ENT: Ears Flashcards
Acoustic neuroma
- like tumor of Schwann cells affecting CN VIII
- mean age 50
- risk factors: neurofibromatosis, loud noise exposure
- clin pres: hearing loss, tinnitus, problems walking/balance, if tumor grow=CNA problems
- PE: usually incidental finding, make sure other cranial nerves aren’t involved
DX acoustic neuroma
-imaging
RX acoustic neuroma
-surgery (ENT + neuro)
Labrynthitis/vestibular neuritis
- inflammation of vestibular nerve
- clin pres: severe vertigo, N/V
- PE: imbalance, nystagmus
RX labrynthitis/vestibular neuritis
- usually self-limited (viral)
- some improvement w/ steroids
- treat sxs
Endolymphatic hydrops
Meniere Disease
Meniere Disease
-disorder of the inner ear due to distention of the endolymphatic compartments of the inner ear, causing hearing loss, vertigo, tinnitus
Epidemiology of Meniere disease
- occurs at any age but usually 20-40
- trauma
- infection (syphilis)
- immunologic
- endocrine (adrenal-pituitary insufficiency, hypothyroidism)
- vascular disorders
Pathophysiology of Meniere disease
-ions alter function of ear
Clinical presentation of Meniere disease
- episodic vertigo, sensorineural hearing loss, tinnitus, nausea, feel like ear is full
- sxs referable to ANS
DX Meniere disease
-clinicallys, PE, history, comorbid disorder (diabetes)
RX Meniere disease
- modify diet (limit salt/caffeine)
- lifestyle modification (avoid triggers)
- sxs relief
- ENT involved (possibly surgery)
- diuretics
- main focus is to attempt to reduce distention of endolymphatic space (med or surgical)
Benign paroxysmal positional vertigo
- sensation of whirling or spinning motion
- otoliths become dislodged from their gelatinous base, causing vertigo that is precipitated by changes in the recumbent head position
- most common cause of pathologic vertigo & develops in people over 40
RX bening paroxysmal positional vertigo
- drugs to control vertigo-induced nausea
- habituation exercises
- otolith repositioning
Vertigo
- motion sickness
- this is a sxs, can’t diagnose this
Peripheral vertigo
-severe in intensity & episodic/brief in nature
Central vertigo
-mild, constant/chronic in duration
RX vertigo
- meds (anticholinergic)
- special movements
Nystagmus
-involuntary eye movement that preserves eye fixation on stable objects in the visual field during angular & rotational movements of the eye
Mastoiditis
- infection in mastoid air cells
- pathogenesis: infection
- epidemiology: usually school-aged kids but also adults
- risk factors: history of recurrent AOM
PE of mastoiditis
-post-auricular redness, swelling, tender, possibly displaced ear
DX of mastoiditis
-clinically, CT (to determine extent)
RX of mastoiditis
- admit to hospital
- IV abx
- possibly drain
- ENT consult
complications of mastoiditis
-more severe brain infections
Barotrauma
-injury caused by change in air pressure
Cholesteatoma
- mass of abnormal skin growth or cyst-like growth
- abnormal accumulation of epithelium, grows rapidly, conductive hearing loss
- clin pres: new onset of hearing loss
Risk factors for cholesteatoma
- recurrent AOM
- frequent tubes
- cleft palate
PE for cholesteatoma
- white discoloration behind TM
- erosion of TM (usually around periphery)
DX cholesteatoma
-CT scan to determine extent if needed
RX cholesteatoma
- place tubes
- surgical excision
complications of cholesteatoma
- cranial nerve palsies
- brain abscess
- vertigo
Perforated tympanic membrane
- causes: trauma (Qtip, fall/head injury), noise, pressure, infection
- PE: vertigo, hearing loss
Management of perforated tympanic membrane
- abx if showing signs of infection
- avoid water in ear
- will usually heal well
- frequent perforation -> scaring -> some hearing loss
Conductive hearing loss
- auditory stimuli are not adequately transmitted through the auditory canal, TM, middle ear, or ossicle chain to inner ear
- can be from external ear: impacted wax, FB, OE
- middle ear: trauma, AOM, OME, otosclerosis tumors
Sensorineural hearing loss
- disorders that affect the inner ear, auditory nerve, or auditory pathways of brain
- can be from: trauma, CNS infections, presbycusis, atherosclerosis, sudden deafness, ototoxic drugs, tumors, idiopathic (Meniere disease)
Tinnitus
- ringing in the ears/any abnormal ear or head noise
- most common between 40-70
- endogenous: maskable (louder environment better)
- exogenous: (silence better)
- slow brainstem tinnitus
RX tinnitus
- instrumentation
- pharmacotherapy
- hearing aids
- can be caused by some meds, so stop those
Objective tinnitus
-rare cases in which the sound is detected/potentially detectable by another observer
Subjective tinnitus
-perception when there is no sound stimulation of the cochlea
Presbycusis
age related hearing loss
Otosclerosis
- formation of new spongy bone around the stapes & oval window which results in progressive deafness
- usually familial & follows an autosomal dominant pattern w/ variable penetrance
- most commonly appears between 20-30, accelerates during pregnancy
- may contribute to sensorineural hearing loss, tinnitus, vertigo
SXS otosclerosis
-insidious conductive hearing loss
RX otosclerosis
- medical or surgical
- hearing aids
- sodium fluoride (has been used w/ otospongiosis)
- stapedectomy w/ stapedial reconstruction
Otitis media (types)
- acute
- with effusion
- chronic
Acute otitis media (pathophysiology, PE)
- risk factors: history of infections, bottle fed, pacifier use, smoking
- patho: problem w/ inflammatory/respiratory mucosa
- PE: TM retracted/bulging, limited mobility, most likely febrile
Etiology of AOM
-S. pnumoniae, H. influenzae, M. catarrhalis
RX AOM
-after 3 days start amok, azithro, cephalosporins
complications of AOM
- rupture
- labrynthitis
- mastoiditis
Otitis media w/ effusion
- risk factors: eustachian tube dysfunction, bottle fed, smoking
- usually not bacterial
- clin pres: conductive hearing loss, speech delay, sleep disturbance, vertigo
PE otitis media w/ effusion
-TM will look normal (could be blue/retracted), no mobility
RX otitis media w/ effusion
- > 3 months -> audiologist, usually resolved on its own
- surgical referral, tubes
complications of OME
- conductive hearing loss
- cholesteatoma
- scarring of TM
- recurrent OM
Chronic otitis media
-risk factors: low socioeconomic status, smoking, eustachian tube dysfunction
Etiology of chronic otitis media
-P. aeruginosa, S. aureus, fungi, MRSA
Clinical presentation, PE, DX chronic otitis media
- clin pres: fluid behind membrane, inflammation, otorrhea >2 weeks
- PE: discharge, perforation
- DX: history & PE
RX chronic otitis media
- ear irritation
- topical abx (quinolones)
- surgery/ENT referral (tubes)
- avoid ahminoglycosides w/ perforation*
Otorrhea
-draining from the ear
Eustachian tube dysfunction (2 types)
- abnormal patency
2. obstruction
Abnormal patently (eustachian tube dysfunction)
- eustachian tube does not close or does not close completely
- common in infants & young kids
Obstruction (eustachian tube dysfunction)
- functional: persistent collapse of eustachian tube due to late of tubal stiffness or poor function of the tensor veil palatine muscle that controls opening of eustachian tube (common in infants because cartilage still developing)
- mechanical: results from internal obstruction or external compression of the eustachian tub (could be from ethnic differences & varied structure of palate)
Otitis externa
-clin pres: hearing loss, itching, otorrhea, history of swimming, Qtips, FB
Etiology of otitis externa
-P. aeruginos, S. aureus
Epidemiology, risk factors, PE otitis externa
- epidemiology: older kids/adults
- risk factors: trauma, irritation to external ear
- PE: pain w/ moving ear, ear canal red/swollen, discharge, otoscopic exam painful
RX otitis externa
- topical abx/steroid (fluroquinolones, aminoglycosides)
- pain reliever (auralgan)
- ear wick
complications of otitis externa
-malignant otitis externa (severe infection usually in immunocompromised)
Impacted cerumen
- usually asymptomatic unless wax hardens and touches TM
- can cause conductive hearing loss, tinnitus
RX impacted cerumen
- ear irrigation
- wire loop/curette
- ceruminolytic agens for more sever cases
