ENT-Hugus Flashcards
Conductive hearing loss
- Define
- General tx:
dysfunction of external/middle ear
i.e obstruction, mid-ear effusion, scarring, ossicular disruption, otosclerosis (abn bone formation)
Generally corrected with medical or surgical therapy
Sensorineural hearing loss
- define
- sx/sxs
- tx
- deterioration of cochlea or vesibulocochlear nerve Causes majority of hearing losses
- difficulty distinguishing foreground voices against noisy backgrounds, loss of directionality of sound, perception that people mumble, difficulty when on phone
- Generally permanent: depends on etiology
Neural cause of hearing loss
- Cause
- risk factors
- Tx
- Lesions of cochlear nerve VIII or central pathway
- MS, cerebrovasc disease, acoustic neuroma
- Etiology dependent
Sensory cause of hearing loss
- cause
- risk factors
- tx
damage or deficiency of cochlea, usually loss of hair cells.
- Presbycusis (age related) from degeneration of cochlea, noise trauma, otoxicity
- hearing aids/implants
Weber test
- unilateral conductive hearing loss
vs
- unilateral sensorineural hearing loss
Midline of head
- sound lateralizes (is heard in) the bad ear
- sounds lateralizes to good ear
Rinne test
- Conductive
vs.
- Sensorineural
mastoid: infront of ear
1. BC>AC (bone conduction vs air conduction)
2. BC
External ear hematoma
- blunt trauma, blood accumulates in subperichondrial space and can compromise blood flow to cartilage. Neocartilage deposisted after 7-10 days
- Immediate surgical evacuation with pressure dressing
- Cauliflower ear (necrosis), infection
What can be used to paralyze insect in ear before removal?
2% lidocaine
Tinnitus
- Define
- theories
- etiologies
- ringing/buzzing sound or whooshing in case of pulsatile tinnitus
- Middle ear pressure derangement, vascular d/o, neural firing.
- High frequency sensorineural hearing loss, ototoxic meds, infxn, ischemia, acoustic neuroma
Eustachian tube dysfxn (ETD)
- Define
- Risk factors
- failure of ET to open properly (more common in kids due to the horizontal placement of tube vs in vertical in adults)
- rhinitis, URI, sinusitis, chronic OM, bad anatomy
ETD
- sx/sxs
- tx
- fullness, pressure, otalgia(ear pain), tinnitus, mild acute hearing loss. Retracted TM, decreased mobility with insufflation
- decongestants(short term) nasal spray, valsalva (long term)
Barotrauma
- define
- risk factors
- sxs/exam findings
- caused by air/water pressure
- flying, diving, explosions
- Acute pain usually resolves in hours and mild/moderate hearing loss
exam: hyperamia (excess blood supplying specific organ), edema, ecchymosis of mid ear mucosa, medial displacement of TM, fluid in mid ear, TM perforation in severe cases. Resolves on its own 2-3 weeks
TM perforation
- trauma, mid ear infxn
- if trauma, 90% heal spontaneously, otherwise surgery. Keep ears dry
- Ear infxn (chronic), CT temporal, likely need abx, tx with topical abx if otorrhea (drainage) present. Keep ears dry
*AOM (acute otitis media)
- MC age group?
- risk factors?
- most common reason for abx for kids. Boys>girls 6-24 months of age
- day care, immune related, exposure to smoke
AOM
- define
- pathophys
- MC pathogens
- acute infxn of mid ear fluid
- pt has URI, inflamm edema of mucosa, eustachian tube obstruction, - midd ear pressure, build up secretions, accumulates in mid ear space- virus/bacteria enters space
- Bacterial: strep pneumonia, h. influenza, m. catarrhalis
viral: RSV, rhinovirus, influenza, adenovirus
AOM
- Clinical manifestation
- tx
- fever, irritated, restlessness, HA, ear pain, buldging/erythematous TM, HEARING LOSS, decreased mobility with pneumotoscopy
- analgesics/ abx- Amoxicillin (if 2> or TM perf 10 day abx, otherwise 5-7)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/320/033/949/a_image_thumb.png?1599107493)
Chronic Otitis Media
- define/cause
- Sx
- pathogen
- chronic drainage from middle ear associated with TM perf. Often preceded by AOM that isnt diagnosed or treated properly
- May have hearing loss, not usually painful, common in young kids <2
- Psudomonas a., ptoteus, S aureus
![](https://s3.amazonaws.com/brainscape-prod/system/cm/320/033/951/a_image_thumb.png?1599169753)
Chronic otitis media
- exam findings
- tx
- TM perf+purulent discharge
- Aural toilet (suction, dry mop, earwick, gentle syringe, to remove moisture and debris) + topical quinolone
Abx for 2 weeks: otoflaxin otic solution or ciprofloxacin otic solution