HEENT QUIZ 3 - EAR Flashcards
incidence of AOM
-peak at 6-24 months
-70 % of infants will have at least one infection
risk factors for AOM
-family of smokers
-fhx
-daycare
-lack of breastfeeding
Pathogenesis of AOM
-ET dysfunction, usually follows URI
-in children, ET is shorter and more horizontal which causes issues with drainage, therefore bacteria will proliferate and cause ciliary dismotility.
symptoms of AOM
-oltagia
-diarrhea and vomit
-high fever
-irritability
-decreased oral intake –can lead to hypoglycemia, dehydration and respiratory distress in infants
AOM findings
-red TM
-decreased light reflex
-bulging of the tm with effusion - difficult to see the malleus
-drainage with TM rupture
is AOM usually unilateral or bilateral
Acute otitis media is usually unilateral
Bacterial causes of AOM
-strep pneumoniae (G+)
-Hemophilus influenzae (G-)
-m. cat moxarella catarrhalis (G+)
TX for AOM
Amoxicillin for initial and uncomplicated AOM
-topical benzocaine ear drops for pain , unless TM is ruptured
who should receive immediate antibiotics for AOM
-infants less that 6 months old
-toxic appearing
-immunocompromised
- craniofacial abnormalities
without risk how long should you wait for tx of AOM
observe for 48-72 hours, treat if no improvement after 48 hours
Chronic otitis media (COM) definition
recurrent or persistent infection
what type of hearing loss is associated with chronic otitis media?
conductive hearing loss
Common PE finding for COM
perforation of the tympanic membrane
Will pt have pain with COM ?
pain may or may not be present with COM
-if rupture happens, may not have pain with this if fluid drains from the ear
which other middle ear disorder is associated with COM?
cholestotoma
Which middle ear disorder can lead to acute mastoiditis ?
acute otitis media
Definition of otitis media with effusion (OME)
serous effusion of middle ear – not pus
can otitis media be tx with antibiotics?
no, its not an infection
causes of OME
-Allergic rhinitis
-smokers with allergies
-large adenoids
-ET blockage
what will be seen in a PE of OME?
-TM will be retracted and immobile
-bubbles, fluid/air levels seen
will there be hearing loss in OME ?
yes, OME is associated with conductive hearing loss
symptoms in Bollous myringitis ?
-severe pain
-clear, watery discharge
-short lasting symptoms
-sudden onset
ear findings in bollous myringitis ?
-vesicles (blisters) in the MT
- clear, watery discharges- pain usually goes away after it drains
-intact TM
what is the usual etiology of bollous myringitis
viral etiology
persistant, malodorous watery discharge is commonly seen in?
cholesteatoma
possible complications of cholesteatoma
-bone erosion
-meningitis
-facial muscle paralysis
- conductive hearing loss
pathophysiology of cholesteatoma
- COM causes chronic negative pressure in the middle ear
- eardrum is pulled and retracted inward
- pars flaccida pulled in forms a sac
- sac is filled with debri and becomes granulation tissue
fluid in the middle ear eventually turns into a glue like consistency after…
chronic otitis media causes cholesteatoma
Acute mastoiditis cause
acute otitis media
symptoms seen in acute mastoiditis
-subperiosteal abscess
-high fever
- ear discharge
- erythma, edema and tenderness of the mastoid area
-ear my be budging outside of the head
is acute mastoiditis difficult to treat
yes, acute mastoiditis is difficult to treat with antibiotics
pt presents with edema, redness and tenderness of mastoid areas following an episode of AOM .What labs should be ordered?
- leukocytosis
- ESR (look for increases)
- blood c/s
to R/O bacteremia
-MRI to plan surgical tx if needed
onset and incidence of ostosclerosis
-15-35 y/o
usually familial
pathophysiology of otosclerosis
-metabolic bone disease
- periosteal bone replaces endochondral bone
sx of otosclerosis
ankylosis spondylitis: hardening of the stapes causes conductive hearing loss
can pts with otosclerosis present with tinnitus
75% of patients with otosclerosis present with tinnitus
pt is a swimmer and presents with severe pain cant right side, skin is macerated what are possible etiologies
Acute otitis externa - swimmers ear
-strep, staph, pseudomonas
possible complications of acute otitis externa and what would be the symptoms
cellulitis can develop which extends from the epidermis to deeper ear tissue
-if this occurs pt will present with LAO and fever
treatment for acute otitis externa
-keep water out of ear canal
-antibiotic eardrops
-oral pain meds
which external ear disorder is associated with skin conditions
chronic otitis externa
which skin disorders are associated with chronic otitis externa ?
- atopic dermatitis
- seborrheic dermatitis
- psoriasis
pt has intense pruritus of the external ear and a hix of psoriasis, likely dx?
chronic otitis externa
possible complication of chronic otitis externa ?
secondary bacterial infection due to sticking things in the ear to scratch
pt presents with deformed pinna after getting a piercing , possible dx?
perichondritis
etiology of perichondritis
-trauma
-bacterial(piercing)
-insect bite
pathophysiology of perichondritis
avuscular necrosis
multi-system, episodic inflammation comoon in cartilaginous tissues
relapsing polychondritis
inital symptoms of relapsing polychondritis
ear pain and eythema
-vioelacceous pina is the 1st sx
vioelacceous pina is the 1st symptom of what ear disorder
relapsing polychondritis
later symptoms of relapsing polychondritis
joint pain and weight loss
what can cause death in a pt with relapsing polychondritis
airway cartilage destruction
what age group is more commonly associated with relapsing polychondritis
middle aged adults
what part of the ear is spared in relapsing polychondritis
spares the earlobe except the pina
what systemic disorder is associated with relapsing polychondritis
arthritis
cause of herpers zoster oticus
sequelae of shingles
pt presents with ear rash, loss of taste, dry eyes and mouth. pt reports having severe pain prior to the rash appearing . possible dx?
herpes zoster oticus
herpes zoster oticus sx
-severe ear pain prior to rash
-dry eyes and mouht
-loss of taste
ramsay-hunt syndrome is associated with?
herpes zoster oticus
ramsay-hunt syndrome sx?
- facial paresis
- paroxysmal deep ear pain
- vertigo
- tinnitus
- ipsilateral hearing loss
pt presents with ipsilteral ear pain, vertigo, tinnitus, facial weakness and sudden deep ear pain following a shingles episode, possible dx?
ramsay-hunt syndrome
Onset of meniere’s disease/syndrome
usually 50s
difference between menieres syndrome and disease
syndrome: secondary cause
dz: familial, idiopathic
possible causes menieres syndrome
thyroid problems
autoimmune disease
syphillis
trauma
sx of menieres
-sudden onset of vertigo; severe isolated attacks
-nausea and vomiting
-attacks can last hours at a time
-progressive hearing loss : low frequency sounds first
-usually unilateral but 10-15% of cases are bilateral
-tinnitus
what type of hearing loss is meniere’s disease
sensorineural HL
Diagnostic criteria of meneire’s
- complete neuro exam
- weber and rinne test
- thyroid studies, electrolytes, glucose
- CBC,ESR, ANA, fluorescent treponemal ab (syphillis)
- MRI of the brain to R/O acoustic neuroma
- dietary cahnges: decrease salt intake, avoid caffeine and decrease tobacco use
what causes meneire’s disease
endolymphatic HTM
incidence of vestibular neuronitis
peak in 30s and 40s
etiology of vestibular neuronitis
viral infection. inflammation of the vestibular division of CNVIIi
sx of vestibular neuronitis
- undirectonal horizontal nystagmus : made better by gaze fixation
- abrupt onset of debilitating vertigo
- nausea and vomiting
no hearing loss or tinnitus , only vertigo
diagnostics for vestibular neuronitis
-(+) Romberg test
-CBC, glucose
-MRI if suspicious of CNS cause of vertigo
sx of vestibular migraines
- episodic vertigo
-h/a: not always present
-interictal symptoms: mild vertigo between attacks, susceptible to motion sickness
diagnostic criteria for vestibular migranes
- at least 5 episodes of vestibular sx of moderate or severe intensity, lasting between 5 to 72 hours
- one or more migranes feature with at least 50%of vestibular episodes
- hx of migraine headaches
- sx not better accounted fro by another dx
what type of vertigo and nystagmus is seen in a patient with acoustic neuroma
ocassional vertigo, rarely happens if it does it is central vertigo
-vertical nystagmus worsened by gaze fixation and non-fatiguing
what is the most common cause of vertigo
benign positional vertigo (BPV)
