix with water) after swimming. Keeps ph acidic
No gtts for otitis externa if
TM is perforated
Otalgia
ear pain
Otorrhea
drainage form the ear
Otitis Median SS
Otalgia Otorrhea TM redness (not always present) Effusion may persist for months can cause hearing and speech problems N/V Fever (often coexist with URI symptoms) anorexia
Otitis Media Treatment
Watchful waiting for kids 2-12
Amoxil 80-90mg/kg/dose
Tympanosotmy may be placed for
persistant effusions and it allows Cx of fluid
Foreign body in ear
Kill bugs w/ mineral oil or petroleum jelly
Assess object 1st before attempting to remove the foreign object
What is serous otitis?
fluid build up in middle ear
Treatment for serous otitis
Open eustachian tube Antihistamines Decongestants Nasal steroids Valsalva Gum chewing
Cholesteatoma
a cyst or skin growth behind the TM of into the mastoid
Cholesteatoma cause
recurrent infection
congenital (rare)
Cholesteatoma symptoms
recurrent drainage full feeling dizziness facial paralysis Hearing loss
Cholesteatoma Tx
surgical removal
Tinnitus
refer some tx available
occurs due to trauma
Meniere’s Disease Sxs
Vertigo Hearing loss tinnitus aural fullness unilateral hearing loss lasts 24 minutes to 24 hours
Meniere’s Disease Cause
syphilis
chronic OM
trauma
Endolumpatic hydrops (fluid in middle ear)
Meniere’s Disease Tx
surgery
vestibular sedative
chemical ablation
Mastoiditis
Infection of the mastoid process
Has the potential to spread to meningitis of brain
More common in kids
What is the most common causative agent of mastoiditis?
Strep pneumoniae H-flu
Group A beta hemolytic strep
Treatment for Mastoiditis
(High dose PCN or IV abx)
Augmentin
Biaxin
Bactrim
Epistaxis
nosebleed
What do you want to check for with epistaxis?
CBC liver disease (if present treat)
Causes for epistaxis
trauma
liver disease
Tx for Epistaxis
Ice pack, keep head up and forward (for trauma)
May need a vasoconstrictor (Neosynephrine or packing)
Acute Viral Rhinitis
Common cold
has a sudden onset
SS of Viral Rhinits
low or no fever mild pharyngitis erthemic TM erythemic nasal mucosa thin discharge with mucopurulent after 2-3 days post nasal drip
Treatment for Viral Rhinitis
usually not needed
self limiting
Allergic Rhinitis
Caused by allergens releasing histamine—Causing pale boggy turbuniates
SS of Allergic Rhinitis
Clear discharge
Nasal crease
Conjuctival edema
Dry hacky cough
Tx for Allergic Rhinitis
Nasal steroids (2nd gen b/c r less drowsy than antihistamines) Leukotriene inhibitor (Singulair)
Vasomotor Rhinitis SS
Stuffiness
Clear or mucoid discharge
Sneezing
Drippy nose
What causes vasomotor rhinitis?
Changes in blood flow to nares
Temperature change
Pollutants
Tobacco
Tx for Vasomotor Rhinitis
Mast cell stabilizers (Astelin) Anticholinergic sprays (Atrovent)
Afrin
It is a rhinitis medication that causes rebound reaction which is worse than the original symptoms
SS include nasal stuffiness and congestion along with pale boggy turbinates
Acute Sinusitis SS
Low grade fever Mucopurulent nasal discharge or pressure PND (post nasal drainage) Edema Facial tenderness Tooth ache
Tx for Acute Sinusitis
URI >7 days therapy for 10-14days
CT scan after 6 week Tx
Surgery
Epstein Barr Virus
Pharyngitis caused by Mononucleosis
Occurs in adolescent and young adults
SS of Mononucleosis
Fever Fatigue Dysphagia Posterior and anterior pre auricular lymph eedma Soft palate petechaie
What diagnostic test is done for Epstien Barr aka Mononucleosis?
Heterophil antibody test
CBC
Throat Cx if unsure of viral vs. bacterial infection
Patient education with Mononucleosis
No contact sport x4 weeks (at least)
Avoid heavy lifting x4 weeks
No running x2 weeks
Herpangina
Usually caused by coxsackie virus
Type of phyrangitis most common in children during the summer
SS of herpangina
Fever
Cervical lymph edema
Ulcerations or vesicles on soft palate and tonsillar pillars
Tx for Herpangina
Usually self-limiting
Tylenol for the fever
Cocsackie Virus
causes pharyngitis
SS include malaise, diarrhea, lesions, cervical lymph edema; eroding vesicles and oral mucosa
vesicles on palms and soles of feet as well
Maalox to treat inflammation
Strep Throat SS
erythema
sometimes white patches
scarlet fecer rash 2ndry to reacton to strep toxins
Strep Throat Tx
Amoxil x10days (to reduce the risk of Rheumatic heart disease)
Macrolides
Cephalosporins
Clindamycin if allergic to PCN
Peritonsillar abcess
in 20-30; rare <12
Excessive drooling
Muffled voice (hot potato)
Tx fo Peritonsillar abcess
Requires aspiration in ED of ENT office
Clindamycin
Epiglotitis
kids <2
MEDICAL EMERGENCY
Inflammation of the epiglottis (cartilage that covers the trachea)
Epiglotitis Tx
IV cephalosporins
Influenza
Highly contagious viral infection
Influenza Tx
Tamiflu give w/in 48hours of Sx onset
Tamilfu is pregnancy category
C
not safe for kids <1
