External and Middle Ear - Exam 4 Flashcards

1
Q

What is the medical term for “swimmers ear”? What organism is MC?

A

Acute otitis externa (AOE)- diffuse

pseudomonas- MC

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2
Q

_____ is infection of a hair follicle. What organism is MC?

A

furunculosis

Staph Aureus

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3
Q

_____ is infection of the external ear with a fungal species

A

otomycosis

Chronic otitis externa

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4
Q

Healthy ear canal skin has an ____ pH. What is the job of the cerumen?

A

acidic

Serves as a water-repellent coating for the skin of the canal and provides antimicrobial properties

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5
Q

Itching
Severe pain
Conductive hearing loss
Feeling of fullness or pressure
Purulent discharge
Pain with palpation of tragus or traction of auricle (classic sign)
Swollen, red canal
Moist debris in canal
TM difficult to visualize

What am I?
What is the highlighted sign?
What is the tx?

A

Acute Otitis Externa - Diffuse

Pain with palpation of tragus or traction of auricle (classic sign)

tx:
-clean ear canal to remove debris
-**topical abx: ofloxacin, cipro, neomycin, Polymyxin B
- pain relief
-ear wick

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6
Q

What is an ear wick? When is it used?

A

drop a few abx drops onto wick and place in ear. Helps distribute medicine and keep medicine in canal
Expands as its moistened

Acute Otitis Externa - Diffuse

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7
Q

Severe diffuse acute otitis externa is commonly seen in what pt population? **What is the tx?

A

Immunocompromised, elderly, DM

Cipro 500mg BID for 1 week only for severe cases/ immunocompromised

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8
Q

Acute Otitis Externa - Furunculosis is commonly found in the ____ of the canal. What is is caused by? What organism? What is the tx?

A

Usually lateral ⅓ of canal

Infection of hair follicle

Staph aureus

tx: **Oral Dicloxacillin or Cephalexin (Keflex)
I&D if needed

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9
Q

Chronic Otitis Externa - Otomycosis is a ____ infection of the ear canal. What are the 2 MC organisms?

A

fungal infection

Aspergillosis and Candidiasis

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10
Q

Ear itching: deep seated itching
discomfort
discharge
foreign body sensation in ear
less severe edema
May resemble mold growing on spoiled food
soft, white, sebaceous-like material that may fill ear canal

What am I?
What is the highlighted symptom?
what is the tx?

A

Otomycosis

deep seated itching

tx:
-clean canal
-Cotrimazole 1% solution BID 10-14 days

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11
Q

Seborrheic Dermatitis
Psoriasis
Contact Dermatitis
Canal is red, scaly and dry

What am I?
what is the tx?

A

Chronic Otitis Externa - Non-infective

Topical Hydrocortisone cream/otic drops

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12
Q

Potentially life-threatening
Infections spreads from skin to bone and marrow spaces of the skull base
Elderly patients with Diabetes Mellitus
Immunocompromised patients
severe, deep seated otalgia out of proportion to exam findings
progressive
purulent otorrhea, very foul-smelling
temporal HA
Granulation tissue at the bony cartilaginous junction of the ear canal floor

What am I?
What is the MC organism?
What are the 2 highlighted s/s?

A

Chronic Otitis Externa - Malignant/Necrotizing

Pseudomonas M/C

Severe, deep seated otalgia out of proportion to examination findings
Granulation tissue at the bony cartilaginous junction of the ear canal floor

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13
Q

What are complications of Chronic Otitis Externa - Malignant/Necrotizing? What is the highlighted one?

A

Spread to base of skull - osteomyelitis
Spread to meninges and brain
CN involvement - cranial nerve palsy
Thrombosis of sigmoid sinus
High mortality rate

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14
Q

How do you dx Chronic Otitis Externa - Malignant/Necrotizing? what is the tx? How long do you need to continue tx?

A

CT: to determine the extent of dz

tx: IV and oral abx
1st line: IV Ciprofloxacin 200-400mg BID, tx until clinical improvement then can change to oral cipro 500-1000mg BID

Treat until gallium (nuclear) scan is clear of inflammation (generally 6-8 weeks)

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15
Q

What is another name for Chronic Otitis Externa - Herpes Zoster Oticus? What does it present like? What is the tx?

A

Ramsay Hunt Syndrome

Unilateral facial nerve (CN VII) palsy, severe otalgia, vesicular eruption on the face. May have altered taste and tongue lesions. (Cannot close eye)

Prednisone and Famciclovir (Famvir) or Valacyclovir (Valtrex)

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16
Q

Where is cerumen produced?

A

outer portion of ear canal

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17
Q

Ear pain
Fullness
conductive hearing loss

What am I?
What is the tx?

A

cerumen impaction

irrigation with water
mechanical removal with ear curette
3% hydrogen peroxide
OTC Debrox

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18
Q

What are CI for cerumen impaction?

A

Presence or history of perforated TM
Previous pain on irrigation
Previous surgery of the middle ear or mastoidectomy
Uncooperative patient
Very hard cerumen

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19
Q

What are some foreign body removal techniques for the ear?

A

irrigation : avoid if object could expand when wet

alligator forceps

if its an insect need to immobilize with lidocaine first

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20
Q

What is an auricle hematoma? What is a result from? ____ will result if left untreated?

A

Collection of blood under the perichondria

Results from direct trauma to the anterior auricle

“Cauliflower ear” or “Wrestler’s Ear” as a result of untreated

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21
Q

What is the tx for auricle hematoma?

A

needs to be within 7 days
Lidocaine 1%: auricle block
I&D
Irrigate pocket with NS
Compression dressing
Leave on for 7 days
Re-examine for recurrence every 24 hours for several days
Avoid NSAIDS
Antibiotic prophylaxis +/-

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22
Q

For an auricular laceration, when are abx indicated? Need to also consider giving _____

A

Contaminated wound
Bite injuries
Signs of inflammation

tetanus vaccine

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23
Q

Auricular Laceration _____ is preferred. Why? What is the technique?

A

primary closure

Failure to cover exposed cartilage increases risk of infection

Anesthesia
Debridement
Copious Irrigation
Suture
Packing
Xeroform strips into ear crevices
Petrolatum occlusive dressing
Compression dressing
Recheck 24 hours
Sutures out in 4 - 5 days

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24
Q

Describe the correct way to numb an ear?

A

2 punctures with a needle

1 at the top of the ear, aim down towards the tragus, injection solution as you are pulling out, rotate the needle 45 degrees without pulling out and aim for the auricle. Repeat at the base of the ear lobe

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25
What 3 nerves are you aiming to block when performing a auricular block?
auriculotemproal nerve lesser occipital nerve greater auricular nerve
26
When would you want to refer to plastic surgery for a auricular laceration?
Large skin avulsions (5 mm or >) Severe crush injuries Complete or near complete avulsion Auricular hematoma Large cartilage defect (> 5 mm) Wounds that require removal of > 5 mm tissue Involvement of auditory canal Tissue devitalization
27
______ is a swollen, erythematous, hot external ear lobule usually due from a minor trauma, insect bite, or ear piercing. What is the tx? What is the tx for severe?
Auricular Cellulitis Choose 1: Cephalexin Trimethoprim-Sulfamethoxazole (MRSA) Clindamycin (MRSA) and warm compresses NSAIDs for pain severe: IV Vanc if pt is tachycardic, erythema is rapidly progressing, continues to grow even once on oral abx, fever over 100.5
28
auricular cellulitis is called by ____ and ______
Staph aureus and Streptococci
29
______ Infection of the perichondrium of the auricular cartilage. What is usually due to ? What causes the ear deformity? What can it rapidly progress to?
Perichondritis local trauma, surgery or burns. Lobe is NOT involved Interruption to blood supply of cartilage causes ear deformity Rapidly progress to produce necrosis of cartilage
30
What are the MC organisms that cause perichondritis? What is the tx?
Pseudomonas and Staph aureus M/C oral or IV Cipro I&D
31
What is this? What color would you describe it?
normal TM pearly gray color
32
What is it called when their is fluid in the middle ear? acute infection of the middle ear fluid?
middle ear effusion or serous otitis media (middle ear fluid that is NOT infected) acute otitis media
33
______ is an acute, suppurative, infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the inner ear space.
Acute Otitis Media
34
What is the most frequent dx in sick children and is the MC reason for abx use? ____ can reduce the occurence
acute otitis media pneumococcal vaccine
35
What are some risk factors for acute otitis media?
age between 6 - 24 months Family History Daycare Lack of breastfeeding Tobacco use Seasonal Altered host defenses and underlying disease Pacifier use
36
_____ generally precedes acute otitis media. Usually a result of _____. What is the pathogenesis?
URI Eustachian tube dysfunction Impaired function of the Eustachian tube, results in the retention and suppuration of retained secretions. Dysfunction induces a negative pressure in the middle ear space. Negative pressure followed by accumulation of secretions produced by the middle ear mucosa. Viruses and bacteria that colonize the upper respiratory tract enter the middle ear
37
What are the 3 MC organisms that cause AOM?
strep pneu H. Influ: think bilateral OM M. Catarrhalis: 10% of cases
38
_____ cause of OM is more common in older children and has more local complications ____ is the cause of OM in infants younger than 2 weeks
Group A strep Group B Strep
39
_____ cause of OM leads to acute otorrhea in children with tympanostomy tubes
Staphlococcus
40
____ is the cause of AOM in first months of life ____ is the cause of chronic and suppurative OM
E. coli Pseudomonas
41
ear pain (not always but common) Cough, congestion, Fever, irritability, headache, anorexia, N/V/D, ear tugging, and some decreased hearing bulging of TM poor mobility of TM erythema of TM TM is opaque What am I? What are the 2 highlighted s/s?
Acute otitis media **bulging of TM: Distinguishes AOM from otitis media with effusion **mobility of TM
42
What is the tx for mild/moderate AOM? What if the pt has exposure to abx within 30 days or treatment failure after 72 hours?
Amoxicillin 875mg BID Cefdinir is another option for PCN NOT anaphylaxis Amoxicillin plus Clavulanate 875mg (Augmentin ES or XR) PO in divided doses BID, Cefdinir (Omnicef) 300mg BID
43
what is the all the tx options for AOM, include first line, not severe PCN allergy and severe PCN allergy.
first line: amoxicillin NOT severe PCN: Cefdinir severe PCN: zithromax or doxy
44
What is considered severe AOM? What is another common dz to see along side AOM? What is the tx?
Significant hearing loss, severe pain, fever > 102⁰F, immunocompromised, under 6 months of age and or marked TM erythema bacterial conjunctivitis (Likely H. Influenza) tx: augmentin or ceftriazone
45
What do you give for severe AOM if the pt has been exposed to abx within 30 days or recent treatment failure?
Ceftriaxone (Rocephin), OR Clindamycin, OR Consider tympanocentesis
46
When prescribing pharmacotherapy, how do you decide how long to initiate therapy for?
10 days for patients <6 years old and /or patients with severe disease, TM perforation or recurrent AOM 5 - 7 days (with consideration of observation only in previously healthy individuals with mild disease) for patients ≥6 years old need to re-evaluate in 48-72 hours if no improvment
47
When do you need to refer out for AOM? What is the tx?
3 or > AOM within 6 months OR 4 or > AOM within 12 months OR Unresponsive to pharmacological treatment regime Tympanostomy Tubes
48
What are some complications of AOM?
Hearing loss Balance and motor problems TM perforation Tympanosclerosis Chronic suppurative OM Cholesteatoma Ossicular fixation Extension of suppurative process to adjacent structures Mastoiditis Intracranial complications Meningitis, epidural abscess, brain abscess, lateral sinus thrombosis, cavernous sinus thrombosis
49
What are some preventions for AOM? What is the major one?
-breastfeeding: IgA is secreted through breastmilk - upright for bottle feeding -Avoid passive smoke exposure -Limit exposure to groups of children -Careful hand washing -Avoid pacifier use >10 months old **-IMMUNIZATIONS!!!!!
50
______ is associated with AOM with bullae present on the TM. What is the tx?
Bullous Myringitis: more painful tx: same as AOM (amoxicillin but may need to cover for atypicals: azithromycin)
51
_____ is an AOM complications that results in rupture accompanied by sudden decrease in pain, followed by otorrhea. What is the tx?
Tympanic Membrane Rupture audiogram now and repeat in 3 months same abx: amoxicillin, augmentin, cefdinir can add low ototoxic topical abx: ofloxacin, ciprodex earplugs when swimming and bathing Should resolve on its own but tympanoplasty if no resolution
52
_____ is a scar on the TM
Tympanosclerosis
53
______ is the presence of perforation of the TM with chronic purulent drainage from the middle ear for >6 weeks. What is another name for it? Is it painful? What is the tx?
Chronic suppurative OM “otorrhea” pain is NOT common Refer to otolaryngologist
54
What bacteria are common for CHRONIC otitis media? What is the tx? What is the definitive management?
Pseudomonas, Proteus, S aureus, and mixed anaerobic infections Topical and oral Abx: -topical: Ofloxacin or Cipro with dexamethasone for exacerbations -Oral: Ciprofloxacin 500 mg BID X 1-6 weeks -remove debris and use earplugs sx: TM repair
55
______ Abnormal growth of squamous epithelium in middle ear and mastoid. May enlarge to surround and destroy the ossicles. What is it due to? What is the MC cause?
Cholesteatoma Due to chronic negative pressure in the middle ear Prolonged eustachian tube dysfunction
56
Deep retraction pockets White mass behind the TM Focal granulation at the TM periphery Can become chronically infected Ear drainage for >2 weeks despite treatment Hearing loss - conduction - due to ossicular erosion What am I? What is the tx?
Cholesteatoma tx: surgery Surgical marsupialization or removal
57
_____ occurs after several weeks of untreated or inadequately treated OM. ____ air cells connect with middle ear. Pus filling the air cells. Erosion of the surrounding bone. Formation of abscess-like cavities
Mastoiditis Mastoid
58
Pain, erythema and swelling over _____ process with proptosis of ear Fever S/Sx of AOM What am I? What organisms? How do you dx?
Mastoid process mastoiditis S. pneumoniae, H. flu, S. pyogenes, S. aureus, pseudomonas CT scan
59
What is the tx for mastoiditis?
IV antibiotics 7-10 days Empiric until culture results available Ceftriaxane (Rocephin) 1g QD Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr Followed by oral antibiotics Amoxicillin/Clavulanate acid Cefdnir Myringotomy: surgical drainage of TM to allow drainage of middle ear fluid Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
60
What is the function of the Eustachian Tube? When is it normally open? What is dysfunction of the eustachian tube? What are 3 common causes? what is the MC?
Provides ventilation and drainage for the middle ear Normally opens only during yawning or swallowing Dysfunction - air trapped in middle ear becomes absorbed and negative pressure results **Viral URI- MC** Allergies Edema of the tubal lining
61
Fullness in ear Mild to moderate hearing impairment Partially blocked tube swallowing or yawning creates popping or crackling sound Retraction of TM decreased TM mobility What am I? What commonly happened before these s/s appeared? What is the tx?
Auditory “Eustachian” Tube Dysfunction Lasts days to weeks following a viral infection oral or intranasal decongestants Auto-inflation by forced exhalation against closed nostrils intranasal steroids Avoid air travel and altitude change, underwater diving
62
_____ unable to equalize the barometric stress on middle ear during air travel, rapid altitude change, or underwater diving. ____ is air filled.
Barotrauma Middle Ear Space
63
What are some prevention strategies for barotrauma? Treatment?
Do not dive with conditions that can lead to ET dysfunction: viral URI Swallow, yawn, and auto inflate often during descent Systemic decongestants several hours before arrival Topical decongestants 1 hour before arrival No diving with URI or allergies No diving with TM perforation ______ oral decongestants attempt autoinflation myringotomy (ear tube)
64
Which is worse in terms of potential barotrauma, diving or flying? With barotrauma, is it common to see _____ and ______
underwater diving is worse than flying Hemotympanum Perilymphatic fistula
65
_____ and ____ are bony overgrowths of the ear canals d/t benign tumors. Skin-covered mounds in medial ear. What is the cause? What is the tx?
Exostoses and Osteomas Acquired from repeated exposure to cold water sx
66
What is the MC neoplasia of the ear canal? Why is it dangerous?
Squamous cell carcinoma Tumor tends to invade lymphatic of cranial base. Requires wide surgical resection and radiation therapy
67
______ tumor originate from ceruminous glands and are more indolent
Adenomatous
68