HEENT ears Flashcards
weber test, unilateral conductive HL…. and SNHL goes to which ear
affected ear … unaffected ear
Tympanograms measures
type a
type b
type C
ear drum pressure and used for otitis media
a - normal
b - flat = when ear has fluid, hole, wax
c- ET dyfunction = pressure not equalized
most common cause of SNHL is
presbycusis (age related)
destruction of the cochlear hair cells and CN8 pathway will lead to
SNHL
otoxic medications like …..5…. can lead to SNHL
amingolycosides, cisplatin, furosemide, vancomcin, aspirin
autoimmune diseases like MS, SLE,
meniere’s disease
acoustic neuroma (vestibular schwannoma)
SNHL
why would you get MRI with and without contrast for SNHL
to see if its MS, acoustic neuroma
sudden sensorineural HL
occurs when:
associated symptoms
within hours or days, and its unilateral
tinnitus, dizziness
what causes sudden SNHL
idiopathic, vascular, autoimmune, viral infections
even though sudden SNHL can improve by itself, you still give high oral dose of…
oral steroid taper, or intratympanic steroid injection
no improvement after medication for Sudden SNHL, you get the following tests done
MRI of the brain with IAC with contrast to R/O acoustic neuroma
tinnitus, which is ringing in the ears, is very common if it is…… and concerning if it is…
subjective, bilateral, constant or intermed, non pulsatile
objective, pulsatile, unilateral, constant
medications that can cause tinnitus is
NSAIDs
loop dieutics
chemotherap.
amingolycoside antibiotics
for tinnitus, you will start with an audiogram, and then order the follow lab work up
Sed rate, CBC, lyme, thyroid function, rheumatoid factor, FTA-ABS, ANA
MRI with contrast and MRA if unilateral, vertigo, and pulsatile
CT - cholesteatoma
impaired transmission of sound along the EAC, ossicles, and oval window can cause
CHL
common causes of CHL is
cerumen impaction **
E.T dysfunction
middle ear infection
otosclerosis
tm perforation
cholesteatoma
ossicular disruption/ trauma
to imagine for CHL, get
CT scan the temporal bone WITHOUT to look behind the TM
abnormal bone growth around stapes, which causes CHL, is called … and you have to refer to ENT
otosclerosis . tympanogram will look normal
auricular hematoma is trauma to the … ear, which results in ….
outer eat
swelling, tenderness
if you do not treat auricular hematoma by making an incisions, draining, and compressing with dressing to prevent reaccumlation, the ear will become
cauliflower ear
pt has a history of ear fullness, hearing loss, and discomfort. exam reveals CHL. the pt has
cerumen impaction
cerumen ipaction treatment consist of
olive oil to soften wax
ear curette, warm water and peroxide
NEVER irrigate if TM is perforated
t/f small batteries causes necrosis in the ear
true
FB in the ear can lead to the following complications
infection
granulation tissue
laceration of ear canal
rupture of TM
otitis externa is known as the …
cause
history
PE
swimmers ear
cause: fungal, moisture, trauma, dermatitis
history: ear pain, otorrhea, hearing changes
tenderness with auricle movement, TM moves normal, erythema and edema, otorrhea
which organisms cause OE
Pseudomonas **
Staph Aureus
Fungal- candida, aspergillus niger (otomycosis)
treatment for OE is
Topical Antibiotic/
+/-Corticosteroid
Acetic Acid Otic
Clotrimazole
Oral Antibiotics?
Debridement
Ear Wick
can you give antibiotics to treat fungal OE (otomycosis)
no, bc its fungal. send to ent
why should you not give cortisporin gtts to a patient
bc it contains neomycin, which is ototoxic and can cause itching if allergic
is acetic acid bad for the ear?
no, but avoid if TM if perforated
what med is safe for the middle ear?
FQ type drops
floxin (ofloxacin)
ciprofloxacin
Ciprodex
how do you treat OE
NO ORAL Abx unless you see celluitis of the face, neck, auricle. NO ORAL alone
ORAL and topical Otics to increase efficacy
Intact TM: FQ -/+ corticosteroid
unknwn TM status: FQ + topical steroid
consider ear wick if sig edema
No water in ear. use cotton ball with vasline
OE Tx
abx 7-10d
dry ear/ no manipulation
recheck ears 1-2 weeks
no improvement: culture and sens
* consider psuedomonas or mrsa
OE fungal Tx
clean ear canal
several appts
vosol otic drops - acetic acid in propolyene glycol
vosol HC otic drops if swelling +fungal
Lotrimin solution (clotrimazole)
what can you do to prevent swimmers ear or fungus?
50% white vinegar and 50% rubbing alcohol
if you see eczematous OE, you can use
OTC 1% hydrocortisone to outer ear canal with Q-tip when ear itches
what is a complication of OE?
Malignant OE / AKA necrotizing OE
Malignant OE / AKA necrotizing OE
is..
seen in which group of people…
caused by …
S/S….
diagnosis…
treatment…
osteomyelitis of temporal bone
pseudomonas
IC ppl, diabetic, elderly
foul discharge , deep ear pain, cranial nerve palsies
CT/ MRI
IV cipro, debridement
Viral OE / Herpes zoster oticus
severe pain
+/- SNHL
herptic vesciles in EAC
Treatment: acyclovir +/- steriods
what syndrome can you get with viral OE and CNVII, and what are the Symptoms of it
ramsey hunt syndrome
pain, rash, facial nerve palsy, SNHL
complications for Ramsey hunt syndrome is
permanent HL
permanent facial never weakness
eye damage
post herpetic neuralgia
TM perforation can be caused by
trauma, barotrauma, acute infection, cholesteatoma
tympanosclerosis will look like and be from..
a white warm
be due long standing ear infection = scarring of ear drum
blood in the ear drum is called
hemotympanum
barotrauma
is:
happens when:
prevent/treat:
could result in
inability to = barometric stress on middle ear
secondary to diving/flying
swallow, yarn, systemic, or topical decongestants
hemotympanum, TM perforation, middle ear infection
fluid filled hemorrhagic blebs on the TM that causes sever pain is called
bullous myringitis
treatment = I & D
caused by mycoplasma pneumoniae
E.T dysfunction, inflammation of E.T = negative pressure in ear
cause
history
PE
treatment
cause: viral, allergies, sinusitis
history: decreased hearing, discomfort, fullness
PE: retracted TM
treatment: decongestants and valsalva
E.t dysfunction treatment
correcting rhinities: smoking, pregnancy, allergies, sinnuties, decongestant spray abuse, reflux
meds: oral/nasal steriod/ antihistamine … short term decongestants
valsalva and otovent
PE tubes not recom.
serous otitis media is a middle ear effusion that results from E.T dysfunction
cause
history
pe
cause: URI
history: hearing loss , ear pain, pressure
pe: translucent effusion, immobile tm, flat tympanogram, CHL, weber to the affected ear
treatment for serous OM / OME
NO antihistamine
oral/intranasal steroid
expectorants, decongestants
chronic: myringotomy with and without PE tubes
AOM is a bacterial infection of middle ear due to viral URI
cause
history
pe
treatment
cause: viral URI
* m. cat, H. flu, strep pneumonia, group A strep, staph aureus, pseudomonas
history : acute, ear pain, hearing loss
pe: TM erythema/bulging, immobile tm, flat tympan., weber to affected ear bc CHL
treatment: abs and drainage.
treatment for AOM
no treatment unless mild –> analgesics
antibotic -oral only if rupture of TM
INITAL - amoxicllin
doesnt work –> high dose oral amoxicillin/clavulanate (augmentin).
oral cefuroxime
IM ceftrixone
PNC allergy: bactrim, azithromycin, clindamycin
Chronic OM
definition
history
cause
treatment
happens when fail to response to meds/ untreated
speech/blanace delay
hearing problems
staph aureus , pseudomonas
(allergies, smoking, daycare)
myringtomy with pe tubes
adenoidectomy
reasons to place a PE tube (for ventilation to = pressure)
recurrent AOM
hearing loss and speech delay
failure for OME to resolve
