ENT Disorders Flashcards
Acute Otitis Media (AOM)
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
Overview of the ear anatomy
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
Vaccines for prevention of AOM
HiB and Prevnar
Most common pathogens associated with AOM
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 *
When is surgical implantation of a myringotomy w/ PE tubes recommended in AOM episodes?
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
Otitis media w/ effusions (OME)
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
When to use audiometry and the types of audiometry
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
The 4 Ds associated with disorders of the external ear
Discharge
Displacement
Deformities
Discoloration
these are the 4 things you have to check for when examining an ear
When is irrigation of the ear to remove dry cerumen contraindicated?
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
How to treat ear discharge
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
Mastoiditis
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.
Parotitis
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
Mumps parotits
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
Basilar skull fracture “Battle sign”
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
Causes of deformities of the pinna
Her idea Tory factors
Blunt force/trauma
Teratogens
Unusual intrauterine positioning
