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Senoir 21-2 > External EAR! > Flashcards

External EAR! Flashcards

1
Q

How do you use the otoscope for adults and kids

A

Gentle traction on pinna

  • Up for adults
  • Back for kids
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2
Q

A pt presents a non healing lump of the outer ear

What is the 1st DDX

A

Basal Cell Carcinoma

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3
Q

In treating a non healing lump on the outer ear

What is the Tx approach

A

This is high index of suspicion for Basal Cell Carcinoma

Refer to ENT

Non surgical options include:
Topical 5-Flourouracil or Radiation

Surgical options: Local Excision
Or MOHS surgery (99% cure rate)

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4
Q

What surgery has a 99% cure rate for Basal Cell Carcinoma

A

MOHS surgery

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5
Q

A pt presents with a non healing ULCER/PLAQUE on the outer ear

What is High on the DDx

A

Squamous cell Carcinoma

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6
Q

What is the treatment approach to Advanced cases of Squamous cell carcinoma on the outer ear

A

Neck dissection and parotidecotmy

Squamous cell has a high metz rate

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7
Q

A pt presents with a PIGMNENTED lesion on the outer ear

What is high on the DDx

A

Malignant Melanoma

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8
Q

What is the prognosis of thick vs thin melanoma

A

Thin (epidermis) <10% risk of mets

Thick (dermis) >90% risk of mets

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9
Q

A pt presents with a swollen, fluctuant and red ear
With loss of land marks of the external ear

Post trauma

Think

A

Auricular Hemotoma

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10
Q

A pt with a auricular hematoma presents

What is the tx approach

A

I&D

Then a pressure dressing

ABX for prophylaxis
-Dicloxacillin or Cephalexin
(Cover staph)

STAT referal is more than 7 days old

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11
Q

If a pt presents with an auricular hematoma and they were in the water or have diabetes

What is the ABX of choice

A

CIPRO!

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12
Q

If a pt has a auricular hematoma older than 7 days

What should you do

A

STAT REFERAL!

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13
Q

When doing an I&D on an áuricular hematoma

What is the technique

A

Incise parallel to the skin folds

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14
Q

What is the onset of cauliflower ear

A

Auricular hematoma not treated within 48-72 hours

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15
Q

What is the difference of an easy vs extensive ear laceration

A

Simple- skin only

Extensive- Involves cartilage

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16
Q

What should you do before evaluation an ear laceration

A

Infiltrate with anesthetic

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17
Q

What are the S/s of a basi

A

Retroauricular hematoma (Battle sign)

Ecchymosis around eyes (Raccoon eyes)

CSF in ears or nosE

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18
Q

When should you do primary vs secondary closure for an ear laceration

A

Primary if less than 24 hours old

Sec. If older.

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19
Q

How do you prevent a hematoma in an ear laceration

A

Covers repairs with a pressure dressing

20
Q

What ABX can penetrate the cartilage in an ear laceration

A

CIPRO!

21
Q

How can you tell the difference with Cellulitus and perichondritis

A

Inflammation of the lobe means Cellulitus every time

22
Q

Common causes of -itis to the ear

A

Piercings (esp. the cartilage)
Sports
Post surgery

23
Q

What is the agent in 95% of ear -itis cases

A

Pseudomonas

24
Q

What is the tx approach to -itis of the external ear

A

Mild- Treat and refer to ENT
— PO fluoroquinolone- F/U in 24 hrs max

Moderate/severe- Admit

  • IV antibiotics- fluoroquinolone +/- aminoglycoside
  • Potential surgical debridement
25
Q

What are the S/s of a cerumen impaction

A

Usually none

Can present with decreased hearing
A feeling of fullness in the ear

+/- pain and itching

26
Q

Can you clean out the ear with irrigation if the TM is rupured?

A

NO!

27
Q

What is the Tx approach to a cerum impaction

A

Mechanical removal of cerumen

+/- suction

Irrigation only if TM is intact

28
Q

When should you refer a pt with cerum impaction

A

Recurrent

Refractory to routine treatment

TM Perforation

Chronic Otitis Media

Child who is noncompliant

29
Q

When are forieghn bodies to the ear very concerning

A

Middle or inner ear involvement

S/s dizzyness, or Senory HL

30
Q

If a pt has a forieghn body obstruction with an organic material what should you NOT do!

A

DO NOT use aqueous irrigation

Organic objects can swell

31
Q

What are the common agents of external otitis

A

Water exposure

  • pseudomonas
  • fungus
32
Q

If a pt presents with Otitis Externa without infection

What is the Tx

A

Irritation from water in ear w/o infection

-Drying agent- 50/50 isopropyl alcohol and vinegar

33
Q

What is the tx for otitis extrema with an infection

A

Infection present- topical ABX
-Neomycin/Polymixin B/Hydrocortisone
—DO NOT use if concerns for TM perf

Ciprofloxacin or Ofloxacin

34
Q

In pts with refractory Externa otitis or Cellulitis

What is the ABX

A

Oral fluoroquinolones- ciprofloxacin 500 mg twice a day for 1 week

35
Q

What are the S.s of malignant external otitis

A

Persistent, foul aural discharge

Deep otalgia

Temporal headaches

Late sign- CN palsies

36
Q

How does malignant otitis externa develop

A

Pseudomonas penetrates the temporal bone

2/2 DM, AIDS or immunocomp pts

37
Q

A pt presents with foul D/c, granulations in the external ear canal and CN palsies

Think

A

Necrotizing Otitis Externa

38
Q

What is the gold standard to eval Necrotzing Otitis externa

A

CT!

39
Q

What is the tx for Malignant/ Necrotizing external otitis

A

ABX for month!

Fluoroquinolones (CIPRO!)
IV!

Treat until gallium scanning shows resolution

40
Q

A pt with refractory malignant external otitis should get what tx

A

Hyperbaric Oxygen

41
Q

What is the common cause and treatment of pruritus for the ear

A

MC from over cleaning

TX: Allow cerumen to regenerate	
Avoid: 
-Soap and water
-Cotton tipped applicator (CTA)
-Scratching

Excessively dry skin- Mineral oil

Inflammation- Topical steroid (0.1% triamcinolone)

42
Q

What is an exostoses/ oseomas

A

Bony overgrowth of the EAC

Bening and As/s

Can be from repeated cold water exposure

Generally no treatment required

If S/s then SRGICAL removal may be necessary

43
Q

What is the most common neoplasia of the External ear canal

A

Squamous cell carninoma

44
Q

If you find a visible ulcerated lesion in the external ear canal

Think

A

Neoplasia

Very likely SCC

45
Q

What is the tx approach to Neoplasias of the ear

A

REFER!

Senoir 21-2 (77 decks)

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