Head & Ears Flashcards
2
Q
What are some common facial features of FAS (Fetal Alcohol Syndrome)
A
- Short palpebral fissures2. Thin vermilion border (upper lip)3. Smooth filtrum
3
Q
Common Trisomy 21 features?
A
- Epicanthal folds2. Macroglossia3. Small ears & mouth4. Brushfield spots
4
Q
What are Brushfield spots?
A
White spots on Iris
5
Q
What connective tissue is Marfan’s Syndrome a disorder of?
A
Fibrillin
6
Q
Common features of Marfan’s Syndrome?
A
1.Tall2. Loose joints3. Crowded Teeth4. Valvular & Aortic abnormalities5. Pectus Caravatum
7
Q
What defines the outer ear?
A
Visible ear & external auditory canal
8
Q
What are the contents of the middle ear?
A
1.Tympanic Membrane2. Malleus, Incus, Stapes3. Eustachian Tube
9
Q
What defines the inner ear?
A
Semicircular canals & Cochlea
10
Q
In a Weber test, where is the tuning fork placed?
A
Top of head or general midline structure
11
Q
In a Rinne test, where is the tuning for placed?
A
1st on the mastoid bone & then beside the ear
12
Q
What is the Weber test supposed to detect?
A
Unilateral hearing loss
13
Q
If you have Conductive hearing loss, which side will be louder in a Weber test?
A
Impaired ear
14
Q
If you have Sensorineural hearing loss, which side will be louder in a Rinne test?
A
Unaffected ear
15
Q
If you start with a Rinne test and AC > BC but not 2:1, which type of hearing loss is it?
A
Sensory
16
Q
If you start with a Rinne test and AC < BC, which type of hearing loss is it?
A
Conductive (Negative rinne test)
17
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
18
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
19
Q
Conductive hearing loss is found in which sections of the ear?
A
External & middle
20
Q
What are the 4 mechanisms of Conductive hearing loss?
A
- Obstruction in EAC2. Mass-loading (effusion)3. Stiffness effect4. Discontinuity
21
Q
Is it easy or difficult to differentiate between sensory & neural hearing loss?
A
difficult
22
Q
What does a ‘deterioration of the cochlea’ imply?
A
loss of hair cells from organ of Corti
23
Q
Most common form of Sensory hearing loss?
A
Presbyacusis
24
Q
What is presbyacusis?
A
progressive hearing loss due to advanced age?
25
Q
What frequency is lost first in presbyacusis?
A
high frequency
26
Contributing factors of presbyacusis
1. Excessive noise exposure2. Head trauma3. Systemic diseases4. Smoking5. Ototoxicity
27
Lesions of the 8th cranial nerve involve what type of hearing loss?
Neural
28
Neural hearing loss involves lesions on...
1. CN VIII2. Auditory nuclei3. Ascending tracts4. Auditory cortex
29
Causes of Neural hearing loss lesions
1. Acoustic Neuroma2. MS3. Auditory Neuropathy
30
Treatments for sensorineural hearing loss?
1. Prevention (ear plugs)2. Hearing aids3. Cochlear implants
31
Common term for Traumatic auricular hematoma?
Cauliflower ear
32
Why do you have to quickly treat Cauliflower ear?
prevent cosmetic deformity
33
Why do you have to quickly treat cellulitis of the auricle?
prevent perichondritis
34
Function of Cerumen?
Protects ear by trapping dust, bacteria, etc
35
Where is Cerumen produced?
ear canal in outer 3rd cartilaginous portion
36
Cerumen is made of...
Mixture of...1. Viscous secretions from sebaceous glands2. Less viscous secretions from modified apocrine sweat glands
37
What is the most common cause of hearing loss?
Cerumen impaction
38
Symptoms of Cerumen Impaction
1. Earache2. Fullness Sensation3. Tinnitus4. Partial conductive hearing loss
39
Treatment for Cerumen Impaction
1. Baby oil/mineral oil2. Drops - Debrox a.k.a glycerine 3. Sodium Bicarb + H204. H202 + H20
40
Complications of cerumen impaction removal?
1. Otitis Externa2. Bleeding3. Retained water in ear4. TM perforation
41
What are overgrowths of bone in the ear canal called?
Exostoses/Osteomas
42
When do you NOT irrigate for a foreign body in an ear?
if the FB is organic (beans, insects)...they might swell
43
What is one of the biggest emergencies when it comes to foreign bodies in the ear?
batteries
44
What is Pruritis?
Itchy ear
45
How do you get Pruritus
Excoriation or by overly zealous ear cleaning
46
Treatment for Pruritis
1. Stop using Q-Tips2. Mineral oil3. Topical corticosteroids4. Antihistamines
47
Characteristics of Otitis Externa?
1. Erythema & edema of ear canal skin2. purulent exudate3. Pain when touching auricle
48
What is a dangerous complication of OE?
osteomyelitis in the skull base (malignant external otitis)
49
Common causes of Otitis Externa?
1. Moisture2. Dirty Water3. High temp & humidity4. Removing Cerumen5. FB (foreign bodies)6. trauma7. Dermatologic diseases
50
Treatments for OE
Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals
51
Prevention for OE
Alcohol drops
52
What is another name for Necrotizing Otitis Externa?
Malignant Otitis Externa
53
Where does NOE/MOE spread to?
temporal bone
54
What is the most common pathogen in NOE/MOE?
Pseudomonas
55
How dangerous is NOE/MOE?
fatal if not treated
56
How does NOE/MOE present?
1. Persistent foul aural discharge2. Granulations in ear canal3. Deep otalgia4. Progressive CN palsies (6,7,9,10,11,12)
57
How is NOE/MOE diagnosed?
CT scan w/bone
58
Treament of NOE/MOE
1. Daily Debridement of EAC2. Glucose control3. Antipseudomonal drugs (Quinolones)4. Surgery
59
Most common neoplasm of ear canal?
Squamous cell carcinoma
60
Mortality rate for Squamous Cell Carcinoma of the Ear Canal?
5-year (very high)
61
Treatment for Squamous Cell Carcinoma of the Ear Canal?
Surgical resection & radiation therapy
62
What does Eustachian Tube Dysfunction (ETD) cause?
unequal air pressure on either side of eardrum
63
Symptoms of ETD
1. Aural fullness2. Fluctuating hearing3. "Popping" in ears4. Discomfort with pressure changes
64
What is someone with ETD at risk for?
Serous Otitis Media
65
Does ETD result in positive or negative pressure in the middle ear
negative
66
Most common cause of ETD?
Viral URI & allergies
67
Treatment of ETD
Systemic & intranasal decongestants
68
What causes Serous Otitis Media?
Blocked Eustachian tube for a long time
69
What age group most commonly gets SOM?
children
70
How do adults get SOM?
1. Post URI2. Barotrauma3. Chronic allergic rhinitis
71
What is the most important thing to exclude with persistent SOM?
nasopharyngeal carcinoma
72
Treatment for SOM
Controversial1. short course of oral corticosteroids (prednisone)2. Oral antibiotics(amoxicillin)
73
What is Barotrauma?
Poor Eustachian tube function -- unable to equalize pressure in Eustachian tubes
74
Symptoms of Barotrauma
1. Ear discomfort/pain2. Slight hearing loss (usually)3. dizziness
75
Treatment of Barotrauma
Chew gum, yawn, anything that opens the Eustachain tube.Also antihistamines, decongestants, steroids, analgesics
76
What might you see in severe cases of barotrauma
hemotympanum
77
Signs/Symptoms of Acute Otitis Media (AOM)
- Fever- Decreased eardrum mobility- Cloudy/red/bulging TM- Otorrhea (if perforated TM)
78
Risk Factors for AOM
- Bottle feeding- sleeping w/bottle- Pacifier use- Passive smoking- M > F- Family History
79
If AOM in an adult is unilateral and recurrent, what must we worry about?
nasopharyngeal carcinoma
80
What 3 bacteria cause AOM?
- Steptococcus pneumoniae- H. influenzae- Moraxella catarrhalis
81
Treatment of AOM
- 80% resolve w/o clinical intervention- ***Amoxicillin 80-90mg/kg/d- Auralgan
82
What is Auralgan?
pain killer drops
83
T/F...at 2 weeks, 50% will still have fluid
True
84
T/F...at 10 weeks, 10% will still have fluid
True
85
With AOM, how long should adults wait before ENT referral?
~8 weeks
86
What is an issue with using antibiotic prophylaxis to treat Chronic OM?
increasing antibiotic resistance
87
What usually must happen first to place PE tubes in COM?
- 3 distinct episodes of AOM in 6 monthsOR- 4 episodes in a year
88
What is the only type of water allowed around the ears in someone with PE tubes?
chlorinated water (such as in a pool)
89
What can you do for occluded PE tubes?
- Abx gtts (Antibiotic drops)- H202- ENT cleaning
90
How do PE tubes usually come out?
90% spontaneously
91
Some complications of OM?
- Hearing loss- TM perforation- Facial Paralysis- Tympanosclerosis- Cholesteatoma
92
How do you treat a perforated TM?
- Abx gtts & Oral Abx- H20 precautions- Most heal in a month
93
What is a Cholesteatoma?
Skin cyst in the middle ear & skull bone
94
Symptoms of a Cholesteatoma?
- Hearing Loss- Recurrent ear drainage- Foul/unpleasant odor- Vertigo
95
Complications of Cholesteatoma?
- Erosion of bony structures- Necrosis of Incus- Facial nerve Palsy- Meningitis- Brain Abscess
96
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
97
Treatment of Cholesteatoma
Surgery. May need to repair ossicles
98
What is Acute Suppurative Mastoiditis?
Infection of the mastoid bone of the skull
99
What is Acute Suppurative Mastoiditis caused by?
Middle ear infection spreading to mastoid bone
100
In Acute Suppurative Mastoiditis, what does the mastoid bone fill with?
pus
101
Who is affected most by Acute Suppurative Mastoiditis?
Children
102
Symptoms of Mastoiditis?
- Ear pain/discharge- Fever- headache- hearing loss- Erythema of the ear/behind the ear- post auricular edema
103
Diagnosis of Mastoiditis
- CT at level of middle ear- Head CT- skull x-ray
104
Treatment of Mastoiditis?
- Cefazolin & myringotomy- Mastoidectomy
105
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
106
What is Petrous Apicitis?
Medial portion of petrous bone becomes site of persistent infection b/c of drainage of pneumatic cell tracts
107
What does Petrous Apicitis cause?
- foul discharge- deep otalgia- 6th nerve palsy (Gradenigo syndrome)
108
What is Facial Paralysis associated with?
Acute/Chonic Otitis Media
109
What anatomically causes Facial Paralysis?
inflammation of the 7th nerve
110
Prognosis for AOM paralysis?
excellent. complete recovery usually
111
Prognosis for Chronic OM paralysis?
slower; less favorable
112
What is the definition of Otosclerosis?
- Abnormal sponge-like bone growing in middle ear
113
How does Otosclerosis inhibit hearing?
Prevents the ear bones from vibrating
114
What is the most common cause of middle ear hearing loss in young adults?
Otosclerosis
115
Symptoms of Otosclerosis?
- Hearing loss- Tinnitus- Vertigo
116
Is otosclerosis 1. Progressive/non-progressive & 2. familial/non-familial
1. Progressive2. Familial
117
Otosclerosis leads to lesions on which bone of the middle ear & what type of hearing loss is it?
- Stapes- Conductive
118
Treatment of Otosclerosis
- Surgical - stapedectomy- hearing aid
119
Who is affected more by Otoclerosis, M or F?
Females
120
With persistent TM perforations, what is one thing we might worry about?
secondary infections from exposure to water
121
With diseases of the cochlea (loss of hairs), is hearing loss reversible or irreversible?
usually irreversible
122
Are most cochlear diseases Bbilateral/unilateral hearing loss?
Bilateral & symmetric
123
What might unilateral/asymmetric hearing loss mean in a cochlear disease?
lesion proximal to cochlea
124
Primary management goal in cochlear diseases
- Prevention of further loss- improvement w/amplification
125
What are the first & second most common causes of sensory hearing loss?
1. Presbyacusis2. Noise Trauma
126
Name some irreversible ototoxic medications
- Aminoglycosides- Erythromycin- Vancomycin- Loop diuretics (Furosemide, Bumetanide)
127
Name a reversible ototoxic medication
Salicylates such as aspirin
128
What is the most common cause of sudden sensory hearing loss?
idiopathic...perhaps viral infection or sudden vascular occlusion of internal auditory artery
129
Treatment for sudden sensory hearing loss?
cortical steroids (oral prednisone)
130
Hereditary hearing loss is often found in what type of disorders?
mitochondrial
131
Hereditary hearing loss usually develops at what stage of life?
adulthood
132
Autoimmune hearing loss is associated with...?
- Systemic Lupus erythematosus- Wegener granulomatosis- Cogan syndrome
133
Prognosis for autoimmune hearing loss?
Progressive. Gradual evolution to permanent loss
134
What types of things do we look for when we screen for autoimmune diseases?
- Antinuclear antibody (ANA)- Rheumatoid factor (RF)-Erythrocyte sedimentation rate (ESR)
135
What is tinnitus?
perception of abnormal ear or head noises
136
What does persistent tinnitis indicate?
sensory hearing loss
137
Treatment for tinnitis?
- avoid exposure to excessive noise & ototoxic agents- transcranial magnetic stimulation of central auditory system
138
What is Hyperacusis?
Excessive sensitivity to sound
139
Does it occur with normal hearing or only with hearing loss?
normal hearing
140
What can cause hyperacusis?
- ear disease- noise trauma- psychological
141
When talking about cochlear dysfunction, what does "recruitment" mean?
abnormal sensitivity to sounds despite reduced sensitivity to softer ones
142
What is Vertigo?
Sensation of motion w/o actual movementORExaggerated sense of motion
143
Characteristics of Peripheral Vertigo
- Sudden onset- associated w/tinnitis & hearing loss- Horizontal nystagmus
144
Characteristics of Central Vertigo
- Gradual onset- progressive- no auditory symptoms- Vertical nystagmus (when present)
145
Triggers for Peripheral Vertigo
- Diet (high salt: Meniere's disease)- stress/fatigue- bright lights
146
What are Endolympathic Hydrops also known as?
Méniére's Syndrome
147
What is the classic triad associated with EH/Meniere's syndrome?
- tinnitis- transient hearing loss- vertigo
148
Cause of EH/Meniere's syndrome
- Mostly unknown- syphilis- head trauma
149
How long does EH/Meniere's syndrome last
- several hours
150
What happens anatomically in EH/Meniere's syndrome?
Distention of endolymphatic compartment of inner ear
151
Fist line of treatment for EH/Meniere's Syndrome?
- Low salt diet (<1500mg per day)- Oral diuretic therapy
152
Characteristics of Labrynthitis
- acute onset- lasts several days to a week- hearing loss and tinnitis
153
What is labrynthitis caused by?
- Mostly viral infection (usually follows an URI)- bacterial infection, allergy
154
Prognosis for hearing with labrynthitis
- hearing may return to normal or remain permanently impaired
155
Treatment for labrynthitis
-antibiotics if febrile/have bacterial infection
156
Define Benign Paroxysmal Positioning Vertigo (BPPV)
- Recurrent episode of vertigo lasting under several minutes per episode
157
Name 1 way BPPV is different than other types of vertigo
- actual movement is what causes the problem
158
Name the anatomical cause of BPPV
Otoconia (a.k.a otoliths) - calcium carbonate crystals in semi-circular canals
159
What do the Calcium Carbonate Crystals in BPPV do?
move endolymph and stimulate sensation of movement
160
Define Vestibular Neuronitis
single attack of vertigo that lasts for several days to a week
161
A key distinguishing feature of Vestibular Neuronitis
No accompanying hearing loss
162
Name two other distinguishing features of Vestibular Neuronitis that occur in the Acute phase
-Nystagmus-absent responses to caloric stimulation
163
Treatment of Vestibular Neuronitis
Supportive Care & diazepam/meclizine in acute phase only
164
What is the most common cause of vertigo following a head injury?
Traumatic vertigo
165
Treatment of Traumatic Vertigo
Supportive care & diazepam/meclizine
166
What is a Perilymphatic fistula?
- leakage of perilymphatic fluid from inner ear into tympanic cavity
167
Causes of Perilymphatic fistula
- physical injury- extreme barotrauma
168
Treatment of Perilymphatic fistula
- middle ear exploration and window sealing
169
Causes of Cervical Vertigo
- after neck injury (esp. hyperextension)- Degenerative cervical spine disease
170
Management of Cervical Vertigo
- Neck movement exercises (PT)
171
What is a Vestibular Schwannoma (a.k.a Acoustic Neuroma)?
Benign tumor on 8th CN
172
Characteristics of Acoustic Neuroma
- slow growing- unilateral hearing loss- tinnitus
173
Which gender is more prone to acoustic neuromas?
females
174
How do you diagnose an acoustic neuroma?
MRI
175
Treatment of Acoustic Neuroma?
-surgical-radiation
176
What is a common cause of vertigo in the elderly?
Vertebrobasilar insufficiency (VBI)
177
What is VBI triggered by?
changes in posture or extension of neck
178
Diagnosis of VBI?
- Rule out other causes- Reduced flow demonstrated magnetic resonance angiography
179
What does Protean mean?
variable, not specific
180
In those with AIDS, what is the most common middle ear manifestation?
Serous Otitis Media due to ETD
181
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)
