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OTO > External ear > Flashcards

External ear Flashcards

1
Q

Otalgia

A

pain in ear

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2
Q

Otorrhea

A

D/c in ear

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3
Q

Right, left, both ears

A

AD
AS
AU

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4
Q

External auricular canal

A

Auricle/ Pinna

External canal

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5
Q

External Auricular Canal notes

A

2.5cm long - adult
S-shaped
Cerumen (wax)

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6
Q

Cereum is secreted where?

A

Sebaceous glands in lateral third of EAC

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7
Q

Middle ear anatomy

A 
Air filled
Ossicles
-Malleus (hammer)
-Incus (anvil)
-Stapes (stirrup)
Windows
-Oval
-Round
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8
Q

Inner ear anatomy

A 
Cochlea - organs of corti
Semicircular canals
- loops (sup/post/lat)
- vestibular control
CN VIII 
-Vestibular n.
-Cochlear n.
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9
Q

What structure is responsible for vestibular control?

A

Semicircular canals

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10
Q

Mastoid process anatomy

A

Portion of temporal bone
Numerous air cells
Communicates w/ middle ear (infection potential)

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11
Q

Basal cell carcinoma of auricle due to

A

UVB radiation (chronic sun exposure)

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12
Q

Basal cell carcinoma of auricle Appearance

A

Nodular lesion - May ulcerate/bleed

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13
Q

Basal cell carcinoma of auricle Grows how fast?

A

Slow

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14
Q

Basal cell carcinoma of auricle TXT

A

Consult ENT/Derm

  • local excise
  • Mohs surgery
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15
Q

Squamous cell carcinoma of auricle MC pop

A

Elderly males

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16
Q

Squamous cell carcinoma of auricle RFs

A 
>age
Immunosuppression
Non-healing ulcer
Chemical exposure
UV radiation
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17
Q

Squamous cell carcinoma of auricle Appearance

A

Plaque, nodule, ulcer

Prone to bleed

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18
Q

Which is more aggressive- BCC vs SCC?

A

SCC

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19
Q

Precursor to SCC

A

Actinic keratosis

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20
Q

SCC txt

A

Req larger excision than BCC

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21
Q

SCC eval for mets?

A

Eval neck for nodules w/ careful F/Us

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22
Q

Malignant melanoma of auricle is

A

Unpredictable tumor affecting all ages w/ high M/M

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23
Q

Malignant melanoma of auricle Appearance

A

Pigmented lesions changes w/ growth, color, margin, ulcer, bleed, deep pigmentations

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24
Q

Malignant melanoma of auricle Pathophys

A

Stars in epidermis >
Invades Dermis >
Predictor of severity

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25
Q

Malignant melanoma of auricle Lifesaving txt?

A

Early ID

excision

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26
Q

Epidermal inclusion cyst presents as?

A

Slow growing
Central puncture
Well defined, non-TTP
Soft, mobile, cystic mass

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27
Q

Epidermal inclusion cyst Can spontaneously what?

A

Drain - foul smell

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28
Q

EIC Dx

A

Clinical

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29
Q

EIC Txt

A

Self limiting - pt can request txt
–inj triamcinolone into dermis May speed resolution.
OR
—excise - when not inflamed - wait 4-6w PRN

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30
Q

Auriclar hematoma is

A

Blood build-up between cartilage/Perichondrium, usually due to blunt trauma

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31
Q

Auriclar hematoma Pathophys

A

Cartilage lacks blood supply >
Hematoma develops >
Necrosis of cartilage

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32
Q

To PVT deformities due to Auriclar hematoma?

A

Prompt drainage and pressure dressings

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33
Q

Fluctuate def?

A

Fluid underneath skin

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34
Q

Auriclar hematoma Presents as

A

Edema
Fluctuate
Eccymotic
Loss of NL landmarks

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35
Q

Auriclar hematoma TXT

A

Evacuate hematoma
Pressure dressing
Splinting
Prph (PO) Abx

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36
Q

Purpose of Abx for Auriclar hematoma?

A

Lacks blood supply so susceptible to infection

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37
Q

When to refer Auriclar hematoma?

A

ENT - >7d hematoma

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38
Q

Abx used for Auriclar hematoma?

A

Staph/pseudomonas

  • Dicloxicillin or cephalexin
  • cipro > pseudomonas
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39
Q

Auriclar hematoma Complications?

A

Necrosis
Infection
Cauliflower deformity

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40
Q

When does Cauliflower deformity set in?

A

48-72h

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41
Q

Evacuation of a ear hematoma process?

A 
Cleanse > anesthesia
FNA - <24h sml
Or
Incision - >24h lrg/<7d old
Dressing x1w - check 24h
(PO) Abx
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42
Q

How to incise a hematoma?

A

Along posterior following skin curvature
-curved hemastats
Irrigate

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43
Q

Auricle nerve supply

A

Auriculotemporal n. = superiorly/anteriorly

Greater auricular/lesser occipital n = posterior/inferior

Vagus n. = concha and external auditory meatus

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44
Q

Serious underlying trauma (and SOC)

A

Middle ear trauma
Basilar skull fx
Facial n. or parotid gland involved

-CT w/out contrast

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45
Q

Middle ear trauma - S/S

A 
Hemotympanum 
Middle ear effusion
Otorrhea
Hearing deficit (Weber/Rinne)
Battle sign
Facial n. Dysfx
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46
Q

Basilar skull fx

A

CSF in ears, nose - CN VIII deficits +-

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47
Q

Lacerations of ear preferred txt?

A

Primary closure - limits exposure time to inf
Or
Delayed if >24h old or red, warm, edema.
+ quinolone Abx

48
Q

Laceration of ear txt procedure

A

10mL syringe 1% lidocaine
NO EPI
1- local block (INJ posteriorly/anteriorly)
2- Regional blk- maj lacerations (avoid skin disrupt)
—Do not exceed 4mg/kg 1% lidocaine

49
Q

Other consideration to TXT for lacerations of ear?

A

Tetanus shot
Prph Abx
Aftercare - daily cleanse w/ (Top) Abx

50
Q

Cellulitis def

A

an infection of the skin

51
Q

Perichondritis

A

an infection of the tissue surrounding the cartilage

52
Q

Chondritis

A

infection of the cartilage (does not involve lobule)

53
Q

Cellulitis / Perichondritis / Chondritis - present as?

A

Edema, warm, TTP, erythematous auricle

Pain on deflection of auricle (pinch of auricle = pain)

54
Q

Cellulitis / Perichondritis / Chondritis TXT

A 
Poor blood circulation -difficult
Remove jewelry
Mils - (PO FQ and F/U 24h max)
Mod-Sev - (IV Abx - FQ, Aminoglycoside, PCN) or debridement
ENT refer
55
Q

Cellulitis / Perichondritis / Chondritis is due to

A

Due to P. Aeruginosa - 95%

56
Q

Dz of EAC

A 
Cerumen impaction
FOB
Traumatic External Otitis
AOE/MOE
Pruritis
Exostosis
Osteomas
Neoplasm
57
Q

Cerumen Fx

A

Secreted by outer portion of EAC so it may protect the skin of canal by acidifing it > PVTs bacteria/fungus

Lipid rich > PVTs penetration/maceration (hydrophobic)

58
Q

Lateral 1/3 EAC has

A

cartilaginous EAC with hair and glandular-bearing skin

59
Q

Medial 2/3 EAC has

A

bony EAC w/ thin skin attached to periosteum of temporal bone

60
Q

Isthmus is?

A

Where canal narrows

61
Q

Reasons for Cerumen impaction

A
  1. Obstruction from EAC dz
  2. Narrowing EAC
  3. Failure of epithelial migration
  4. Overproduction
62
Q

Obstruction of EAC leading to impactions is due to?

A

Exostoses
Inf/derm (otitis externa, eczema, psoriasis, seb derm)
Cutaneous S/S of systemic dz (SLE, Crohn’s)

63
Q

Narrowing of EAC leading to impactions is due to?

A

NL anatomy, tumors, excess hair, lareal 1/3 collapse of cartilage (trauma).

64
Q

Failure of epthelial migration leading to impactions is due to?

A

Aging
Atrophic glands > produce harder/thicker cerumen
Ear plugs/hearing aids
Q-tips - sticking crap in the ear

65
Q

Overproduction of cerumen in EAC leading to impactions is due to?

A

Local trauma, retained water, idiopathic

66
Q

Cerumen Impaction - presents

A

Usually asymp - incidental finding w/ otoscopic exam

Symp > hearling loss, otalgia, itch, fullness

67
Q

Cerumen Impaction - home hygeine

A

Clean external opening w/ washcloth/index finger once/wk

68
Q

Removal indications of cerumen impaction

A

Symptomatic > removal= avg 10dB hearing improve

Asymptomatic > Observe

69
Q

Removal includes what 3 therapeutic options?

A

1st-L > cerumenolytic agents
then > irrigation
then > Manual removal by clinician

70
Q

Cerumenolytic CI

A

TM damage suspected

  • Otorrhea
  • Otalgia
  • Hx freq ear infections
71
Q

Cerumenolytic are safe to use in what pts?

A

No hx of infection, perf, otologic surgery

72
Q

Cerumenolytic max dosing regiment time?

A

Do not exceed 3-5d

73
Q

Cerumenolytic Rx’s

A

OTC - mineral oil or hydrogen peroxide 3%

Rx - Carbamide peroxide (5-10drops in canal)

74
Q

Complications of Cerumenolytic?

A 
Allergic rxn
Otitis externa
Earache
Transient hearing loss
Dizzy
75
Q

Irrigation is more effeective for?

A

Hard impactions

76
Q

Irrigation solution?

A

warm water w/ hydrogen peroxide 1:10

F/U w/ acidification (water+2% acetic acid or boric acid)

77
Q

Following irrigation perform a?

A

Otoscopy

78
Q

What environment encourages bacterial growth?

A

Wet desquam skin + high pH environment

79
Q

Irrigation complications?

A

Retention of water behind residual cerumen = maceration > infection

80
Q

Too aggressive irrigation can cause

A

TM perf
HL or tinnitus +- vertigo
Pain

81
Q

Manual removal/cleaning under microscope guidance reqs?

A

ENT consult

82
Q

Complications of manual removal?

A

Otalgia
TM perf
Inf
bleed/laceration

83
Q

Cerumen Impaction - Prevention if recurrent

A

Mineral oil cotton ball placed in EAC 10-20m once/w > helps liquefy cerumen and aid NL elimination

Remove hearing aids during sleep
Routine clean by HCP q6-12mo

84
Q

FOB S/S

A

Present w/ pain, pruritis, conductive HL, and/or bld

Persistent object > inf/formation of granulation tissue

85
Q

TXT of FOB

A

Remove w/ care (NOT blindly remove)
Prepare w/ correct instuments
Irrigate may dislodge (CI if organic object (beans/bugs)
Insect > 2% viscous lidocaine > kill/anesthatizes

86
Q

Otitis Externa S/S?

A

Painful itchy erythema (esp auricle/tragus manipulation)
Edema of EAC
Purulent exudate
TM mobile
Can evolve to OM of skull base (x-imm or DM)

87
Q

Otitis Externa AKA?

A

Swimmers ear - inflammatory/infectious process

88
Q

Otitis Externa is due to?

A

Pseudomonas aeruginosa and Staphylococcus aureus

89
Q

Predispoing factors of Otitis Externa?

A 
Freq/aggresive cleaning
Q-tips
Water exposure
scratching
All = lack of cerumen (too clean)
90
Q

Advanced Otitis Externa may see what S/S?

A

LAD of periauricular and anterior cervical lymph nodes

91
Q

AOE TXT?

A

1- cleaning - gently remove loose debris

2- TXT inflam/infection (top)

92
Q

Mild - AOE w/out infection - TXT?

A

Drying agent - 50/50 isopropyl etoh/white vinegar
2% acetic acid (5gtts into canal tid/bid) change pH
–P. aeruginosa/S. aureus grow in 6.5-7.3 pH

93
Q

Mod - AOE w/ infection or high risk - TXT?

A

Polymyxin B/hydrocortisone- inexpensive , but contains neomycin - potent sensitizer (itch, erythema, edema)

Aminoglycosides (gentamicin sulfate 0.3%): more expensive and potentially ototoxic (? TM)

Quinolones (ciprofloxacin or ofloxacin): highly effective but expensive (qd – bid dosing)

Rx: Ofloxacin Otic; 10 gtts into affected ear(s) 1/d x7 d

94
Q

AOE systemic TXT indications? or +- refer

A 
Cellulitis
DM
X-imm
Hx radiation to ear
Severe otitis externa
Sigedema inhibiting topical meds
95
Q

AOE systemic TXT Rx?

A

Ciprofloxacin (P. aeruginosa and S. aureus) 500mg/w

Control pain - NSAIDs opioid analgeiscs

96
Q

AOE PVT?

A

Protect water from ears
Cotton ball w/ p. jelly during her bath
Educate/PVT

97
Q

Necrotizing Otitis Externa is?

A

Malignant - otitis externa

Severe bacterial infection of EAC/skull base

98
Q

Necrotizing Otitis Externa MC pop?

A

Elderly DM

X-imm

99
Q

Necrotizing Otitis Externa typical offending agent?

A

Pseudomonas

100
Q

Necrotizing Otitis Externa pathophys?

A

1st- external otitis spreads to temporal bone > the skull base, leading to fatal complications

101
Q

Necrotizing Otitis Externa S/S?

A

deep otalgia, EAC granulation, persistent foul otorrhea

Cranial nerve palsies are a poor prognostic sign (VI, VII, IX, X, XI, or XII)

102
Q

Necrotizing Otitis Externa Dx?

A

CT, with bone windows, can dx infection in the bone (which is the sequelae of this disease)

103
Q

Necrotizing Otitis Externa is AKA?

A

Malignant otitis externa (however nothing to do w/ malig) - its an infection

104
Q

Necrotizing Otitis Externa TXT

A

ENT consult
Daily debride
Antipseudomonas Abx/ear drops
-Ciprofloxacin (po/IV) 3mo

Refrac > surgical debridement

105
Q

Pruritis - notes

A

Common
Self-induced (excoriations/ear cleaning)
Ass/w external otitis, psoriasis, seb derm.

106
Q

Pruritis TXT

A 
Allow cereum build up
Avoid cleaning EAC
Mineral oil - repel moisture
Inflam > (top) triamcinolone 
(po) Benadryl
107
Q

Exostoses is

A

multiple EAC lesions, firm, bony, broad-based lesions composed of lamellar bone, reactive bone formation

108
Q

Osteoma is

A

pedunculated bony EAC lesion, benign osseous neoplasms, attached to the tympanosquamous or tympanomastoid suture line

109
Q

Exostoses Ass/w

A

Chronic cold water exposure

110
Q

Exostoses AKA

A

Surfers ear

111
Q

Structural ear canal D/Os?

A

Exostoses

Osteomoa

112
Q

Structural D/O - Txt single lesion

A

Unless very Lrg - no txt

113
Q

Structural D/O - Txt multiple lesions

A

Often progress req surgery

114
Q

MC neoplasm of EAC?

A

SCC

115
Q

If obvious otitis externa does not resolve w/ therapy think?

A

Malignancy

116
Q

EAC malignancy - notes

A 
High mortality (w/in 5yr)
Ivades lymphatics of cranial base
117
Q

Tumors of the ceruminous glnads are called?

A

Adenomatous tumors (less severe)

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