ENT Disorders Flashcards

1
Q

Acute Otitis Media (AOM)

A

Acute infections/inflammation of the middle ear
- usually presents with edema and inflammation of the Eustachian tube mucosa as well which prevents drainage

Often seen with acute upper respiratory tract infections that are followed with a secondary temperature spike one-several days after onset or respiratory symptoms

Highest incidence of occurrence is between 6-11 months and decreases with age

Symptoms/sign:

  • bulging erythmatous tympanic membrane
  • acute perforation of tympanic membrane
  • otalgia (especially when trying to sleep)
  • irritability
  • general malaise
  • high fever (<39C)

Treatment:

1) amoxicillin is first line (80-90mg)
2) amoxicillin-clavulanate, cefuroxime axetil, cefdinir or ceftriaxone are 2nd line if any of the following are met:
- has used amoxicillin in the past 30 days
- Purulent conjunctivitis is present
- unresponsive to amoxicillin

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2
Q

Overview of the ear anatomy

A

External ear includes

  • pinna
  • auricle
  • external auditory canal
  • tympanic membrane (cutoff point of external-> middle ear)

Middle ear includes

  • ossicles
  • mastoid
  • inner surface fo the eardrum

Inner ear includes

  • cochlea
  • labyrinth
  • semicircular canals
  • 7th/8th cranial nerves
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3
Q

Vaccines for prevention of AOM

A

HiB and Prevnar

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4
Q

Most common pathogens associated with AOM

A

1) Streptococcus pneumoniae (44%)
2) Haemophilus influenza (41%)
3) Moraxella catarrhalis (14%)
* Note: 50% of AOM infections are penicillin resistant w/ all moraxella infections being resistant *

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5
Q

When is surgical implantation of a myringotomy w/ PE tubes recommended in AOM episodes?

A

Any of the following:

  • middle ear fluid dose not resolve in 6 months
  • patient has AOM 3 or more times in the past 6 months
  • patient has AOM 4 or more times in the past year
  • persistence of serous effusions for longer than 3-4 months w/ significant hearing loss
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6
Q

Otitis media w/ effusions (OME)

A

Middle ear infections without signs/symptoms of acute inflammation

  • presents with serous effusion that becomes persistent clear gray or yellow appearing behind eardrum
  • often associated with Eustachian tube dysfunction
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7
Q

When to use audiometry and the types of audiometry

A

Used to help prevent/combat hearing impairment that is associated with Middle ear infections w/ effusions
- especially chronic MEEs

Types:

1) behavioral audiometry
- best used for children older than 5 years

2) visual reinforcement audiometry
- best used for children 6 months - 2 years

3) play audiometry
- best used for children older than 2 years

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8
Q

The 4 Ds associated with disorders of the external ear

A

Discharge

Displacement

Deformities

Discoloration

these are the 4 things you have to check for when examining an ear

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9
Q

When is irrigation of the ear to remove dry cerumen contraindicated?

A

If there is any possibility that the eardrum may be ruptured
- during irrigation in this instance will send the cerumen into the middle ear and cause permanent deafness

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10
Q

How to treat ear discharge

A

Should always obtain cultures if possible to treat more accurately

Generalized treatment includes:
- topical otic antimicrobial/steroid preparations

Specific treatments:
- systemic antibiotics = when pain is severe, evidence of otitis media is present or there is uncertainty about AOM
(if the infection is known can use narrow antibiotics, otherwise use broad spectrum)

  • parenteral antibiotics = evidence of cellulitis or mastoiditis is present
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11
Q

Mastoiditis

A

Rare condition caused by chronic/untreated AOM/MME that extends into the the mastoid air cells and out to the periosteum of the skull

Is the MOST severe condition causing displacement of the ear/ear canal

Signs/symptoms:

  • erythema and edema of skin over mastoid
  • tenderness of mastoid
  • sagging got ear canal
  • Purulent otorrhea
  • fever
  • toxic appearance overall

Treatment:

  • parenteral antibiotic therapy and myringotomy are 1st line always
  • Mastoidectomy is 2nd line and used if CT scans indicate complicated bone erosion of CNS extension.
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12
Q

Parotitis

A

Prominent induration and enlargement of a parotid gland (usually unilateral)
- can also cause inflammation of the salivary glands if untreated

Most common viral etiologies associated are mumps, S. Aureus infections and enteroviruses infections

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13
Q

Mumps parotits

A

Specific parotitis caused by the mumps virus ( is highly contagious)

Incubation period for the disease is 16-18 days and is contagious 1-7 days before symptoms and 5-9 days after symptoms

Symptoms/signs: Note most symptoms are prodromal

  • fever
  • headache
  • malaise
  • anorexia
  • onset of earache/face pain (1st symptom)
  • salivation and chewing elicits worsened pain
  • parotid swelling (usually bilateral)

Treatment:
- treat underlying mumps and broad NSAIDs to reduce inflammation

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14
Q

Basilar skull fracture “Battle sign”

A

Temporal bone is fractured Just post auricular and along the mastoid tip

Shows post auricular ecchymoses and erythema of the pinna w/out infection/discharge

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15
Q

Causes of deformities of the pinna

A

Her idea Tory factors

Blunt force/trauma

Teratogens

Unusual intrauterine positioning

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16
Q

Nasal congestion in children

A

In early infancy, all children have small easily obstructed nares.

Between 1-3 months old, All children are obligate nose breathers which causes respiratory distress if the nares are blocked

17
Q

Supportive care for nasal congestion in infants

A

1) parents should hold infants up on shoulders and burp them for 10-15 minutes after feedings (prevents blockage)
2) have nasal saline drops and sanctioning available to prevent congestion

DONT use oral decongestants since these cause serious ADRs in children under 2 years old

18
Q

Choanal atresia

A

Congenital disorder where the back of the nasal passages (choana) are blocked

  • 90% of these are bony w/ 10% benign membranous
  • can be bilateral or unilateral

Bilateral choanal atresia often manifests with severe respiratory distress and cyanosis at brith
- relieved by crying and returns with rest (paradoxical cyanosis)

Determined by the use of a Van Buren urethral sound. Suction catheter