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Clinical Medicine 1 > Head & Ears > Flashcards

Head & Ears Flashcards

1
Q

What are some common facial features of FAS (Fetal Alcohol Syndrome)

A
  1. Short palpebral fissures
  2. Thin vermilion border (upper lip)
  3. Smooth filtrum
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2
Q

Common Trisomy 21 features?

A
  1. Epicanthal folds
  2. Macroglossia
  3. Small ears & mouth
  4. Brushfield spots
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3
Q

What are Brushfield spots?

A

White spots on Iris

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4
Q

What connective tissue is Marfan’s Syndrome a disorder of?

A

Fibrillin

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5
Q

Common features of Marfan’s Syndrome?

A
  1. Tall
  2. Loose joints
  3. Crowded Teeth
  4. Valvular & Aortic abnormalities
  5. Pectus Caravatum
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6
Q

What defines the outer ear?

A

Visible ear & external auditory canal

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7
Q

What are the contents of the middle ear?

A
  1. Tympanic Membrane
  2. Malleus, Incus, Stapes
  3. Eustachian Tube
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8
Q

What defines the inner ear?

A

Semicircular canals & Cochlea

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9
Q

In a Weber test, where is the tuning fork placed?

A

Top of head or general midline structure

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10
Q

In a Rinne test, where is the tuning fork placed?

A

1st on the mastoid bone & then beside the ear

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11
Q

What is the Weber test supposed to detect?

A

Unilateral hearing loss

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12
Q

If you have Conductive hearing loss, which side will be louder in a Weber test?

A

Impaired ear

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13
Q

If you have Sensorineural hearing loss, which side will be louder in a Weber test?

A

Unaffected ear

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14
Q

If you start with a Rinne test and AC > BC but not 2:1, which type of hearing loss is it?

A

Sensory

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15
Q

If you start with a Rinne test and AC < BC, which type of hearing loss is it?

A

Conductive (Negative rinne test)

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16
Q

If the Rinne test shows AC < BC & Weber test is louder in the left ear, what is the diagnosis?

A

Conductive hearing loss in left ear

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17
Q

If the Rinne test shows AC > BC & Weber test is louder in the left ear, what is the diagnosis?

A

Sensorineural hearing loss in the right ear

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18
Q

Conductive hearing loss is found in which sections of the ear?

A

External & middle

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19
Q

What are the 4 mechanisms of Conductive hearing loss?

A
  1. Obstruction in EAC
  2. Mass-loading (effusion)
  3. Stiffness effect
  4. Discontinuity
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20
Q

Is it easy or difficult to differentiate between sensory & neural hearing loss?

A

difficult

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21
Q

What does a ‘deterioration of the cochlea’ imply?

A

loss of hair cells from organ of Corti

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22
Q

Most common form of Sensory hearing loss?

A

Presbyacusis

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23
Q

What is presbyacusis?

A

progressive hearing loss due to advanced age

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24
Q

What frequency is lost first in presbyacusis?

A

high frequency

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25
Q

Contributing factors of presbyacusis

A
  1. Excessive noise exposure
  2. Head trauma
  3. Systemic diseases
  4. Smoking
  5. Ototoxicity
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26
Q

Lesions of the 8th cranial nerve involve what type of hearing loss?

A

Neural

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27
Q

Neural hearing loss involves lesions on…

A
  1. CN VIII
  2. Auditory nuclei
  3. Ascending tracts
  4. Auditory cortex
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28
Q

Causes of Neural hearing loss lesions

A
  1. Acoustic Neuroma
  2. MS
  3. Auditory Neuropathy
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29
Q

Treatments for sensorineural hearing loss?

A
  1. Prevention (ear plugs)
  2. Hearing aids
  3. Cochlear implants
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30
Q

Common term for Traumatic auricular hematoma?

A

Cauliflower ear

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31
Q

Why do you have to quickly treat Cauliflower ear?

A

prevent cosmetic deformity

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32
Q

Why do you have to quickly treat cellulitis of the auricle?

A

prevent perichondritis

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33
Q

Function of Cerumen?

A

Protects ear by trapping dust, bacteria, etc

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34
Q

Where is Cerumen produced?

A

ear canal in outer 3rd cartilaginous portion

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35
Q

Cerumen is made of…

A

Mixture of…

  1. Viscous secretions from sebaceous glands
  2. Less viscous secretions from modified apocrine sweat glands
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36
Q

What is the most common cause of hearing loss?

A

Cerumen impaction

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37
Q

Symptoms of Cerumen Impaction

A
  1. Earache
  2. Fullness Sensation
  3. Tinnitus
  4. Partial conductive hearing loss
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38
Q

Treatment for Cerumen Impaction

A
  1. Baby oil/mineral oil
  2. Drops - Debrox a.k.a glycerine
  3. Sodium Bicarb + H20
  4. H202 + H20
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39
Q

Complications of cerumen impaction removal?

A
  1. Otitis Externa
  2. Bleeding
  3. Retained water in ear
  4. TM perforation
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40
Q

What are overgrowths of bone in the ear canal called?

A

Exostoses/Osteomas

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41
Q

When do you NOT irrigate for a foreign body in an ear?

A

if the FB is organic (beans, insects)…they might swell

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42
Q

What is one of the biggest emergencies when it comes to foreign bodies in the ear?

A

batteries

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43
Q

What is Pruritis?

A

Itchy ear

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44
Q

How do you get Pruritus

A

Excoriation or by overly zealous ear cleaning

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45
Q

Treatment for Pruritis

A
  1. Stop using Q-Tips
  2. Mineral oil
  3. Topical corticosteroids
  4. Antihistamines
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46
Q

Characteristics of Otitis Externa?

A
  1. Erythema & edema of ear canal skin
  2. purulent exudate
  3. Pain when touching auricle
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47
Q

What is a dangerous complication of OE?

A

osteomyelitis in the skull base (malignant external otitis)

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48
Q

Common causes of Otitis Externa?

A
  1. Moisture
  2. Dirty Water
  3. High temp & humidity
  4. Removing Cerumen
  5. FB (foreign bodies)
  6. trauma
  7. Dermatologic diseases
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49
Q

Treatments for OE

A

Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals

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50
Q

Prevention for OE

A

Alcohol drops

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51
Q

What is another name for Necrotizing Otitis Externa?

A

Malignant Otitis Externa

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52
Q

Where does NOE/MOE spread to?

A

temporal bone

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53
Q

What is the most common pathogen in NOE/MOE?

A

Pseudomonas

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54
Q

How dangerous is NOE/MOE?

A

fatal if not treated

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55
Q

How does NOE/MOE present?

A
  1. Persistent foul aural discharge
  2. Granulations in ear canal
  3. Deep otalgia
  4. Progressive CN palsies (6,7,9,10,11,12)
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56
Q

How is NOE/MOE diagnosed?

A

CT scan w/bone

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57
Q

Treament of NOE/MOE

A
  1. Daily Debridement of EAC
  2. Glucose control
  3. Antipseudomonal drugs (Quinolones)
  4. Surgery
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58
Q

Most common neoplasm of ear canal?

A

Squamous cell carcinoma

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59
Q

Mortality rate for Squamous Cell Carcinoma of the Ear Canal?

A

5-year (very high)

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60
Q

Treatment for Squamous Cell Carcinoma of the Ear Canal?

A

Surgical resection & radiation therapy

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61
Q

What does Eustachian Tube Dysfunction (ETD) cause?

A

unequal air pressure on either side of eardrum

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62
Q

Symptoms of ETD

A
  1. Aural fullness
  2. Fluctuating hearing
  3. “Popping” in ears
  4. Discomfort with pressure changes
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63
Q

What is someone with ETD at risk for?

A

Serous Otitis Media

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64
Q

Does ETD result in positive or negative pressure in the middle ear

A

negative

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65
Q

Most common cause of ETD?

A

Viral URI & allergies

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66
Q

Treatment of ETD

A

Systemic & intranasal decongestants

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67
Q

What causes Serous Otitis Media?

A

Blocked Eustachian tube for a long time

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68
Q

What age group most commonly gets SOM?

A

children

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69
Q

How do adults get SOM?

A
  1. Post URI
  2. Barotrauma
  3. Chronic allergic rhinitis
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70
Q

What is the most important thing to exclude with persistent SOM?

A

nasopharyngeal carcinoma

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71
Q

Treatment for SOM

A

Controversial
1. short course of oral corticosteroids (prednisone)
2. Oral antibiotics
(amoxicillin)

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72
Q

What is Barotrauma?

A

Poor Eustachian tube function – unable to equalize pressure in Eustachian tubes

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73
Q

Symptoms of Barotrauma

A
  1. Ear discomfort/pain
  2. Slight hearing loss (usually)
  3. dizziness
74
Q

Treatment of Barotrauma

A

Chew gum, yawn, anything that opens the Eustachain tube.

Also antihistamines, decongestants, steroids, analgesics

75
Q

What might you see in severe cases of barotrauma

A

hemotympanum

76
Q

Signs/Symptoms of Acute Otitis Media (AOM)

A
  • Fever
  • Decreased eardrum mobility
  • Cloudy/red/bulging TM
  • Otorrhea (if perforated TM)
77
Q

Risk Factors for AOM

A
  • Bottle feeding
  • sleeping w/bottle
  • Pacifier use
  • Passive smoking
  • M > F
  • Family History
78
Q

If AOM in an adult is unilateral and recurrent, what must we worry about?

A

nasopharyngeal carcinoma

79
Q

What 3 bacteria cause AOM?

A
  • Steptococcus pneumoniae
  • H. influenzae
  • Moraxella catarrhalis
80
Q

Treatment of AOM

A
  • 80% resolve w/o clinical intervention
  • ***Amoxicillin 80-90mg/kg/d
  • Auralgan
81
Q

What is Auralgan?

A

pain killer drops

82
Q

T/F…at 2 weeks, 50% will still have fluid

A

True

83
Q

T/F…at 10 weeks, 10% will still have fluid

A

True

84
Q

With AOM, how long should adults wait before ENT referral?

A

~8 weeks

85
Q

What is an issue with using antibiotic prophylaxis to treat Chronic OM?

A

increasing antibiotic resistance

86
Q

What usually must happen first to place PE tubes in COM?

A
  • 3 distinct episodes of AOM in 6 months
    OR
  • 4 episodes in a year
87
Q

What is the only type of water allowed around the ears in someone with PE tubes?

A

chlorinated water (such as in a pool)

88
Q

What can you do for occluded PE tubes?

A
  • Abx gtts (Antibiotic drops)
  • H202
  • ENT cleaning
89
Q

How do PE tubes usually come out?

A

90% spontaneously

90
Q

Some complications of OM?

A
  • Hearing loss
  • TM perforation
  • Facial Paralysis
  • Tympanosclerosis
  • Cholesteatoma
91
Q

How do you treat a perforated TM?

A
  • Abx gtts & Oral Abx
  • H20 precautions
  • Most heal in a month
92
Q

What is a Cholesteatoma?

A

Skin cyst in the middle ear & skull bone

93
Q

Symptoms of a Cholesteatoma?

A
  • Hearing Loss
  • Recurrent ear drainage
  • Foul/unpleasant odor
  • Vertigo
94
Q

Complications of Cholesteatoma?

A
  • Erosion of bony structures
  • Necrosis of Incus
  • Facial nerve Palsy
  • Meningitis
  • Brain Abscess
95
Q

Diagnosis of Cholesteatoma?

A
  • history & clinical findings
  • Ear discharge
  • crust/keratin in the attic, pars flaccida or pars tensa
  • with or w/out perforation of TM
96
Q

Treatment of Cholesteatoma

A

Surgery. May need to repair ossicles

97
Q

What is Acute Suppurative Mastoiditis?

A

Infection of the mastoid bone of the skull

98
Q

What is Acute Suppurative Mastoiditis caused by?

A

Middle ear infection spreading to mastoid bone

99
Q

In Acute Suppurative Mastoiditis, what does the mastoid bone fill with?

A

pus

100
Q

Who is affected most by Acute Suppurative Mastoiditis?

A

Children

101
Q

Symptoms of Mastoiditis?

A
  • Ear pain/discharge
  • Fever
  • headache
  • hearing loss
  • Erythema of the ear/behind the ear
  • post auricular edema
102
Q

Diagnosis of Mastoiditis

A
  • CT at level of middle ear
  • Head CT
  • skull x-ray
103
Q

Treatment of Mastoiditis?

A
  • Cefazolin & myringotomy

- Mastoidectomy

104
Q

Complications of Mastoiditis

A
  • Destruction of Mastoid bone
  • Vertigo
  • Epidural abscess
  • facial paralysis
  • meningitis
  • partial/complete hearing loss
  • partial/complete spread of infection to brain/body
105
Q

What is Petrous Apicitis?

A

Medial portion of petrous bone becomes site of persistent infection b/c of drainage of pneumatic cell tracts

106
Q

What does Petrous Apicitis cause?

A
  • foul discharge
  • deep otalgia
  • 6th nerve palsy (Gradenigo syndrome)
107
Q

What is Facial Paralysis associated with?

A

Acute/Chonic Otitis Media

108
Q

What anatomically causes Facial Paralysis?

A

inflammation of the 7th nerve

109
Q

Prognosis for AOM paralysis?

A

excellent. complete recovery usually

110
Q

Prognosis for Chronic OM paralysis?

A

slower; less favorable

111
Q

What is the definition of Otosclerosis?

A
  • Abnormal sponge-like bone growing in middle ear
112
Q

How does Otosclerosis inhibit hearing?

A

Prevents the ear bones from vibrating

113
Q

What is the most common cause of middle ear hearing loss in young adults?

A

Otosclerosis

114
Q

Symptoms of Otosclerosis?

A
  • Hearing loss
  • Tinnitus
  • Vertigo
115
Q

Is otosclerosis 1. Progressive/non-progressive & 2. familial/non-familial

A
  1. Progressive

2. Familial

116
Q

Otosclerosis leads to lesions on which bone of the middle ear & what type of hearing loss is it?

A
  • Stapes

- Conductive

117
Q

Treatment of Otosclerosis

A
  • Surgical - stapedectomy

- hearing aid

118
Q

Who is affected more by Otoclerosis, M or F?

A

Females

119
Q

With persistent TM perforations, what is one thing we might worry about?

A

secondary infections from exposure to water

120
Q

With diseases of the cochlea (loss of hairs), is hearing loss reversible or irreversible?

A

usually irreversible

121
Q

Are most cochlear diseases Bbilateral/unilateral hearing loss?

A

Bilateral & symmetric

122
Q

What might unilateral/asymmetric hearing loss mean in a cochlear disease?

A

lesion proximal to cochlea

123
Q

Primary management goal in cochlear diseases

A
  • Prevention of further loss

- improvement w/amplification

124
Q

What are the first & second most common causes of sensory hearing loss?

A
  1. Presbyacusis

2. Noise Trauma

125
Q

Name some irreversible ototoxic medications

A
  • Aminoglycosides
  • Erythromycin
  • Vancomycin
  • Loop diuretics (Furosemide, Bumetanide)
126
Q

Name a reversible ototoxic medication

A

Salicylates such as aspirin

127
Q

What is the most common cause of sudden sensory hearing loss?

A

idiopathic…perhaps viral infection or sudden vascular occlusion of internal auditory artery

128
Q

Treatment for sudden sensory hearing loss?

A

cortical steroids (oral prednisone)

129
Q

Hereditary hearing loss is often found in what type of disorders?

A

mitochondrial

130
Q

Hereditary hearing loss usually develops at what stage of life?

A

adulthood

131
Q

Autoimmune hearing loss is associated with…?

A
  • Systemic Lupus erythematosus
  • Wegener granulomatosis
  • Cogan syndrome
132
Q

Prognosis for autoimmune hearing loss?

A

Progressive. Gradual evolution to permanent loss

133
Q

What types of things do we look for when we screen for autoimmune diseases?

A
  • Antinuclear antibody (ANA)
  • Rheumatoid factor (RF)
  • Erythrocyte sedimentation rate (ESR)
134
Q

What is tinnitus?

A

perception of abnormal ear or head noises

135
Q

What does persistent tinnitis indicate?

A

sensory hearing loss

136
Q

Treatment for tinnitis?

A
  • avoid exposure to excessive noise & ototoxic agents

- transcranial magnetic stimulation of central auditory system

137
Q

What is Hyperacusis?

A

Excessive sensitivity to sound

138
Q

Does it occur with normal hearing or only with hearing loss?

A

normal hearing

139
Q

What can cause hyperacusis?

A
  • ear disease
  • noise trauma
  • psychological
140
Q

When talking about cochlear dysfunction, what does “recruitment” mean?

A

abnormal sensitivity to sounds despite reduced sensitivity to softer ones

141
Q

What is Vertigo?

A

Sensation of motion w/o actual movement
OR
Exaggerated sense of motion

142
Q

Characteristics of Peripheral Vertigo

A
  • Sudden onset
  • associated w/tinnitis & hearing loss
  • Horizontal nystagmus
143
Q

Characteristics of Central Vertigo

A
  • Gradual onset
  • progressive
  • no auditory symptoms
  • Vertical nystagmus (when present)
144
Q

Triggers for Peripheral Vertigo

A
  • Diet (high salt: Meniere’s disease)
  • stress/fatigue
  • bright lights
145
Q

What are Endolympathic Hydrops also known as?

A

Méniére’s Syndrome

146
Q

What is the classic triad associated with EH/Meniere’s syndrome?

A
  • tinnitis
  • transient hearing loss
  • vertigo
147
Q

Cause of EH/Meniere’s syndrome

A
  • Mostly unknown
  • syphilis
  • head trauma
148
Q

How long does EH/Meniere’s syndrome last

A
  • several hours
149
Q

What happens anatomically in EH/Meniere’s syndrome?

A

Distention of endolymphatic compartment of inner ear

150
Q

Fist line of treatment for EH/Meniere’s Syndrome?

A
  • Low salt diet (<1500mg per day)

- Oral diuretic therapy

151
Q

Characteristics of Labrynthitis

A
  • acute onset
  • lasts several days to a week
  • hearing loss and tinnitis
152
Q

What is labrynthitis caused by?

A
  • Mostly viral infection (usually follows an URI)

- bacterial infection, allergy

153
Q

Prognosis for hearing with labrynthitis

A
  • hearing may return to normal or remain permanently impaired
154
Q

Treatment for labrynthitis

A

-antibiotics if febrile/have bacterial infection

155
Q

Define Benign Paroxysmal Positioning Vertigo (BPPV)

A
  • Recurrent episode of vertigo lasting under several minutes per episode
156
Q

Name 1 way BPPV is different than other types of vertigo

A
  • actual movement is what causes the problem
157
Q

Name the anatomical cause of BPPV

A

Otoconia (a.k.a otoliths) - calcium carbonate crystals in semi-circular canals

158
Q

What do the Calcium Carbonate Crystals in BPPV do?

A

move endolymph and stimulate sensation of movement

159
Q

Define Vestibular Neuronitis

A

single attack of vertigo that lasts for several days to a week

160
Q

A key distinguishing feature of Vestibular Neuronitis

A

No accompanying hearing loss

161
Q

Name two other distinguishing features of Vestibular Neuronitis that occur in the Acute phase

A
  • Nystagmus

- absent responses to caloric stimulation

162
Q

Treatment of Vestibular Neuronitis

A

Supportive Care & diazepam/meclizine in acute phase only

163
Q

What is the most common cause of vertigo following a head injury?

A

Traumatic vertigo

164
Q

Treatment of Traumatic Vertigo

A

Supportive care & diazepam/meclizine

165
Q

What is a Perilymphatic fistula?

A
  • leakage of perilymphatic fluid from inner ear into tympanic cavity
166
Q

Causes of Perilymphatic fistula

A
  • physical injury

- extreme barotrauma

167
Q

Treatment of Perilymphatic fistula

A
  • middle ear exploration and window sealing
168
Q

Causes of Cervical Vertigo

A
  • after neck injury (esp. hyperextension)

- Degenerative cervical spine disease

169
Q

Management of Cervical Vertigo

A
  • Neck movement exercises (PT)
170
Q

What is a Vestibular Schwannoma (a.k.a Acoustic Neuroma)?

A

Benign tumor on 8th CN

171
Q

Characteristics of Acoustic Neuroma

A
  • slow growing
  • unilateral hearing loss
  • tinnitus
172
Q

Which gender is more prone to acoustic neuromas?

A

females

173
Q

How do you diagnose an acoustic neuroma?

A

MRI

174
Q

Treatment of Acoustic Neuroma?

A
  • surgical

- radiation

175
Q

What is a common cause of vertigo in the elderly?

A

Vertebrobasilar insufficiency (VBI)

176
Q

What is VBI triggered by?

A

changes in posture or extension of neck

177
Q

Diagnosis of VBI?

A
  • Rule out other causes

- Reduced flow demonstrated magnetic resonance angiography

178
Q

What does Protean mean?

A

variable, not specific

179
Q

In those with AIDS, what is the most common middle ear manifestation?

A

Serous Otitis Media due to ETD

180
Q

What are some complications of SOM in those with AIDS?

A

Progressive hearing loss (caused by cryptococcal meningitis & syphilis)

Acute facial paralysis (caused by herpes zoster infection-Ramsay Hunt Syndrome)

181
Q

which type of earwax is dominant?

A

Wet

182
Q

Which hearing problem will show a perfect 2:1 Rinne test?

A

Presbyacusis

Clinical Medicine 1 (4 decks)

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