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Clin Med > Head & Ears > Flashcards

Head & Ears Flashcards

2
Q

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

A
  1. Short palpebral fissures2. Thin vermilion border (upper lip)3. Smooth filtrum
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3
Q

Common Trisomy 21 features?

A
  1. Epicanthal folds2. Macroglossia3. Small ears & mouth4. Brushfield spots
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4
Q

What are Brushfield spots?

A

White spots on Iris

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5
Q

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

A

Fibrillin

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6
Q

Common features of Marfan’s Syndrome?

A

1.Tall2. Loose joints3. Crowded Teeth4. Valvular & Aortic abnormalities5. Pectus Caravatum

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7
Q

What defines the outer ear?

A

Visible ear & external auditory canal

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8
Q

What are the contents of the middle ear?

A

1.Tympanic Membrane2. Malleus, Incus, Stapes3. Eustachian Tube

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9
Q

What defines the inner ear?

A

Semicircular canals & Cochlea

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10
Q

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

A

Top of head or general midline structure

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11
Q

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

A

1st on the mastoid bone & then beside the ear

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12
Q

What is the Weber test supposed to detect?

A

Unilateral hearing loss

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13
Q

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

A

Impaired ear

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14
Q

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

A

Unaffected ear

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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

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16
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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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

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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

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19
Q

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

A

External & middle

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20
Q

What are the 4 mechanisms of Conductive hearing loss?

A
  1. Obstruction in EAC2. Mass-loading (effusion)3. Stiffness effect4. Discontinuity
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21
Q

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

A

difficult

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22
Q

What does a ‘deterioration of the cochlea’ imply?

A

loss of hair cells from organ of Corti

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23
Q

Most common form of Sensory hearing loss?

A

Presbyacusis

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24
Q

What is presbyacusis?

A

progressive hearing loss due to advanced age?

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25
Q

What frequency is lost first in presbyacusis?

A

high frequency

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26
Q

Contributing factors of presbyacusis

A
  1. Excessive noise exposure2. Head trauma3. Systemic diseases4. Smoking5. Ototoxicity
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27
Q

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

A

Neural

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28
Q

Neural hearing loss involves lesions on…

A
  1. CN VIII2. Auditory nuclei3. Ascending tracts4. Auditory cortex
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29
Q

Causes of Neural hearing loss lesions

A
  1. Acoustic Neuroma2. MS3. Auditory Neuropathy
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30
Q

Treatments for sensorineural hearing loss?

A
  1. Prevention (ear plugs)2. Hearing aids3. Cochlear implants
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31
Q

Common term for Traumatic auricular hematoma?

A

Cauliflower ear

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32
Q

Why do you have to quickly treat Cauliflower ear?

A

prevent cosmetic deformity

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33
Q

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

A

prevent perichondritis

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34
Q

Function of Cerumen?

A

Protects ear by trapping dust, bacteria, etc

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35
Q

Where is Cerumen produced?

A

ear canal in outer 3rd cartilaginous portion

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36
Q

Cerumen is made of…

A

Mixture of…1. Viscous secretions from sebaceous glands2. Less viscous secretions from modified apocrine sweat glands

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37
Q

What is the most common cause of hearing loss?

A

Cerumen impaction

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38
Q

Symptoms of Cerumen Impaction

A
  1. Earache2. Fullness Sensation3. Tinnitus4. Partial conductive hearing loss
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39
Q

Treatment for Cerumen Impaction

A
  1. Baby oil/mineral oil2. Drops - Debrox a.k.a glycerine 3. Sodium Bicarb + H204. H202 + H20
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40
Q

Complications of cerumen impaction removal?

A
  1. Otitis Externa2. Bleeding3. Retained water in ear4. TM perforation
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41
Q

What are overgrowths of bone in the ear canal called?

A

Exostoses/Osteomas

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42
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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43
Q

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

A

batteries

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44
Q

What is Pruritis?

A

Itchy ear

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45
Q

How do you get Pruritus

A

Excoriation or by overly zealous ear cleaning

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46
Q

Treatment for Pruritis

A
  1. Stop using Q-Tips2. Mineral oil3. Topical corticosteroids4. Antihistamines
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47
Q

Characteristics of Otitis Externa?

A
  1. Erythema & edema of ear canal skin2. purulent exudate3. Pain when touching auricle
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48
Q

What is a dangerous complication of OE?

A

osteomyelitis in the skull base (malignant external otitis)

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49
Q

Common causes of Otitis Externa?

A
  1. Moisture2. Dirty Water3. High temp & humidity4. Removing Cerumen5. FB (foreign bodies)6. trauma7. Dermatologic diseases
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50
Q

Treatments for OE

A

Antibiotic drops (Aminoglycoside/fluoroquinolone) or antifungals

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51
Q

Prevention for OE

A

Alcohol drops

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52
Q

What is another name for Necrotizing Otitis Externa?

A

Malignant Otitis Externa

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53
Q

Where does NOE/MOE spread to?

A

temporal bone

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54
Q

What is the most common pathogen in NOE/MOE?

A

Pseudomonas

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55
Q

How dangerous is NOE/MOE?

A

fatal if not treated

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56
Q

How does NOE/MOE present?

A
  1. Persistent foul aural discharge2. Granulations in ear canal3. Deep otalgia4. Progressive CN palsies (6,7,9,10,11,12)
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57
Q

How is NOE/MOE diagnosed?

A

CT scan w/bone

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58
Q

Treament of NOE/MOE

A
  1. Daily Debridement of EAC2. Glucose control3. Antipseudomonal drugs (Quinolones)4. Surgery
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59
Q

Most common neoplasm of ear canal?

A

Squamous cell carcinoma

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60
Q

Mortality rate for Squamous Cell Carcinoma of the Ear Canal?

A

5-year (very high)

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61
Q

Treatment for Squamous Cell Carcinoma of the Ear Canal?

A

Surgical resection & radiation therapy

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62
Q

What does Eustachian Tube Dysfunction (ETD) cause?

A

unequal air pressure on either side of eardrum

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63
Q

Symptoms of ETD

A
  1. Aural fullness2. Fluctuating hearing3. “Popping” in ears4. Discomfort with pressure changes
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64
Q

What is someone with ETD at risk for?

A

Serous Otitis Media

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65
Q

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

A

negative

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66
Q

Most common cause of ETD?

A

Viral URI & allergies

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67
Q

Treatment of ETD

A

Systemic & intranasal decongestants

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68
Q

What causes Serous Otitis Media?

A

Blocked Eustachian tube for a long time

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69
Q

What age group most commonly gets SOM?

A

children

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70
Q

How do adults get SOM?

A
  1. Post URI2. Barotrauma3. Chronic allergic rhinitis
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71
Q

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

A

nasopharyngeal carcinoma

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72
Q

Treatment for SOM

A

Controversial1. short course of oral corticosteroids (prednisone)2. Oral antibiotics(amoxicillin)

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73
Q

What is Barotrauma?

A

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

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74
Q

Symptoms of Barotrauma

A
  1. Ear discomfort/pain2. Slight hearing loss (usually)3. dizziness
75
Q

Treatment of Barotrauma

A

Chew gum, yawn, anything that opens the Eustachain tube.Also antihistamines, decongestants, steroids, analgesics

76
Q

What might you see in severe cases of barotrauma

A

hemotympanum

77
Q

Signs/Symptoms of Acute Otitis Media (AOM)

A
  • Fever- Decreased eardrum mobility- Cloudy/red/bulging TM- Otorrhea (if perforated TM)
78
Q

Risk Factors for AOM

A
  • Bottle feeding- sleeping w/bottle- Pacifier use- Passive smoking- M > F- Family History
79
Q

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

A

nasopharyngeal carcinoma

80
Q

What 3 bacteria cause AOM?

A
  • Steptococcus pneumoniae- H. influenzae- Moraxella catarrhalis
81
Q

Treatment of AOM

A
  • 80% resolve w/o clinical intervention- ***Amoxicillin 80-90mg/kg/d- Auralgan
82
Q

What is Auralgan?

A

pain killer drops

83
Q

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

A

True

84
Q

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

A

True

85
Q

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

A

~8 weeks

86
Q

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

A

increasing antibiotic resistance

87
Q

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

A
  • 3 distinct episodes of AOM in 6 monthsOR- 4 episodes in a year
88
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)

89
Q

What can you do for occluded PE tubes?

A
  • Abx gtts (Antibiotic drops)- H202- ENT cleaning
90
Q

How do PE tubes usually come out?

A

90% spontaneously

91
Q

Some complications of OM?

A
  • Hearing loss- TM perforation- Facial Paralysis- Tympanosclerosis- Cholesteatoma
92
Q

How do you treat a perforated TM?

A
  • Abx gtts & Oral Abx- H20 precautions- Most heal in a month
93
Q

What is a Cholesteatoma?

A

Skin cyst in the middle ear & skull bone

94
Q

Symptoms of a Cholesteatoma?

A
  • Hearing Loss- Recurrent ear drainage- Foul/unpleasant odor- Vertigo
95
Q

Complications of Cholesteatoma?

A
  • Erosion of bony structures- Necrosis of Incus- Facial nerve Palsy- Meningitis- Brain Abscess
96
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
97
Q

Treatment of Cholesteatoma

A

Surgery. May need to repair ossicles

98
Q

What is Acute Suppurative Mastoiditis?

A

Infection of the mastoid bone of the skull

99
Q

What is Acute Suppurative Mastoiditis caused by?

A

Middle ear infection spreading to mastoid bone

100
Q

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

A

pus

101
Q

Who is affected most by Acute Suppurative Mastoiditis?

A

Children

102
Q

Symptoms of Mastoiditis?

A
  • Ear pain/discharge- Fever- headache- hearing loss- Erythema of the ear/behind the ear- post auricular edema
103
Q

Diagnosis of Mastoiditis

A
  • CT at level of middle ear- Head CT- skull x-ray
104
Q

Treatment of Mastoiditis?

A
  • Cefazolin & myringotomy- Mastoidectomy
105
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
106
Q

What is Petrous Apicitis?

A

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

107
Q

What does Petrous Apicitis cause?

A
  • foul discharge- deep otalgia- 6th nerve palsy (Gradenigo syndrome)
108
Q

What is Facial Paralysis associated with?

A

Acute/Chonic Otitis Media

109
Q

What anatomically causes Facial Paralysis?

A

inflammation of the 7th nerve

110
Q

Prognosis for AOM paralysis?

A

excellent. complete recovery usually

111
Q

Prognosis for Chronic OM paralysis?

A

slower; less favorable

112
Q

What is the definition of Otosclerosis?

A
  • Abnormal sponge-like bone growing in middle ear
113
Q

How does Otosclerosis inhibit hearing?

A

Prevents the ear bones from vibrating

114
Q

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

A

Otosclerosis

115
Q

Symptoms of Otosclerosis?

A
  • Hearing loss- Tinnitus- Vertigo
116
Q

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

A
  1. Progressive2. Familial
117
Q

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

A
  • Stapes- Conductive
118
Q

Treatment of Otosclerosis

A
  • Surgical - stapedectomy- hearing aid
119
Q

Who is affected more by Otoclerosis, M or F?

A

Females

120
Q

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

A

secondary infections from exposure to water

121
Q

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

A

usually irreversible

122
Q

Are most cochlear diseases Bbilateral/unilateral hearing loss?

A

Bilateral & symmetric

123
Q

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

A

lesion proximal to cochlea

124
Q

Primary management goal in cochlear diseases

A
  • Prevention of further loss- improvement w/amplification
125
Q

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

A
  1. Presbyacusis2. Noise Trauma
126
Q

Name some irreversible ototoxic medications

A
  • Aminoglycosides- Erythromycin- Vancomycin- Loop diuretics (Furosemide, Bumetanide)
127
Q

Name a reversible ototoxic medication

A

Salicylates such as aspirin

128
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

129
Q

Treatment for sudden sensory hearing loss?

A

cortical steroids (oral prednisone)

130
Q

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

A

mitochondrial

131
Q

Hereditary hearing loss usually develops at what stage of life?

A

adulthood

132
Q

Autoimmune hearing loss is associated with…?

A
  • Systemic Lupus erythematosus- Wegener granulomatosis- Cogan syndrome
133
Q

Prognosis for autoimmune hearing loss?

A

Progressive. Gradual evolution to permanent loss

134
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)
135
Q

What is tinnitus?

A

perception of abnormal ear or head noises

136
Q

What does persistent tinnitis indicate?

A

sensory hearing loss

137
Q

Treatment for tinnitis?

A
  • avoid exposure to excessive noise & ototoxic agents- transcranial magnetic stimulation of central auditory system
138
Q

What is Hyperacusis?

A

Excessive sensitivity to sound

139
Q

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

A

normal hearing

140
Q

What can cause hyperacusis?

A
  • ear disease- noise trauma- psychological
141
Q

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

A

abnormal sensitivity to sounds despite reduced sensitivity to softer ones

142
Q

What is Vertigo?

A

Sensation of motion w/o actual movementORExaggerated sense of motion

143
Q

Characteristics of Peripheral Vertigo

A
  • Sudden onset- associated w/tinnitis & hearing loss- Horizontal nystagmus
144
Q

Characteristics of Central Vertigo

A
  • Gradual onset- progressive- no auditory symptoms- Vertical nystagmus (when present)
145
Q

Triggers for Peripheral Vertigo

A
  • Diet (high salt: Meniere’s disease)- stress/fatigue- bright lights
146
Q

What are Endolympathic Hydrops also known as?

A

Méniére’s Syndrome

147
Q

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

A
  • tinnitis- transient hearing loss- vertigo
148
Q

Cause of EH/Meniere’s syndrome

A
  • Mostly unknown- syphilis- head trauma
149
Q

How long does EH/Meniere’s syndrome last

A
  • several hours
150
Q

What happens anatomically in EH/Meniere’s syndrome?

A

Distention of endolymphatic compartment of inner ear

151
Q

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

A
  • Low salt diet (<1500mg per day)- Oral diuretic therapy
152
Q

Characteristics of Labrynthitis

A
  • acute onset- lasts several days to a week- hearing loss and tinnitis
153
Q

What is labrynthitis caused by?

A
  • Mostly viral infection (usually follows an URI)- bacterial infection, allergy
154
Q

Prognosis for hearing with labrynthitis

A
  • hearing may return to normal or remain permanently impaired
155
Q

Treatment for labrynthitis

A

-antibiotics if febrile/have bacterial infection

156
Q

Define Benign Paroxysmal Positioning Vertigo (BPPV)

A
  • Recurrent episode of vertigo lasting under several minutes per episode
157
Q

Name 1 way BPPV is different than other types of vertigo

A
  • actual movement is what causes the problem
158
Q

Name the anatomical cause of BPPV

A

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

159
Q

What do the Calcium Carbonate Crystals in BPPV do?

A

move endolymph and stimulate sensation of movement

160
Q

Define Vestibular Neuronitis

A

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

161
Q

A key distinguishing feature of Vestibular Neuronitis

A

No accompanying hearing loss

162
Q

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

A

-Nystagmus-absent responses to caloric stimulation

163
Q

Treatment of Vestibular Neuronitis

A

Supportive Care & diazepam/meclizine in acute phase only

164
Q

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

A

Traumatic vertigo

165
Q

Treatment of Traumatic Vertigo

A

Supportive care & diazepam/meclizine

166
Q

What is a Perilymphatic fistula?

A
  • leakage of perilymphatic fluid from inner ear into tympanic cavity
167
Q

Causes of Perilymphatic fistula

A
  • physical injury- extreme barotrauma
168
Q

Treatment of Perilymphatic fistula

A
  • middle ear exploration and window sealing
169
Q

Causes of Cervical Vertigo

A
  • after neck injury (esp. hyperextension)- Degenerative cervical spine disease
170
Q

Management of Cervical Vertigo

A
  • Neck movement exercises (PT)
171
Q

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

A

Benign tumor on 8th CN

172
Q

Characteristics of Acoustic Neuroma

A
  • slow growing- unilateral hearing loss- tinnitus
173
Q

Which gender is more prone to acoustic neuromas?

A

females

174
Q

How do you diagnose an acoustic neuroma?

A

MRI

175
Q

Treatment of Acoustic Neuroma?

A

-surgical-radiation

176
Q

What is a common cause of vertigo in the elderly?

A

Vertebrobasilar insufficiency (VBI)

177
Q

What is VBI triggered by?

A

changes in posture or extension of neck

178
Q

Diagnosis of VBI?

A
  • Rule out other causes- Reduced flow demonstrated magnetic resonance angiography
179
Q

What does Protean mean?

A

variable, not specific

180
Q

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

A

Serous Otitis Media due to ETD

181
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)

Clin Med (4 decks)

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