HEENT Flashcards
Cerumen Impaction
Ear wax impaction;
most common cause of conductive hearing loss;
PE: cerumen visible in ear;
TX: irrigation, manual removal
Eustacian Tube Dysfunction
Air/fluid trapped in middle ear space;
Occurs after URI, allergy flare or flight;
PE: Pressure, fullness, popping with swallowing;
TX: decongestants, antihistamines, nasal steroid spray, autoinsufflation
Barotrauma
Middle ear damage due to pressure change affecting temporal bone spaces;
Diving, flying, forceful nose blowing;
Vertigo, tinnitus
PE: ecchymosis or hemorrhage in middle ear, retracted TM
TX: decongestants, analgesics, anti-inflammatories, tubes
Otitis Externa
Infection of skin of external ear due to trauma or moist environment - usually bacterial (P. aeruginosa, Staph aureus);
PE: white discharge from ear, painful edema of EAC, tragus pain;
TX: ear hygiene, dry ear precautions; Floxin drops w/ wick if needed. Debride if fungal
Acute Otitis Media
Infection of middle ear; Common pathogens: Strepto pneumonia, Moraxella catarrhalis, Haemophilus influenzae
PE: tugging ear, fever, fussiness, anorexia; bulging non-motile TM, fluid in ear
TX: ABX for 7-10 day (Amox, Augmentin); Adjuvant therapy
Otitis Media w/ Effusion
Fluid from Acute OM or ETD;
PE: serous fluid behind TM, TM nonmotile, hearing loss
TX: observation, consider tubes if tx fails
MOST COMMON CAUSE OF PED HEARING LOSS W/ LANGUAGE DELAYS
TM Perf
Hole in TM;
PE: hole in TM, Hearing loss, otalgia, tinnitus, vertigo
TX: Heal on its own; abx drops if infection (Ofloxacin, Ciprodex); dry ear; refer to ENT if marginal
Cholesteatoma
Tissue accumulation in middle ear;
Caused by chronic ETD, recurrent ear infection;
PE: drainage, hearing loss, retracted TM, white mass visible behind TM
TX: Surgical excision
Mastoiditis
Infection of Mastoid air cells; Comp of Acute OM; S. pneumonia, S. aureus
PE: fever, adenopathy, mastoid tender/edema/red
TX: IV ABX (Ceftazidime & Vanco)
Myringotomy w/ tube insertion
EMERGENCY
Tinnitus
Ringing of ears;
associated with SN hearing loss;
TX: no cure, check for underlying causes and tx, mask sound,
Sudden SN HL
hearing loss due to hereditary or age (MMR); noise induced
DX: AC>BC lateralization to good ear
TX: high dose steroids, tx underlying
Peripheral Vertigo
sudden fatigable vertigo;
head movement, stress, diet, closed eyes;
Causes: vestibular neuronitis, Benign paroxysmal positional vertigo, meniere’s dz, labyrnthitis, tumors;
PE: worse w/ eyes closed, horizontal/rotary nystagmus
TX: Acute vestibular suppression (short term)
Epley maneuver for BBPV
Central Vertigo
Gradual onset, mild, non-fatigable vertigo; weakness & numbness
Better w/ eyes closed
Vertigal Nystagmus
Meniere’s Disease
dilation of endolymphatic space
PE: episodic vertigo, SN hearingloss, tinnitus
TX: low salt & diuretics, vestibular suppressants for acute attacks
Labyrinthitis
inflammation of inner ear nerves
PE: vertigo, hearing loss, tinnitus
TX: Steroids, anti-vertigo, vestibular rehab
Vestibular-Neuronitis
Acute inflammation of inner ear;
PE: vertigo
TX: steroids, atni-vertigo, vestibular rehab
Vestibular Schwannoma
Noncancerous benign, encapsulated growth that is sporadic (most common cerebellar pontine angle tumor);
CN 8 vestibulocochlear nerve
PE: progressive asymmetric high tone hearing loss, tinnitus, vertigo increasing
TX: surgery, radiation
Trauma (Hematoma)
Accumulation of blood in perichondrial space
PE: Edema, bruising, loss of carilage landmarks
TX: I&D, closure, pressure dressing, quinolone
Rhinitis
inflammation of nasal mucosa - edema, vasodilation, rhinorrhea;
seasonal allergies
PE: clear rhinorrhea, sneezing, itching, eye sx, nasal congestion, polyps
TX: steroid spray, decongestants, antihistamines, aticholinergics, saline irrigation
Rhinosinitus/Sinusitis
Inflmmation & Obstruction of sinus outflow tracts;
Viral (Rhinovirus), Bacterial, Fungal
PE: pain/pressure, decreased smell/taste, rhinorrhea, cough, fever
CT GOLD STANDARD
TX: alalgesics, saline, nasal steroids, decongestants; augmentin for bacterial
Nasal Foreign Body
PE: Unilateral, foul smelling nasal drainage/blood
TX: remove object; positive pressure, instrumentation w/ lidocaine and Afrin
Nasal Polyps
Usually lateral nasal wall & bilateral
Postnasal drip, rhinorrhea, hyponasality
PE: smooth, pale, clustered grapelike
TX: Nasal steroid spray, oral steroids, polypectomy, tx underlying allergies
Epistaxis
Nose Bleed Trauma, infection/inflammation, etc... Anterior: Kiesselback's plexus Posterior: Woodruff's plexus TX: Vasoconstriction (Afrin); Pressure on tip of nose leaning forward 10 min; Nasal packing 3-5d, anti-staph ABX; Anterior- silver nitrate cauterization
Nasal Fracture
Most common facial fracture
PE: palpable deformity, epistaxis, edema, nasal obstruction
TX: Closed reduction (w/in first 1-3 hrs before swelling, or 3-10d after swelling, before healing) or Open reduction (3-6m after failed closed reduction)
Acute Viral Pharyngitis
40-60% pharyngitis;
PE: Low fever, Progressively worse, generalized adenopathy, URI sx, more indolent
TX: Supportive (bed rest, hydration, lozenges); precautions (wash hands, throw away toothbrush)
Acute Bacterial Pharyngitis
Casued by Group A B-hemolytic Streptococcus (GABHS);
PE: High fever, Sudden onset, anterior cervical lymph nodes, NO COUGH OR RHINORRHEA, exudate on red, swollen tonsils, HA, nausa, abd pain
TX: ABX, PCN
Peritonsillar Abscess
Spread of infx out of tonsillar capsule; GABHS, Fusobacterium
PE: Odynophagia, trismus (locked jaw), uvula deviated to other side, tonsilar asymmetry, soft palate swelling, drooling, hot potato voice
TX: ENT consult, Needle aspiration vs I&D, IV ABX (Unasyn, clinda), PO ABX d/c (Augmentin, Clinda)
Acute Laryngitis
Mostly Viral (Rhinovirus)
PE: dysphonia (low voice), low fever, cough, rhinitis, PND
TX: voice rest, hydration, no smoking, ABX if bacterial