ENT Flashcards
what questions should be asked on an ear infection history
OPQRST(DFP) AAA
otalgia hearing loss tinnitus otorrhea aural fullness/pressure association with fever or vertigo or URTI sx previous ear infections/episodes
eating
trauma (q tip use), recent swimming
symptoms of acute otitis media
moderate to severe TM bulge
effusion
mild bulge plus less than 48 hours of acute pain or intense erythema
acute onset
inflammation
*no read gold standard for assessment of the tympanic membrane in AOM
most common bacterial causes of AOM
strep pneumo
moraxella cattarhalis
h. influenza
investigations for AOM
none needed
treatment for AOM
key factors are age, severity, levels of illness, estimated degree of access to follow up
abx first line –amoxicillin (erythromycin if pen allergy)
children over 6 with uncomplicated cases can be managed by watchful waiting
tubes/ventilation for recurrent AOM (3 in 6 mo or 4 in 12 mo)
first line abx for AOM
amoxicillin–erythromycin if allergic to penicillin
5 days if older than 2 years, 10 days if under 2 years
how do AOM and OM with effusion differ
AOM has infection of the effusion
symptoms of otitis externa
pain, especially with manipulation of the pinna
externa effusion
etiology of otitis externa
usually bacterial but can be fungal
management of otitis externa
discharge suctioned and removed
topical abx drops (target pseudomonas, s aureus)–often cipro-dex
keep ear dry
avoid Q tips
ear wick for severely swollen canal
abx used for otitis externa
cipro-dexamethasone
what is the role of the ossicles
amplify sound from a larger tympanic membrane to a finer point
types of hearing loss
conductive
sensorineural
hearing loss questions to ask
speed of onset
ototoxic medications
family history of hearing loss
noise exposure
previous surgery
recurrent infections
physical exam for hearing loss
weber and rinne
pure tone audiogram**
what does a pure tone audiogram investigate
used to test hearing loss
investigate each ear separately and check air vs. bone curves for each ear
if air bone curves are at the same level–> SNHL
if air bone gap present–> CHL
if on pure tone audiogram, there is an air bone gap, what type of hearing loss
conductive
if on pure tone audiogram there is no air bone gap but hearing loss is present, what type of hearing loss
SNHL
describe the weber test and what it indicates
tuning for placed in middle of forehead
lateralizes findings to detect unilateral CHL or SNHL
if defective ear hears the tuning fork louder than normal ear–> CHL
if defective ear hears the tuning fork worse than normal ear–> SNHL
describe the rinne test and what it indicates
expectation is louder at the front, but if its louder at the back then its CHL
positive Rinne is NORMAL–> sound heard outside the ear (air conduction) is louder than the initial sound heard when the tuning fork is placed against the mastoid process
in CHL, bone conduction is better than air conduction (negative Rinne)
what is otoscleritis
thickening of the ossicles with normal TM (leads to conductive hearing loss)
treatment for otoscleritis
ongoing observation
trial of amplification
surgery–> stapedotomy if air bone gap above 30 dB
what can cause CHL in external canal
cerumen impaction–> must be completely impacted
severe otitis externa
stenosis
masses
what can cause CHL in the middle ear
otitis media (acute or chronic)
tympanic perforation
cholesteatoma
otosclerosis
ossicular fixation
ossicular deformity