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IPAP Senior ENT > External Ear > Flashcards

External Ear Flashcards

1
Q

Term for Ear Pain

A

Otalgia

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2
Q

Term for discharge from ear

A

Otorrhea

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3
Q

Term for hearing ringing, buzzing, or other sounds w/o an external cause

A

Tinnitus

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4
Q

abbreviation for Right ear

A

AD

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5
Q

Abbreviation for Left ear

A

AS

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6
Q

Abbreviation for both ears

A

AU

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7
Q

the External Auricular Canal (EAC) in __(1)_ long, __(2)__ shaped,

A
  1. 2.5 cm long

2. S-shaped

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8
Q

what secreted cerumen and where is it secreted

A

Cebaceous glands secrete it & located in the lateral 1/3

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9
Q

what does cerumen provide

A

protection:

  1. acidifies canal to prevent overgrowth of bacteria/fungus
  2. lipid rich prevent skin penetration & maceration
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10
Q

What are the ossicles of the middle ear

A

Malleus
Incus
Stapes

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11
Q

what are the openings of the middle ear

A

oval

round

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12
Q

what does the inner ear contain

A

Cochlea
Semicircular Canals
CN VIII

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13
Q

what is the Semicircular canals responsible for

A

vestibular control

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14
Q

This is part of the temporal bone, contains air cells and communicates w/middle ear

A

Mastoid process

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15
Q

what is the most common malignant neoplasm of the auricle

A

Basal cell carcinoma

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16
Q

how does BCC of the auricle present

A

nodular lesion may be ulcerated / bleeding

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17
Q

what is the Tx of BCC of auricle

A

Consult ENT / derm;
local excision or
Mohs surgery

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18
Q

This present as plaque/nodule/ucleration that is prone to bleeding

A

Squamous cell Carcinoma

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19
Q

SCC Tx

A

requires excision of wide margin & eval of neck nodes w/careful follow up

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20
Q

what is a precursor to SCC

A

Actinic Keratosis (AK)

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21
Q

This has a central punctum, well defined boarders, non-tender, soft, moblie, cystic mass and slow growing

A

Epidermal Inclusion Cyst (EIC)

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22
Q

EIC Tx

A

resolve spontaniously

Inj small amount of Triancinolone (Kenalog) in surrounding dermis prevent need for I&D

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23
Q

when to excise EIC

A

4-6 weeks after inflammation has resolved

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24
Q

an accumulation of blood between cartilage & perichondrium space r/t blunt trauma

A

Auricular Hematoma

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25
Tx of Auricular Hematoma
1. Drainage 2. Pressure dressing & splinting 3. Prophylactic Oral Antibiotic: Dicloxicillin /cephalexin (cipro for peudomonas concern)
26
when do you refer Auricular Hematoma to ENT
if >7 days old
27
Complication of auricular Hematoma
1. Necrosis/infection | 2. deformity if not Tx'd w/in 48-72 hour after injury
28
what is the auricle innervated by
1) Auriculotemporal nerve superior / anterior 2) Greater auricular & lesser occipital nerve posterior & inferior 3) Vagus nerve (concha & external auditory meatus)
29
with laceration of external ear what suggests middle ear involvement
1. Hemotympanum 2. amber/clear middle ear effusion 3. otorrhea 4. hearing deficit w/ wber/rinne 5. retroauricular hematoma (battle sign) 6. Facial nerve dysfunction
30
with laceration of external ear what suggests basilar skull Fx
CSF in ears/nose | deficit of CN VIII on Weber/Rinne test
31
when to refer to Plastics / maxillofacial surgeon/ ENT / neurosurgeon if laceration of ear has
1. auricular avulsion 2. Laceration w/EAC extension 3. Laceration w/ middle /inner ear injury 4. laceration with basilar skull Fx 5. chronically split ear lobe or cleft by heavy ear ring/ allergy to ring metal
32
this closure type is preferred with ear lacerations to reduce risk of infections
Primary closure
33
when to use delayed closure w/ ear lacerations
> 24hrs old / signs of inflammation
34
when there is an ear laceration what type of antibiotics should be prescribed
quinolones b/c they are cartilage penetrating
35
what type of lidocaine should be used to complete a local block around ear
1% lidocaine WITH NO EPI
36
Cellulitis
infection of the skin
37
perichondritis
infection of tissue surrounding cartilage
38
chondritis
infection of cartilage
39
cellulitis/perichondritis/chondritis are
indistinguishable caused by injury r/t ear surgery / piercing / contact sports
40
clinical presentation of cellulitis/perichondritis/chondritis
1. swollen warm, tender, erythematous auricle 2. pain on deflection of auricle 3. may involve lobe
41
of cellulitis/perichondritis/chondritis, which will not involve the lobe?
chondritis
42
Tx of mild cellulitis/perichondritis/chondritis
PO fluoroquinolone f/u in 24hr max
43
Tx of moderate to severe cellulitis/perichondritis/chondritis
require IV antibiotics and sometimes surgery
44
main reasons for cerumen impaction
1. obstruction from EAC disease 2. Narrowing of EAC 3. Failure of epithelial migration 4. Overproduction
45
Asymptomatic cerumen impaction
leave it alone
46
Tx of symptomatic cerumen impactionq
1. cerumenolytic agents (1st line) 2. Irrigation 3. Manual removal
47
when to avoid cerumenolytis
if TM damage is suspected; Otorrhea, otalgia, h/o frequent ear infections
48
what must be completed after irrigation
otoscopy w/otoscope | acidification w/ water & 2% acetic or boric acid to prevent infection (required in immunocompromised)
49
when to refer to ENT for cleaning under microscopic duidance
1. TM perforation 2. recurrent impaction 3. no response to routine measures 4. h/o chronic otitis media / TM perforation
50
FOB's in EAC
1. Children>adults 2. pain, pruritis, conductive hearing loss, &/or bleeding 3. persistent may lead to infx / granulation tissue formation
51
FOB's in EAC Tx
1. DON'T BLINDLY REMOVE 2. Irrigate may help (not for organic objects) 3. live insects 2% viscous lidocaine
52
essential for Dx of otits externa
1. painful erythema & edema of ear canal 2. purulent exudate 3. manipulation of auricle = pain
53
in immunocompromised / DM Pt's Otitis externa may involve what
osteomyelitis of skull base
54
common causes of otitis Externa (AOE)
P. aeruginosa | S. aureus
55
predisposing factors of Otitis Externa (AOE)
freq/aggressive cleaning, "Q-tip", exposure to water, scrathing, lack of cerumen
56
Tx mild AOE
2% Acetic Acid (VoSol)
57
Tx moderate AOE
1. Polymyxin B/hydrocortisone (cortisporin) 2. Aminoglycosides (gentamicin) -ototoxic? 3. Quinolones (cipro / ofloxacin)
58
Systemic antibiotic for AOE when these are present
``` cellulitis DM immunodeficiency h/o radiation to ear severe AOE significant edema ```
59
pain control for AOE
NSAID's to opiod depending on severity
60
Diagnosis of necrotizing otitis externa
CT with bone window
61
Tx of Necrotizing Otitis Externa
Prompt ENT referral daily debridement antipseudomonal ear drops & systemic antipseudomonal antibiotics (IV/PO Cipro)
62
Treatment of Pruritis
1. avoid causes 2. avoid soap/cotton swabs in canal 3. mineral oil for dryness & repel moisture 4. topical corticosteroids 5. oral antihistamines 6. topical isopropyl alcohol
63
Exostoses
multiple EAC lesions, firm, bony, broad-based lesions composed of lamellar bone, reactive bone formation associated w/ cold water exposure (Surfers ear)
64
osteoma
pedunculated bony EAC lesion, benign osseous neoplasms, attached to tympanosquamous or tympanomastoid suture line
65
Tx of Exostoses/osteoma
single lesion- no Tx | multiple lesion- often require surgical removal
66
most common ear canal neoplasm & Tx
Squamous Cell Carcinoma; | wide surgical resection & radiation therapy

IPAP Senior ENT (7 decks)

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