Exam 2 Flashcards
test/tools, intro, ear disorders, hearing impairment, rhinosinusitis
1
Q
Audiometry
A
- tests for low/high pitch, loudness, and distinguishing voice and white noise
- performed in office or by audiologist
- Risk: none
- Gold standard: pure tone audiology
- technique: place headphones on ear, series of noises are played into headphones and pt signals when they hear nose
2
Q
Tympanometry
A
- detects problems with fluid/wax buildup, perforated eardrum, ossicle bone damage, tumor in middle ear
- can dx otitis medis, hearing disorders
- can be done in primary care or audiologist
- procedure: insert tympanometer into ear, present a probe tone, want ear canal and middle ear air pressures to be equal
- Looking for compliance: TM moves with small changes in pressure
- Noncompliance: TM is stiff/does not move easily - reduced mobility
3
Q
Newborn hearing test
A
- 2 common tests
- passing test does not indicate clear hearing in adult life
- Otoacoustic emissions (OAE): test outer hair cells response to sound, not adequate for neural hearing loss or any middle ear pathology
- Automated auditory brainstem response (AABR): auditory nerve and brainstem respond to sound, wears small earphones and electrodes, pass/fail results
4
Q
Nasopharyngoscopy
A
- allows visualization of structures from the nasal cavity to vocal cords
- indicated for suspected tumors, polyps, obstructions, hypertrophied tonsils, vocal cord nodules
- Fiberoptic gold standard
- pt is sitting and tube is inserted through nare and down pharynx
5
Q
Tympanocentesis
A
-small puncture through tympanic membrane to draw fluid or administer medication directly to middle ear
6
Q
Pneumatic Otoscopy
A
- examination that determines mobility of pt tympanic membrane in response to pressure changes
- indicates presence of effusion
- gold standard for TM
- want to see movement
- dx: otitis media with effusion, perforation, tympanosclerosis
7
Q
Tympanostomy tubes
A
- small plastic or metal tubes surgically placed in TM to allow drainage of fluid
- indications: fluid in both ears for 3 months and hearing loss or problems with pain, balance, repeated infections
- benefits: decrease ear infections, improved hearing
- Risks: infection
- tubes fall out in 1-2 years
8
Q
Allergy Testing
A
- skin test
- ELISA and RAST
9
Q
Strep testing
A
- test for antibodies of group A step from throat swab
- do culture if negative - gold standard
10
Q
Bordetella
A
- “whooping cough” requires pertussis test
- collect nasopharyngeal secretions or blood
- culture is gold standard
11
Q
Rhinoplasty
A
- nose job
- changes nose shape or improve function
- injury, breathing problems, devited septum, birth defect, cosmetic
12
Q
Uvuloplasty
A
- surgical remedy to snoring and some sleep apneas
- removing part or entire uvula with laser
- not covered by insurace
13
Q
Perichondritis
A
- infection of ear cartilage
- serious
- usually secondary to trauma or psedumonas
- hard to cure due to poor vascularity
14
Q
Cellulitis v. Perichondritis
A
- cellulitis: soft tissue inflamed. Lobe is inflamed and it may spread upward
- perichondritis: cartilage inflamed. lobe is not involved
15
Q
Relapsing polychondritis
A
- same, but bilateral
- probably auto-immune related
16
Q
Otitis Externa
A
- inflammatory disorders of the ear canal not middle ear
- Culprits: psedumonas, fungas, staph aureus
- Swimmer’s ear: excess water in ear canal
- Malignant external otitis is often associated with DM
- Sx: otalgia, pruritis, discharge
- Exam: erythema, edema, pain, can’t really see TM
- tx: otic drops (can use wick), abx if bacterial, isopropyl alcohol for drying, half-strength vinegar for fungal or psedumonal
17
Q
Ceruminosis
A
- accumulate cerumen
- interferes with hearing
- gently irrigate ear
- Cerumenex soften wax and then irrigate
- loops and scoops for stubborn wax
- typically not painful, but if contacting TM very painful
18
Q
Acute otitis media
A
-bacterial infection of middle ear
-S. pneumo, M. cat, H. flu, viruses very important as well
-precipitated by a URI
-more common in children
-
19
Q
Acute Otitis Media Diagnosis
A
- mobility of the TM is the gold standard for determining infection
- single best predictor of AOM is TM immobility
- combo of TM immobility and “cloudiness” is best
- dx: moderate to severe TM bulge, mild TM bulge and ear pain/intense TM erythema
- no effusion then not AOM
- bulging TM, decreased/distorted/absent light reflex, redness
20
Q
Acute otitis media risk factors
A
- Age: 6mo-18mo
- Gender: male>females
- Day care centers
- Pacifier use: slight increase
- Breast feeding: decrease
- Smoking
21
Q
Acute otitis media history
A
- PMHx: known/suspected medical problem, prior surgeries, current medications, allergies, hospitalizations, immunizations status
- CC
- HPI: symptoms, description of each, onset, course, sacred 7
- ROS: fever, appeitite, URI sx, n/v/d, abd pain, lethargic, cough, runny nose, decreased hearing
22
Q
Normal TM
A
- translucent/transparent
- gray or pink color
- neutral position
- fully mobile with pneumatic otoscope
- no effusion
23
Q
Acute Otitis Media TM characteristics
A
- opaque
- red, yellow, white color
- Bulging or full position
- reduced mobility but may respond to positive pressure on pneumatic otoscopy
- effusion present
- white/cloudy stuff is pus
24
Q
Acute Otitis Media tx
A
- decrease fever and pain
- prevent developmental delays
- 80% heal spontaneously
- 94% w/ abx
- tx pain: tylenol/ibuprofen, warm compresses
- observation and waiting is a good tx plan if pt is not really sick
- Amoxicillin: first line
- Augmentin: second line, H. flu
- S.pneumonia needs larger dose of amoxicillin not augment
- should see improvement in 72 hours using abx
- effusion can presist for 12 weeks
25
Q
Acute Otitis Media Prevention
A
- vaccines: pneumococcal vaccine and influenza
- ear tubes
26
Q
Otitis Media w/ Effusion (OME)
A
- not really otitis as there is no infection
- serious middle ear effusion
- can last months
- Worry about hearing: can affect language development
- decreased mobility of TM
- TM often retracted, but not always
- occurs spontaneously b/c of poor estachian tube function or as inflammatory response following AOM
- Referral to ENT
- Place tubes
27
Q
Otitis Media w/ Effusion (OME) TM characteristics
A
- translucent or opaque
- gray or pink color
- neutral or retracted position
- reduced mobility, responds to negative pressure on pneumatic otoscopy
- effusion present
28
Q
OME concerns
A
- hearing loss
- effects on speech, language, and learning
- quality of life
- need accurate diagnosis to distinguish AOM from OME
- distinguishing OME in health child from child at risk for developmental delays
29
Q
OME guidelines
A
- use pneumatic otoscopy as primary diagnostic method to distinguish OME from AOM
- tympanometry is an option
- distinguish child with OME who is at risk for speech, language, or learning problems and promptly evaluate and tx
- children not at risk watch for 3 months
30
Q
Hearing loss with OME
A
- HLs < 20 dB (normal hearing): repeat hearing test should be performed in 3-6 months if OME persists
- HLs 21-39 dB (mild hearing loss): audiologic evaluation, repeat hearing test in 3-6 months if OME persists
- HLs > 40 dB (moderate hearing loss): audiologic evaluation, surgery recommended, can impact speech, language, academic performance
31
Q
Benign Paroxysmal Positional Vertigo (BPPV)
A
- benign, but scary
- ever time someone moves they get very dizzy and throw up
- get a club of cells that don’t role to one side. This sends different signal to the brain from side to side and that gives you vertigo
32
Q
Vertigo
A
- produced by: Meniere disease, BBPV, labyrinthitis, acoustic tumors
- n/v are frequently associated with vertigo and dizziness
33
Q
Maneuvers
A
- Dix-Hallpike: localize labyrinthine dysfunction - positive test with affected ear down, nystagmus toward affected ear
- Epley: reposition otoliths - referral to audiology, ENT, or PT
34
Q
Meniere disease
A
- inner ear disorder
- AKA: idiopathic endolymphatic hydrops
- Onset: 40-60 yr
- Prevalence: 50-200 per 100,000
- too much fluid that causes a triad (tinnitus, hearing loss, vertigo)
- caused by buildup of endolymph pressure
- typically unilateral (nystagmus, possible ear fullness)
- intermittent attacks (last minutes to hours, n/v, sweating, pallor, falling down)
- Not positional: can’t reproduce with changing head position like BBVP
- Risk: white, genetic, stress, allergy
- Differential: teriary syphilis, MS, vestibular schwannoma, BPPV
- Lab: RPR (syphilis), CT
