ENT Flashcards
What do you look for in otoscopic exam?
- color
- other conditions
- mobility
- position
- Lighting
- entire surface
- translucency
- external auditory canal
- seal
Acute Otitis Media (without effusion)
Preschool children
Risks: pacifier use, smokers, daycare, not breast fed
S. pnemoniae, h. influenzae, m. catarrahalis, viruses
RETRACTED OR BULDGING TM, IMPARIED MOBILITY, FEVER, EAR PAIN, EAR PRESSURE, can be errythmateous, doens’t have to be, Triad: buldging, redness, and lack of motility, TYPICALLY COMES FROM URI THAT LEADS TO EUSTACHIAN TUBE DYSFUNCTION OR BLOCKAGE.
WATCHFUL WAITING WHEN WITHOUT SEVERE PAIN AND FEVER!! WAIT 3 DAYS WITH PAIN RELIEFAND SEE IF IT GETS BETTER UNLESS FEVER IS PRESENT THEN ANITBIOTIC, have them call back if symptoms get worse
COMPLICATIONS: MASTOIDITIS, Tm rupture
DOC: AMOXICILLIN, IN RESISTANCE USE AMOXICILLIN CLAVULANATE.
Acute Ottis Media (with effusion); what color is the membrane? is this an infection? what direction is the membrane going? what is the most important test you can do to confirm diagnosis?
LOOK FOR AIR FLUID LINE EFFUSION W/O SIGNS OF SYMPTOMS OF INFECTION
common in children, CAN EFFECT SPEECH
risk facors: AFTER AOM, eustachian tube dysfunction, smokers, alleries, pacifires
generally not as many signs of illness, hearing loss may be the only sympstom, CONDUCTIVE, STRANGE FORMULATION OF SPEECH, sleep disturbance, vertigo, may indicate tubes
TM: pearly gray, neutral or RETRACTED, AIR FLUID LEVELS, PNEUMATIC OTOSCOPY MOST IMPORTANT BECAUSE YOU WONT’ SEE THE MEMBRANE MOVE
NO antibtiocs!! watch and wait since not infected
What do these show?
Chronic Otitis Media; what is it associated with? what bacteria cause this? what do they need to avoid? what abx?
- occurs from repeated episodes of acute otitis, trauma, or cholesteatoma. Associated with low socioeconomic status, smoking.
- Different causitive organisms than AOM
p. aeruginosa, s. aureus, proteus
-perforated tympanic membrane for >2 weeks and chronic ear discharge (ottorhea), with or without pain, can cause conductive hearing loss
needs debriedment, avoidance of water exposure, topical antibiotic drops
***difference between AOM and COM is the time frame the TM is ruptured for, >2 weeks then chronic***
DOC: aural toilet irrigation with WARM water, prevents against vertigo. and vinegar rinse to dry it up. Topical antibiotic Cipro, oflaxacin
what do you not use aminoglycosides for topical ear infections?
aka Gentamycin and tobramycin
They are ototoxic!!
tympanometry
measuring the movement of the tympanic membrane
Cholesteatoma; what important things can this lead to? who is this common in? who is more likely to get it?
pocket of squamous epithelium that becomes hyperactive and makes tumors that go into middle and inner ear
-usually in children under 5 with cleft palate, Downs, facial abnormalties
ETreatment: excision
This is serious, don’t miss it, can lead to meningitis, cranial nerve palsies, hearing loss
Mastoiditis
can occur due to inadequate treatment of prolonged or chronic ottitis media when infection spread from middle ear in mastoid air cells
- spiking fever and post auricular pain, fluctulant painful mass, swollen mastoid,
- CT needed to diagnose
- history is the biggest clue
- DOC: IV cephalosporin, emergent EMT consult
- can lead to meningitis, intercranial pressure
Perforated Tympanic Membrane; what are three things that can cause it? what should patients avoid? How does it heal? most important thing is?
trauma: foreign bodies, barotrauma, headtrauma
loud noises, AOM
-educate patient to avoid water in ear that will promote infection
- don’t do peumatomotry because there is a hole, DUH.
- Refer to audiology if hearing loss or vertigo
-usually will heal on its own, best treatment is PREVENTION, use antibiotic if infected
Otitis Externa; what is this known as? where do you see the pain? coloration? what happens in diabetics or immunocomprimised & where does it infect? what type of bacteria?
“swimmers ear” common exsposed to water, trauma where kids itch ears or cleaning, PSORIASIS OR ECZEMA
p. aerguginosa, s. aureus, fungal
- patients complain of pain especially with movement of the auricle and tragus, black/cauliflower look in fungal infection
- redness and swelling of the ear canal, PURLUENT EXUDATE
doc: antibiotic otic drops aminoglycosides (ok since membrane intact) or fluoroquinolones +- corticosteroids and avoid further moisture. CORTOSPORIN, use with a wick to get the drugs in!! may want to use benzocain with it to numb it up.
in diabetics and immunocompromised: malignant otis externa may develope; a necrotizing infection TEMPORAL BONE, requires HOSPITALIZATION AND PARENTRAL ANTIBIOTICS,
presbycusis; what goes first? how do you treat?
hearing loss with age, high pitches go first
Tx: hearing aids, cochlear implants, cerumin impactions
semisoneural hearing loss
cerumen impaction
increased risk with cotton swab use or hearing aids
only becomes an issue when impacted, secretions and epithelia cells
-fullness and hearing loss
irrigation, cerumlytics, manual removal, warm flushes, colace drops, use WARM water to prevent against vertigo when flushing
Tinnitus
Name the four types! BEES buzz
ringing in the ears
bruits: whoosh whoosh noise, work up
Endogenous, maskable tinnitus: feel better in noisy environment, ambient noise maker
exogenous tinnitus: feel better in a silent environment, hearing aids to filter
slow brainstem tinnitus: feel mentally unstable, non-focalized “noise”, dazed and disortiented
exo and endo are hard to treat but can use benzos in extreme cases or use tinitis retrain to respond differently to stimuli
NO GOLD STANDARD FOR TREATMENT
benign paroxysmal postional vertigo; what testing should you have them do? what can make it better? constant or comes and goes? what does that patient feel like?
vertigo when in certain positions, DIX HALLPIKE POSITION determines vertigo
“the room is spinning”, do orthostatics and EKG, look for nystagmus in vertigo patients, then do dix hallpike position to ellicit nystagmus in vertigo, dizziness comes and goes it is a vestibular issue rather than constant which is CNS. HEARING LOSS WITH PERIPHREAL TYPES.
-calcium in the labyrinth, TX by vestibular rehab, these are what get stuck on the hair cells and tell you that you’re moving when you’re not.
VERTIGO IS A SYMPTOM NOT A DIAGNOSIS
Tx: antihistamine (meclozine), but can make eldery confused, or the manuever
DIX hallpike manuever
used to determine vertigo BPPV
Have the patient tilt head 45 degrees and look for nystagmus, then have them lay down and look for nystagmus again for 30 seconds, once stopped, have then sit up and check again, repeat on the opposit side! BPPV confirmed and should fix the problem. Nystagmus will go away with position changes.
Vestibular neuritis AKA Labrynthitis
-gait imbalance, dizziness, hx of falling, tinnitus usually present, nausea
need to rule out cranial bleed/infarct, ACUTE SEVERE VERTIGO WITH HEARING LOSS AND VERTIGO FOR SEVERAL DAYS TO A WEEK
selflimiting, focus on treating the nausea, meclinazine/zofran
Menieres disease
most common 20-40 year olds
-endolymph disturbance- ion inbalance in inner ear
TO DIAGNOSE: NEED 2 SPONTANEOUS EPISODES OF VERTIGO FOR >20 MINS and audiometry to confirm sensioneural hearing loss, tinnitus, aural fullness
symptomatic, lifestyle changes decreasing salt intake, caffeine, alcohol, meclizine and benzo’s
Acoustic Neuroma; what are the two risk factors, what will be a sign on the eye? AGE?
A schwann cell derived tumor from vestibular nerve
found around age 50
risk factors: neurofibromatosis is a risk factor and so is radiation exsposure
EFFECT CN8
unilateral hearing loss, continous vertigo, MRI diagnosis, ipsilateral corneal reflex will be diminished
Types and characteristics of periphreal vertigo, what direction is the nystagmus?
labyrinthitis, benign paroxysmal postitional vertigo, Menieres, and vestibular neruitis
Periphreal is associated with suddent onset, nausea, vomiting, tinnitus, hearingloss and nystagmus (TYPICALLY HORSIZONTAL NYSTAGMUS)
if the dix-hallpike maneuver helps with benign parozymal positional vertigo, then it likely isn’t central vertigo, if this doens’t help then may be more serious
Central Vertigo; whats the onset like? what disease is associated with this that would be important?? nystagmus direction?
associated with gradual onset and vertical nystagmus NO AUDITORY SYMPTOMS
associated with brainstem vascular disease, arteriovenous malformations, tumors, MS
MRI suggested if CNS involvement is suspected
otosclerosis
abnormal bone growth at the oval window
causes: conductive hearing loss
What is the most common cause of conductive hearing loss?
cerumen impaction
Dental caries; what causes them? what prevents them in the mouth? whats the #1 prevention? Caution when a pt presents with this because?
bacteria form plaques on the teeth, erode the enamel and get into the tooth
Risk: not enough saliva since these contain enzymes, can be genetic or salivary glands
black and white plaques, degraded teeth, craters in the teeth
Tx: treat for pain, be careful of narcotic seekers, refer to a DENTIST and emphasize prevention. fluoride is the best prevention.
complications: can invade into pulp and gingiva, alveolar bone, and orofacial spaces and create absesses, invade the maxillary bone
Dental abscess
- bacteria from plaque gets in deeper
- swelling in the gums, sometimes facial pain
- fluctulant bulging gums and PAIN, don’t have to see the buldge because it can be farther up and give facial pain, can incision and drain with 18 gage needle an, can numb with dental blocks with bruprivicane or oil of clove
DOC: Penicillin or Clinda in allergies ALWAYS PRESCRIBE SO INFECTION DOESN’T SPREAD
Gingivitis; what bacteria causes it? what are interesting findings? what can it cause?
*most common periodontal disease in children*
Prevotella intermedia gram - anaerobes
subgingival plaques are more common in pregnancy, drugs, and poor nuitrition
blue/purple discoloration of gums, bleeding, bad breath, can cause TRENCH MOUTH
DOC: penicillin or Clinda or augmentin, chorahexidine rinses
periodontits; what is it a progression of? what is diagnostic for it? what are two things you could protenially loose? how long does it take? who is it in?
- untreated gingivitis, common in children
- untreated gingivits, loss of alveolar bone and periodonal ligament, weeks to years progression, cauess loose or missing teeth
6mm depth is diagnostic
early,= debrievment, surgery, and prevention is the biggest part
dental trauma; who is it common in? what do you want to check for (2)? important key thing to do when holding tooth?
common in children
-fractures or luxation: displaced but not falling out, want to know if primary or secondary tooth, want to preserve peridontal lig, hold by crown always, often will loose teeth
RF: those with imparied mobility
check maxillary fracture: bite down on TD and twist
oral candidiasis
-dentures, diabetes, immunocomprimised, children, corticosteroids, antibiotics
creamy white patches that can be scraped off to show erythematous mucosa, koh prep
pseudomembraneous (white) and atrophic (bright red in dentures)
DOC: nystatin or clotrimazole candies
angular chellitis; who is it found in? what two things cause it? what do you do to treat it?
- dentures/lip lickers
- candida albicans or staph impetigo(school children) infection, need to determine if fungal or bacterial
red crusty lesions at the corner of the mouth
DOC topical
FUNGAL: topical clotrimiazole, Bacterial: topical bactroban
Herpes Simplex mouth infection
vesicular lesion with erythematous base
usually HSV1 or latten infection
prodromal: burning, numbness, tingling before lesions appear 24 hours prior to outbreak
Tzank smear-giant nucleated cells,
Adults: acyclovir during prodromal phases!
kids: magic mouth wash
don’t need to treat if only on the labia
apthous stomatitis; what are two interesting assocaited diseases?
chancre sore, children adolescent
round, grey lesions WITHOUT ERYTHEMATOUS BASE, some genetic component and can be seen in patients with
Behcets disease: 3x a year, recurrent ulcers anywhere and vasculitis, IBS difficulty clearing up on their own
herpes virus 6
Coxsacki virus
hand, foot, and mouth disease, mostly kids
Coxsackie virus
painful blisters and ulcers on hands and feet, CONTAGIOUS, keep them out of school and isolate them
oral/throat cancer; who is it common in? which virus causes it? where should you always look?
- Males
- HPV16, 50 fold increase
RF: tobacco, alcohol
uclers and lesions that just won’t heal, dentures stop fitting, trouble swallowing, localized papules in the back of the throat, important to examine under the tongue
biopsy, CT, worry about metastisies
Leukoplakia
hyperplasia of squamous epithelium
benign but can turn cancerous, trauma or repetitive lip biting, tabacco, stays on when you rub it unlike thrush
biopsy them, constant monitoring to make sure not cancerous
bacterial pharyngitis; who is it in? what 3 interesting things can cause it? DOC?
kids mostly with daycare
strep, nisseria, chlamydia
Centor swabbing criteria
strep: DOC is penicillin
Strep Kids: DOC is amoxicillin or cephalosporins, if allergic them azithromax
xerostomia (dry mouth); what do you suspect? what do you treat with?
older adults
dry mouth, cobblestone tongue, cracked lips
-radiation, tobacco, chemo, chronic viral infection
sailometry: how much saliva, biopsy saliva for Sjogren’s syndrome (decreased mucous production throughout)
TX: pylocarpine (increases secretions)
