Head & Ears Flashcards
1
Q
What are some common facial features of FAS (Fetal Alcohol Syndrome)
A
- Short palpebral fissures
- Thin vermilion border (upper lip)
- Smooth filtrum
2
Q
Common Trisomy 21 features?
A
- Epicanthal folds
- Macroglossia
- Small ears & mouth
- Brushfield spots
3
Q
What are Brushfield spots?
A
White spots on Iris
4
Q
What connective tissue is Marfan’s Syndrome a disorder of?
A
Fibrillin
5
Q
Common features of Marfan’s Syndrome?
A
- Tall
- Loose joints
- Crowded Teeth
- Valvular & Aortic abnormalities
- Pectus Caravatum
6
Q
What defines the outer ear?
A
Visible ear & external auditory canal
7
Q
What are the contents of the middle ear?
A
- Tympanic Membrane
- Malleus, Incus, Stapes
- Eustachian Tube
8
Q
What defines the inner ear?
A
Semicircular canals & Cochlea
9
Q
In a Weber test, where is the tuning fork placed?
A
Top of head or general midline structure
10
Q
In a Rinne test, where is the tuning fork placed?
A
1st on the mastoid bone & then beside the ear
11
Q
What is the Weber test supposed to detect?
A
Unilateral hearing loss
12
Q
If you have Conductive hearing loss, which side will be louder in a Weber test?
A
Impaired ear
13
Q
If you have Sensorineural hearing loss, which side will be louder in a Weber test?
A
Unaffected ear
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
15
Q
If you start with a Rinne test and AC < BC, which type of hearing loss is it?
A
Conductive (Negative rinne test)
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
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
18
Q
Conductive hearing loss is found in which sections of the ear?
A
External & middle
19
Q
What are the 4 mechanisms of Conductive hearing loss?
A
- Obstruction in EAC
- Mass-loading (effusion)
- Stiffness effect
- Discontinuity
20
Q
Is it easy or difficult to differentiate between sensory & neural hearing loss?
A
difficult
21
Q
What does a ‘deterioration of the cochlea’ imply?
A
loss of hair cells from organ of Corti
22
Q
Most common form of Sensory hearing loss?
A
Presbyacusis
23
Q
What is presbyacusis?
A
progressive hearing loss due to advanced age
24
Q
What frequency is lost first in presbyacusis?
A
high frequency
25
Contributing factors of presbyacusis
1. Excessive noise exposure
2. Head trauma
3. Systemic diseases
4. Smoking
5. Ototoxicity
26
Lesions of the 8th cranial nerve involve what type of hearing loss?
Neural
27
Neural hearing loss involves lesions on...
1. CN VIII
2. Auditory nuclei
3. Ascending tracts
4. Auditory cortex
28
Causes of Neural hearing loss lesions
1. Acoustic Neuroma
2. MS
3. Auditory Neuropathy
29
Treatments for sensorineural hearing loss?
1. Prevention (ear plugs)
2. Hearing aids
3. Cochlear implants
30
Common term for Traumatic auricular hematoma?
Cauliflower ear
31
Why do you have to quickly treat Cauliflower ear?
prevent cosmetic deformity
32
Why do you have to quickly treat cellulitis of the auricle?
prevent perichondritis
33
Function of Cerumen?
Protects ear by trapping dust, bacteria, etc
34
Where is Cerumen produced?
ear canal in outer 3rd cartilaginous portion
35
Cerumen is made of...
Mixture of...
1. Viscous secretions from sebaceous glands
2. Less viscous secretions from modified apocrine sweat glands
36
What is the most common cause of hearing loss?
Cerumen impaction
37
Symptoms of Cerumen Impaction
1. Earache
2. Fullness Sensation
3. Tinnitus
4. Partial conductive hearing loss
38
Treatment for Cerumen Impaction
1. Baby oil/mineral oil
2. Drops - Debrox a.k.a glycerine
3. Sodium Bicarb + H20
4. H202 + H20
39
Complications of cerumen impaction removal?
1. Otitis Externa
2. Bleeding
3. Retained water in ear
4. TM perforation
40
What are overgrowths of bone in the ear canal called?
Exostoses/Osteomas
41
When do you NOT irrigate for a foreign body in an ear?
if the FB is organic (beans, insects)...they might swell
42
What is one of the biggest emergencies when it comes to foreign bodies in the ear?
batteries
43
What is Pruritis?
Itchy ear
44
How do you get Pruritus
Excoriation or by overly zealous ear cleaning
45
Treatment for Pruritis
1. Stop using Q-Tips
2. Mineral oil
3. Topical corticosteroids
4. Antihistamines
46
Characteristics of Otitis Externa?
1. Erythema & edema of ear canal skin
2. purulent exudate
3. Pain when touching auricle
47
What is a dangerous complication of OE?
osteomyelitis in the skull base (malignant external otitis)
48
Common causes of Otitis Externa?
1. Moisture
2. Dirty Water
3. High temp & humidity
4. Removing Cerumen
5. FB (foreign bodies)
6. trauma
7. Dermatologic diseases
49
Treatments for OE
Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals
50
Prevention for OE
Alcohol drops
51
What is another name for Necrotizing Otitis Externa?
Malignant Otitis Externa
52
Where does NOE/MOE spread to?
temporal bone
53
What is the most common pathogen in NOE/MOE?
Pseudomonas
54
How dangerous is NOE/MOE?
fatal if not treated
55
How does NOE/MOE present?
1. Persistent foul aural discharge
2. Granulations in ear canal
3. Deep otalgia
4. Progressive CN palsies (6,7,9,10,11,12)
56
How is NOE/MOE diagnosed?
CT scan w/bone
57
Treament of NOE/MOE
1. Daily Debridement of EAC
2. Glucose control
3. Antipseudomonal drugs (Quinolones)
4. Surgery
58
Most common neoplasm of ear canal?
Squamous cell carcinoma
59
Mortality rate for Squamous Cell Carcinoma of the Ear Canal?
5-year (very high)
60
Treatment for Squamous Cell Carcinoma of the Ear Canal?
Surgical resection & radiation therapy
61
What does Eustachian Tube Dysfunction (ETD) cause?
unequal air pressure on either side of eardrum
62
Symptoms of ETD
1. Aural fullness
2. Fluctuating hearing
3. "Popping" in ears
4. Discomfort with pressure changes
63
What is someone with ETD at risk for?
Serous Otitis Media
64
Does ETD result in positive or negative pressure in the middle ear
negative
65
Most common cause of ETD?
Viral URI & allergies
66
Treatment of ETD
Systemic & intranasal decongestants
67
What causes Serous Otitis Media?
Blocked Eustachian tube for a long time
68
What age group most commonly gets SOM?
children
69
How do adults get SOM?
1. Post URI
2. Barotrauma
3. Chronic allergic rhinitis
70
What is the most important thing to exclude with persistent SOM?
nasopharyngeal carcinoma
71
Treatment for SOM
Controversial
1. short course of oral corticosteroids (prednisone)
2. Oral antibiotics
(amoxicillin)
72
What is Barotrauma?
Poor Eustachian tube function -- unable to equalize pressure in Eustachian tubes
73
Symptoms of Barotrauma
1. Ear discomfort/pain
2. Slight hearing loss (usually)
3. dizziness
74
Treatment of Barotrauma
Chew gum, yawn, anything that opens the Eustachain tube.
| Also antihistamines, decongestants, steroids, analgesics
75
What might you see in severe cases of barotrauma
hemotympanum
76
Signs/Symptoms of Acute Otitis Media (AOM)
- Fever
- Decreased eardrum mobility
- Cloudy/red/bulging TM
- Otorrhea (if perforated TM)
77
Risk Factors for AOM
- Bottle feeding
- sleeping w/bottle
- Pacifier use
- Passive smoking
- M > F
- Family History
78
If AOM in an adult is unilateral and recurrent, what must we worry about?
nasopharyngeal carcinoma
79
What 3 bacteria cause AOM?
- Steptococcus pneumoniae
- H. influenzae
- Moraxella catarrhalis
80
Treatment of AOM
- 80% resolve w/o clinical intervention
- ***Amoxicillin 80-90mg/kg/d
- Auralgan
81
What is Auralgan?
pain killer drops
82
T/F...at 2 weeks, 50% will still have fluid
True
83
T/F...at 10 weeks, 10% will still have fluid
True
84
With AOM, how long should adults wait before ENT referral?
~8 weeks
85
What is an issue with using antibiotic prophylaxis to treat Chronic OM?
increasing antibiotic resistance
86
What usually must happen first to place PE tubes in COM?
- 3 distinct episodes of AOM in 6 months
OR
- 4 episodes in a year
87
What is the only type of water allowed around the ears in someone with PE tubes?
chlorinated water (such as in a pool)
88
What can you do for occluded PE tubes?
- Abx gtts (Antibiotic drops)
- H202
- ENT cleaning
89
How do PE tubes usually come out?
90% spontaneously
90
Some complications of OM?
- Hearing loss
- TM perforation
- Facial Paralysis
- Tympanosclerosis
- Cholesteatoma
91
How do you treat a perforated TM?
- Abx gtts & Oral Abx
- H20 precautions
- Most heal in a month
92
What is a Cholesteatoma?
Skin cyst in the middle ear & skull bone
93
Symptoms of a Cholesteatoma?
- Hearing Loss
- Recurrent ear drainage
- Foul/unpleasant odor
- Vertigo
94
Complications of Cholesteatoma?
- Erosion of bony structures
- Necrosis of Incus
- Facial nerve Palsy
- Meningitis
- Brain Abscess
95
Diagnosis of Cholesteatoma?
- history & clinical findings
- Ear discharge
- crust/keratin in the attic, pars flaccida or pars tensa
- with or w/out perforation of TM
96
Treatment of Cholesteatoma
Surgery. May need to repair ossicles
97
What is Acute Suppurative Mastoiditis?
Infection of the mastoid bone of the skull
98
What is Acute Suppurative Mastoiditis caused by?
Middle ear infection spreading to mastoid bone
99
In Acute Suppurative Mastoiditis, what does the mastoid bone fill with?
pus
100
Who is affected most by Acute Suppurative Mastoiditis?
Children
101
Symptoms of Mastoiditis?
- Ear pain/discharge
- Fever
- headache
- hearing loss
- Erythema of the ear/behind the ear
- post auricular edema
102
Diagnosis of Mastoiditis
- CT at level of middle ear
- Head CT
- skull x-ray
103
Treatment of Mastoiditis?
- Cefazolin & myringotomy
| - Mastoidectomy
104
Complications of Mastoiditis
- Destruction of Mastoid bone
- Vertigo
- Epidural abscess
- facial paralysis
- meningitis
- partial/complete hearing loss
- partial/complete spread of infection to brain/body
105
What is Petrous Apicitis?
Medial portion of petrous bone becomes site of persistent infection b/c of drainage of pneumatic cell tracts
106
What does Petrous Apicitis cause?
- foul discharge
- deep otalgia
- 6th nerve palsy (Gradenigo syndrome)
107
What is Facial Paralysis associated with?
Acute/Chonic Otitis Media
108
What anatomically causes Facial Paralysis?
inflammation of the 7th nerve
109
Prognosis for AOM paralysis?
excellent. complete recovery usually
110
Prognosis for Chronic OM paralysis?
slower; less favorable
111
What is the definition of Otosclerosis?
- Abnormal sponge-like bone growing in middle ear
112
How does Otosclerosis inhibit hearing?
Prevents the ear bones from vibrating
113
What is the most common cause of middle ear hearing loss in young adults?
Otosclerosis
114
Symptoms of Otosclerosis?
- Hearing loss
- Tinnitus
- Vertigo
115
Is otosclerosis 1. Progressive/non-progressive & 2. familial/non-familial
1. Progressive
| 2. Familial
116
Otosclerosis leads to lesions on which bone of the middle ear & what type of hearing loss is it?
- Stapes
| - Conductive
117
Treatment of Otosclerosis
- Surgical - stapedectomy
| - hearing aid
118
Who is affected more by Otoclerosis, M or F?
Females
119
With persistent TM perforations, what is one thing we might worry about?
secondary infections from exposure to water
120
With diseases of the cochlea (loss of hairs), is hearing loss reversible or irreversible?
usually irreversible
121
Are most cochlear diseases Bbilateral/unilateral hearing loss?
Bilateral & symmetric
122
What might unilateral/asymmetric hearing loss mean in a cochlear disease?
lesion proximal to cochlea
123
Primary management goal in cochlear diseases
- Prevention of further loss
| - improvement w/amplification
124
What are the first & second most common causes of sensory hearing loss?
1. Presbyacusis
| 2. Noise Trauma
125
Name some irreversible ototoxic medications
- Aminoglycosides
- Erythromycin
- Vancomycin
- Loop diuretics (Furosemide, Bumetanide)
126
Name a reversible ototoxic medication
Salicylates such as aspirin
127
What is the most common cause of sudden sensory hearing loss?
idiopathic...perhaps viral infection or sudden vascular occlusion of internal auditory artery
128
Treatment for sudden sensory hearing loss?
cortical steroids (oral prednisone)
129
Hereditary hearing loss is often found in what type of disorders?
mitochondrial
130
Hereditary hearing loss usually develops at what stage of life?
adulthood
131
Autoimmune hearing loss is associated with...?
- Systemic Lupus erythematosus
- Wegener granulomatosis
- Cogan syndrome
132
Prognosis for autoimmune hearing loss?
Progressive. Gradual evolution to permanent loss
133
What types of things do we look for when we screen for autoimmune diseases?
- Antinuclear antibody (ANA)
- Rheumatoid factor (RF)
- Erythrocyte sedimentation rate (ESR)
134
What is tinnitus?
perception of abnormal ear or head noises
135
What does persistent tinnitis indicate?
sensory hearing loss
136
Treatment for tinnitis?
- avoid exposure to excessive noise & ototoxic agents
| - transcranial magnetic stimulation of central auditory system
137
What is Hyperacusis?
Excessive sensitivity to sound
138
Does it occur with normal hearing or only with hearing loss?
normal hearing
139
What can cause hyperacusis?
- ear disease
- noise trauma
- psychological
140
When talking about cochlear dysfunction, what does "recruitment" mean?
abnormal sensitivity to sounds despite reduced sensitivity to softer ones
141
What is Vertigo?
Sensation of motion w/o actual movement
OR
Exaggerated sense of motion
142
Characteristics of Peripheral Vertigo
- Sudden onset
- associated w/tinnitis & hearing loss
- Horizontal nystagmus
143
Characteristics of Central Vertigo
- Gradual onset
- progressive
- no auditory symptoms
- Vertical nystagmus (when present)
144
Triggers for Peripheral Vertigo
- Diet (high salt: Meniere's disease)
- stress/fatigue
- bright lights
145
What are Endolympathic Hydrops also known as?
Méniére's Syndrome
146
What is the classic triad associated with EH/Meniere's syndrome?
- tinnitis
- transient hearing loss
- vertigo
147
Cause of EH/Meniere's syndrome
- Mostly unknown
- syphilis
- head trauma
148
How long does EH/Meniere's syndrome last
- several hours
149
What happens anatomically in EH/Meniere's syndrome?
Distention of endolymphatic compartment of inner ear
150
Fist line of treatment for EH/Meniere's Syndrome?
- Low salt diet (<1500mg per day)
| - Oral diuretic therapy
151
Characteristics of Labrynthitis
- acute onset
- lasts several days to a week
- hearing loss and tinnitis
152
What is labrynthitis caused by?
- Mostly viral infection (usually follows an URI)
| - bacterial infection, allergy
153
Prognosis for hearing with labrynthitis
- hearing may return to normal or remain permanently impaired
154
Treatment for labrynthitis
-antibiotics if febrile/have bacterial infection
155
Define Benign Paroxysmal Positioning Vertigo (BPPV)
- Recurrent episode of vertigo lasting under several minutes per episode
156
Name 1 way BPPV is different than other types of vertigo
- actual movement is what causes the problem
157
Name the anatomical cause of BPPV
Otoconia (a.k.a otoliths) - calcium carbonate crystals in semi-circular canals
158
What do the Calcium Carbonate Crystals in BPPV do?
move endolymph and stimulate sensation of movement
159
Define Vestibular Neuronitis
single attack of vertigo that lasts for several days to a week
160
A key distinguishing feature of Vestibular Neuronitis
No accompanying hearing loss
161
Name two other distinguishing features of Vestibular Neuronitis that occur in the Acute phase
- Nystagmus
| - absent responses to caloric stimulation
162
Treatment of Vestibular Neuronitis
Supportive Care & diazepam/meclizine in acute phase only
163
What is the most common cause of vertigo following a head injury?
Traumatic vertigo
164
Treatment of Traumatic Vertigo
Supportive care & diazepam/meclizine
165
What is a Perilymphatic fistula?
- leakage of perilymphatic fluid from inner ear into tympanic cavity
166
Causes of Perilymphatic fistula
- physical injury
| - extreme barotrauma
167
Treatment of Perilymphatic fistula
- middle ear exploration and window sealing
168
Causes of Cervical Vertigo
- after neck injury (esp. hyperextension)
| - Degenerative cervical spine disease
169
Management of Cervical Vertigo
- Neck movement exercises (PT)
170
What is a Vestibular Schwannoma (a.k.a Acoustic Neuroma)?
Benign tumor on 8th CN
171
Characteristics of Acoustic Neuroma
- slow growing
- unilateral hearing loss
- tinnitus
172
Which gender is more prone to acoustic neuromas?
females
173
How do you diagnose an acoustic neuroma?
MRI
174
Treatment of Acoustic Neuroma?
- surgical
| - radiation
175
What is a common cause of vertigo in the elderly?
Vertebrobasilar insufficiency (VBI)
176
What is VBI triggered by?
changes in posture or extension of neck
177
Diagnosis of VBI?
- Rule out other causes
| - Reduced flow demonstrated magnetic resonance angiography
178
What does Protean mean?
variable, not specific
179
In those with AIDS, what is the most common middle ear manifestation?
Serous Otitis Media due to ETD
180
What are some complications of SOM in those with AIDS?
Progressive hearing loss (caused by cryptococcal meningitis & syphilis)
Acute facial paralysis (caused by herpes zoster infection-Ramsay Hunt Syndrome)
181
which type of earwax is dominant?
Wet
182
Which hearing problem will show a perfect 2:1 Rinne test?
Presbyacusis
