ENT Flashcards
4) Tuning Fork Tests-512 Hz
a) (hold tuning for on top of head)
i) Midline (Normal)
ii) Lateralizes to CHL or to better ear
iii) Will not lateralize more than 30 decibles
Weber
4) Tuning Fork Tests-512 Hz
i) AC >BC (Normal)
ii) BC>AC (CHL)
iii) Hold it out by ear, then place on mastoid process
Rinne
a) Stimulus in the ear
b) Receive electrical impulse via brain wave scan
9) Auditory Brainstem Response ABR
a) Outer Hair Cells emit low intensity sound following acoustic stimulation
b) Newborn Screening Test
c) Testing for kids
8) Otoacoustic Emission Testing
a) Autosomal Dominant incomplete penetrance
b) 60 % have family Hx
c) Fluoride prevents
d) Rx: hearing aids or Stapedectomy
12) Otosclerosis
a) Head Trauma
b) SSx: Headache, vertigo, SNHL, CHL, facial nerve paralysis, CSF leak via ear canal or nose
c) Rx: Neurosurgical unit observation, sx relief, lumbar drain, audio, possible ossicular reconstruction
14) Temporal Bone Fracture
a) Asymmetric SNHL
b) Vertigo
c) Facial nerve paralysis
d) Aural Fullness
e) Trigeminal numbness
f) Diplopia
g) Dx: MRI of IACs with contrast
h) Rx: OBS vs SURG vs XRT
15) Acoustic Neuroma
illusion of movement (ie rocking, rotary, ground rolling, since of falling forward/backward), commonly episodic
a) Vertigo
sense of poor coordination with erect posture or movement, usually continuous
b) Dysequilibrium
implies orthopedic or neuro problem
c) Imbalance
all-encompassing term (ie light-headed, orthostatic, hypoglycemic, inability to concentrate)
d) Dizziness
a) Most common peripheral vertigo
b) Cause: post trauma, post viral infection
c) SSx: recurrent brief positional vertigo, latency, fatigability
d) Dx: Hx, Dix-Hallpike
e) Ppys: canalithiasis
f) Normal Hearing
20) Benign Paroxysmal Positional Vertigo
a) Symptoms
i) Fluctuating SNHL
ii) Tinnitus
iii) Episodic Vertigo (min-hr)
iv) Aural fullness
v) 25-30% bilateral
vi) Progressive
vii) Often totally asymptomatic between spells
b) Management
i) R/o stroke and tumor, infection, trauma, hypothyroid
ii) Salt restriction
iii) Evenly spaced meals H2O
iv) Diuretics
v) Steroids
vi) Vestibular suppressants: meclizine, benzos, scopolamine
vii) Allergy Rx
viii) Surgery
21) Meniere’s Disease
a) Viral infection of the vestibular nerve
b) SSx: Vertigo lasts hours to days, No Hearing Loss
c) Prodromal viral URI
d) May last weeks to months
e) Rx: Meclizine, benzos, antiemetics
22) Vestibular Neuronitis
a) SSx: Sudden hearing loss and vertigo, tinnitis
b) Infection spreads from middle ear thru round window or oval window
c) Dx: H & P, audiogram (SNHL)
d) Rx: IV antibiotics, vestibular suppressants, surgical management of middle ear infection, steroids
23) Labyrinthitis Viral or Bacterial
a) Birth Trauma
b) Mobious Syndrome
c) Herpes Infection
d) Tumors
e) Stroke
f) Iatrogenic Injury
g) Neurologic Disease: Guillain-Barre, Myesthenia Gravis
24) Facial Nerve Paralysis
no external ear development
i) 10% are Syndromic
ii) 30% are bilateral
iii) Associated with ear canal atresia and middle ear abnormalities
iv) Reconstruction or prosthesis
v) Bone Anchored Hearing Aid
a) Anotia
i) Ear is slightly smaller than normal
ii) Conchal bowl is cupped
iii) All subunits are present
iv) Surgery usually not needed
b) Microtia Grade I
i) Auricle is half sized
ii) All structures are present
iii) Soft tissues are deficient
iv) Surgery is sometimes beneficial
c) Microtia Grade II
i) Small cartilage piece in superior remnant
ii) Anterior deflected lobule
iii) Surgical repair at age 5-6 years old
iv) Prostheses look pretty good
d) Microtia Grade III
i) Most common external anomaly
ii) Absence of the antihelical fold
iii) Common in certain Royal lineages
iv) Causes grade school ridicule and low self esteem
v) Surgery offered
e) Lop Ear
i) Frequently get infected
ii) Rx with antibiotics and incision and drainage
iii) Completely excise when infection has cleared
iv) Frequently bilateral
v) May affect any part of the auricle
f) Preauricular Pits and Fistulas
i) Arrested development of fusion of the Hillocks of His
ii) Contains cartilage and skin
iii) Excision is elective
iv) Facial nerve is quite superficial in infants and toddlers
g) Auricular Appendages
i) Autoimmune
ii) Looks really red
iii) Episodic & progressive
iv) May involve nose, joints, airway, heart valves
v) ESR and IGg elevation
vi) Rx: steroids and NSAIDS
e) RELAPSING POLYCHONDRITIS
i) ∙Very painful
ii) ∙Usually in older patients
iii) ∙Looks like skin cancer
iv) ∙Benign
v) ∙Rx: Excisional biopsy
f) NODULARIS CHRONICUS HELICUS
i) AVOID PIERCING IN KELOID PRONE PATIENTS
ii) EARLY RX STEROIDS
iii) LATE RX EXCISION
g) KELOIDS OF THE EAR
i) CAUSED BY TRAUMA
ii) TREAT WITH INCISION AND DRAINAGE THEN A BOLSTER
iii) UNTREATED RESULTS IN CAULIFLOWER EAR
h) AURICULAR HEMATOMA
i) SYMPTOMS INCLUDE PAIN, SWELLING, REDNESS, FEVER
ii) ORGANISMS: STAPH, STREP, PSEUDOMONAS
iii) RX ANTIBIOTICS AND PAIN RELIEF
iv) RISK FACTORS DIABETES, FOREIGN BODIES, PIERCINGS, TRAUMA
i) CELLULITIS OF THE PINNA
i) BENIGN PROJECTIONS IN CANAL
ii) SEEN IN NORWEGIANS
iii) MOST PEOPLE THAT HAVE THEM HAD SIG COLD WATER EXPOSURE
iv) SURGICAL REMOVAL IS RARELY INDICATED
v) LOOKS LIKE CHOLESTEATOMA
g) EAR CANAL OSTEOMAS & EXOSTOSIS
i) PAINFUL, BLEEDING SOFT TISSUE MASS IN CANAL
ii) NEEDS BIOPSY
iii) NEEDS EXCISION AND OR RADIATION THERAPY
iv) CAN METASTASIZE
v) CAN BE FATAL
h) CARCINOMA OF EAR CANAL
i) VERY PAINFUL RED SWOLLEN CANAL WITH PURULENCE
ii) SEEN IN SWIMMERS, Q TIP USERS, DIABETICS, IMMUNOSUPRESSION
iii) RX ANTIBIOTIC DROPS AND SYSTEMIC ANTIBX
iv) TOPICAL SUCTIONING AND DEBRIDEMENT
v) PSEUDOMONAS, E COLI, STAPH CORYNEBACTER
vi) HEARING MAY BE AFFECTED
i) OTITIS EXTERNA
i) PURULENT ULCERS IN AND AROUND EAR
ii) DECREASED HEARING
iii) SEVERE PAIN
iv) FACIAL NERVE PARALYSIS
v) ANTIVIRAL RX AND PAIN RELIEF
vi) IMMUNOCOMPROMISE MAJOR RISK FACTOR
j) HERPES ZOSTER OTICUS
i) Hx pain, hearing loss, vertigo, trauma, Rx Hx, previous ear surgery, recent infection
ii) DDx Otitis media, otitis externa, allergy, trauma, CSF leak
iii) Dx culture, GM stain, beta 2 transferrin for csf
k) OTORRHEA ( Ear Drainage)
i) Red itchy flakey skin
ii) Psoriasis of other areas
iii) Rx Topical Steroids, avoid trauma, antibiotics for secondary infection
l) Psoriasis of External Ear Canal
i) CAN BE CONGENITAL OR SECONDARY TO TRAUMA OR INFECTION
ii) NEEDS CANALPLASTY TO ENLARGE CANAL
iii) SMALL AMT WAX PLUGS EAR EASILY
m) EAR CANAL STENOSIS
i) ITCHING PAINFUL EAR DRAINAGE DECREASED HEARING
ii) COMPLICATION OF PRIOR ANTIBACTERIAL RX
iii) ANTIFUNGAL DROPS PILLS PAIN RELIEF
iv) DEBRIDEMENT
v) ALCOHOL, VINEGAR, H2O
n) OTOMYCOSIS
i) Pathophysiolgy: Otitis media, trauma, slag burns, indwelling PE tubes, explosion, diving, water skiing, cerumenectomy, barotrauma, cholesteatoma
ii) SSx Hearing loss, otorrhea, tinnitis
iii) Rx Keep ear dry consider tympanoplasty for persistent perf
iv) NOT All PERFS NEED REPAIR
v) Often heal with time
vi) Tympanoplasty for large conductive hearing loss or to protect middle and inner ear from water and prevent middle ear infection
a) Tympanic Membrane Perforation
i) INFLAMED TM WITH SEROUS BULLAE
ii) ASSOC W VIRUS or MYCOPLASMA p URI
iii) SSx otalgia, otorrhea hearing loss
iv) Rx analgesia, antibiotics decompression of painful vesicles, and steroids for sensorineural hearing loss
b) BULLOUS MYRINGITIS
i) White plaques on TM
ii) Hyalin or Calcium deposition
iii) PPx prior Otitis Media or Trauma (PE Tubes)
iv) Normal hearing if limited to the TM
v) If middle ear involved there may be conductive hearing loss
c) TYMPANOSCLEROSIS
i) SOFT BALL OF KERATIN
ii) INVOLVES SKIN
iii) CAUSES BONE EROSION
iv) SURGERY IS ALMOST ALWAYS INDICATED TO EXCISE TO PREVENT DESTRUCTION OF EAR
d) CHOLESTEATOMA
i) Squamous epithelium in middle ear
ii) Causes bone and soft tissue destruction of ear structures pressure necrosis, secondary infection and proteolytic enzyme release by cholesteatoma.
iii) Dx pearly mass aural fullness, hearing loss, vertigo, chronic otorrhea
iv) Rx surgical removal = tympanomastoidectomy
e) MIDDLE EAR CHOLESTEATOMA
i) Acute middle ear space infection (
f) ACUTE OTITIS MEDIA
i) Fluid in ear
ii) Not treated with anything
iii) May need tubes
g) SEROUS OTITIS MEDIA
h) RISK FACTORS FOR OTITIS MEDIA
i) DAY CARE ATTENDANCE
ii) SMOKE EXPOSURE
iii) BOTTLE FEEDING
iv) ALLERGY TO FOODS
v) NASAL ALLERGY
vi) RECURRENT URI
vii) CRANIOFACIAL/SKULL BASE ANOMALIES
viii) ADENOID HYPERTROPHY
ix) GASTROESOPHAGEAL REFLUX
x) IMMUNOLOGIC DISORDERS (IgA IgG def)
xi) Ciliary Dysfunction
xii) Nasal Intubation (NT NG)
xiii) Nasopharyngeal Tumors
xiv) Cholesteatoma
xv) Genetics (PPGP)
i) SIGNS and SYMPTOMS of AOM
i) Otalgia causing irritability and ear tugging
ii) Aural fullness, something is blocking ear
iii) Hearing loss
iv) Tinnitis
v) Fever
vi) Red or Creamy Yellow TM that Bulges and is Immobile
vii) Remember TM turns red with crying
j) Management of AOM
i) The majority of AOM cases will spontaneously resolve in 24 – 72 hours
ii) Oral antibiotics
iii) Topical antibiotic otic drops if TM perforated
iv) Pain relief, decongestants, antipyretics
v) Prophylactic antibiotics indicated for recurrent infections
vi) Myringotomy for severe otalgia or toxic pts.
k) Surgical Management of Otitis Media
i) Myringotomy and Tubes (PE)
ii) Adenoidectomy
iii) Mastoidectomy
i) • Embryology:
ii) ▫ Cysts consist of squamous cell epithelium containing epidermal appendages
iii) ▫ Epidermal elements are displaced during intramembranous growth phase of nasal bones
iv) ▫ Location can be several: Fronto-temporal region, Orbital region, or Nasoglabellar region
g) Dermoid Cyst
i) • Extracranial protrusions of meninges, CSF fluid, and neural tissue
ii) • Meningoceles present similarly without herniation of brain tissue
iii) • May present as external or internal nasal masses
iv) • Described by location of dehiscence in the skull base
h) Nasal Encephalocele
i) Hypotheses on formation
ii) ▫ Develop from extracranial rests of glial tissue
iii) ▫ Abnormal closure of fonticulus nasofrontalis
iv) ▫ Another theory is that they are possibly encephaloceles which have lost CSF connection
i) Nasal Glioma
i) Viral Rhinits
ii) Occupational Rhinitis
iii) Vasomotor Rhinitis
iv) Nonallergic Rhinitis with Eosinophilia (NARES)
v) Rhinitis Medicamentosa
vi) Rhinitis of Pregnancy
vii) Vasculitides, Autoimmunes & Granulomatous Dxs
k) Nonallergic Rhinitis
i) IgE-mediated hypersensitivity of the nasal mucosa to foreign substances
ii) Affects 20% of the United States population
iii) Rarely occurs before 2 years of age, almost always present by 20 years of age
iv) Male predominance in children, equalizes in adults
v) Atopy: genetic predisposition to respond to environmental allergens with the production of specific IgE antibodies
l) Allergic Rhinitis
a) Complex group of disorders with inflammation as the major universal finding
b) Affects approximately 15% of the adult population in the United States
31) Sinusitis
Sinusitis pathogenesis
i) Bacterial: S aureus, M Cat, H Influ
(1) in up 80% of patients undergoing surgery for CRS
ii) Fungi
(1) Non-invasive colonization—obstruction of sinus ostia
(2) Allergic fungal sinusitis—IgE mediated hypersensitivity
iii) Allergic Rhinitis
iv) Cystic fibrosis carrier state
v) Primary ciliary dyskinesia
vi) Immunodeficiency
vii) Environment irritants: Tobacco smoke, Industrial pollution
