Hollier - EENT - Unit 1 Flashcards
There are 3 types of hearing loss, what are they?
1) Conductive: involving external auditory canal/middle ear
2) Sensorineural: involving inner ear or 8th CN
3) Components of both conductive and sensorineural
A patient comes in with c/o “sudden hearing loss”, what should you do?
Any sudden hearing loss is a medical emergency, referral to ENT immediately is required
Describe conductive hearing loss:
Anything that can occlude or mechanically block sound from traveling through external auditory canal
Describe sensorineural hearing loss:
Anything that prevents sound from traveling through the inner ear or prevents 8th CN from functioning
What are some causes of conductive hearing loss?
Cerumen impaction
TM perforation
Fluid (i.e. serous otitis media)
Tympanosclerosis
What are some causes of sensorineural hearing loss?
Acoustic neuroma Meniere's DZ Ototoxic Drugs (ASA, gentamycin) Injury due to loud noise Viral (especially after mumps) Presbycusis (related to aging
What are some risk factors for hearing loss?
Chronic allergic conditions (CHL) Conditions which cause eustachian tube obstruction (CHL) Heredity (CHL) Use of ototoxic drugs (SNHL) Aging (presbycusis) (SNHL) Exposure to loud noise (SNHL) Syphilis (SNHL) Congenital rubella infection (SNHL)
Name assessment findings for hearing loss:
Hard of hearing
Tinnitus
Dizziness
W/D from group discussions and social activities
Give 3 differential diagnosis for hearing loss:
Conductive hearing loss
Sensorineural hearing loss
Conductive and sensorineural hearing losses
What diagnostic studies are utilized to assess hearing loss?
Audiometry
Tuning fork
Whisper test
What is presbycusis?
Hearing loss related to age
Nonpharmacologic management of hearing loss?
- Removal of cerumen with warm water
- Development of lip reading skills for untreatable forms of hearing loss
- Hearing aid when appropriate
Pharmacologic management of hearing loss?
Agents used to soften ear wax if cerumen impaction
Antibtx if appropriate to treat OM
When should you consult or refer patient for hearing loss?
- ENT for any conductive problem which does not respond after initial treatment
- ENT for any sensorineural hearing loss
- ENT for any sudden hearing loss
- Audiologist for hearing evaluation/hearing aid
When should you have your patient FU for hearing loss?
Depends on etiology; however, for CHL problems, FU needed to insure resolution of problem
What is mastoiditis?
- Bacterial infection of the mastoid antrum and cells which can be asymptomatic or life-threatening.
- Usually is a result of untreated or under treated AOM
What organisms can cause mastoiditis?
S. pneumonaie Group A B-hemolytic Strep H. influenzae, M. catarrhalis S. Aureus Pseudomonas aeruginosa
What are the risk factors for mastoiditis?
- Age <2
- Cholesteatoma (from chronic mastoiditis)
- Recurrent or persistent OM
- Immunocompromised state
- Untreated/undertreated OM
What are the assessment findings for mastoiditis?
- Persistent, throbbing otalgia
- Bulging TM (normal in 10% of pets)
- Fever
- Postauricular swelling & tenderness
- Auricular protrusion (pinna displaced laterally & inferiorly)
- Possible creamy, profuse otorrhea since TM perforation often proceeds mastoiditis
- Possible hearing loss
When should you suspect mastoiditis?
When S/S of AOM persist >2 wks even if TM appears wnl (refer immediately to ENT)
What differential diagnosis are considered for mastoiditis?
- Severe otitis externa
- Neoplasm of the mastoid bone
- Parotitis or mumps (swelling is over the parotid vs. pre auricular area)
- Cellulitis
What diagnostic studies are utilized to rule in/out mastoiditis?
- CBC: demonstrates leukocytosis
- Middle ear aspirate
- Mastoid radiographs: demonstrates clouding of air cells
What prevention measures can be taken to avoid mastoiditis?
- Early treatment of OM
- Early identification of cholesteatoma
What is the nonpharmacologic management of mastoiditis?
- Keep ear dry
- Water precautions
- Myringotomy to drain middle ear (refer)
- Myringotomy
What is the pharmacologic management of mastoiditis?
- Antibiotics (usually IV) on basis of most likely organisms until cx are known
- Topical antibtx
- Analgesics for pain
- Antipyretics for fever
When should you consult/refer patient?
- ENT referral for myringotomy, hospitalization, IV antibtx mgmt
- Neurologist or ENT for suspected meningitis
What is the followup plan for patients with mastoiditis?
- Depends on pt condition & age, but weekly FU after DC
- Post-infection FU needed with audiograms to assess hearing loss
What is the expected course for patients with mastoiditis?
Depends on severity of infection, but prognosis is good if proper therapy initiated early
What are the possible complications due to mastoiditis?
- Meningitis
- Intracranial abscess
- Facial nerve paralysis
What is the expected course due to hearing loss?
- SNHL usually unresponsive to treatment
- CHL usually improve with treatment or no progression of loss
What are the possible complications of hearing loss?
- Depends on etiology of problem
- Middle ear problems may progress to chronic problems
- Permanent hearing loss from loud noise exposure
- Delayed speech in young children
What is otitis externa (swimmer’s ear)?
Infection of the external auditory canal producing inflammation, itching and/or pain
Otitis externa can be affected by what 3 bacteria?
Pseudomonas (most common pathogen)
Staph
Strep
Otitis externa can be affected by what 2 fungal pathogens?
Aspergillus (most common)
Candida albicans
When is otitis external more common?
In the summer months
What are the risk factors for otitis externa?
Swimming, hearing aid use, DM, hot/humid climates, trauma to external canal (i.e. cotton swabs/foreign objects), not drying ears after showering or profuse perspiration
What are the assessment findings for otitis externa?
- Otalgia/conductive hearing loss
- Edema and redness in the external auditory canal
- Itching in the external auditory canal
- Purulent discharge in external auditory canal
- Tragal and/or pinna pain
- Normal TM
Name 3-5 differential diagnosis for otitis externa:
- Wisdom tooth eruption
- TMJ disease
- TM rupture
- Foreign body
- Hearing loss
What, if any, diagnostic studies can be performed for otitis externa?
Culture of discharge (usually not necessary)
What prevention methods can you teach your patients to prevent otitis externa?
- Avoid prolonged ear exposure to warm, humid conditions
- Dry ears after showering/swimming
- Do not place objects in ear which may cause trauma
- Treat ear infections aggressively
- 2% acetic acid (50:50 solution w/water) drops after swim
- Treat eczema before it effects the external auditory canal
What are the nonpharmacologic management for otitis externa?
- Thorough cleansing of external canal
- Use of cotton ear with to facilitate passage of med into edematous painful ear canal
What pharmacological management is recommended for otitis externa?
- Cipro HC Otic 3 gtt bid x7 days (adult & child >1 yr)
- Ciprodex Otic 4 gtt bid x7 days (adult & child >6 mos)
- Cortisporin Adults 4 gtt 3-4x daily (max 10 days)
- Cortisporin Child (2-16 yrs) 3 gtt 3-4x daily (max 10 days)
What FU recommendations are needed for OE?
Usually none
What is the expected course for OE?
Improvement in 24-48 hrs w/tx
Resolution in a few days
What are the possible complications of OE?
- Cellulitis/chondritis
- Infection at contigious bone
What is otitis media (OM)?
Two types:
- Acute otitis media (AOM) sudden onset of middle ear effusion & S/S of local or systemic illness
- Otitis media with effusion (OME) is fluid accumulation in the middle ear w/o evidence of infection - also called middle ear effusion (MEE)
What is the etiology of OM?
Acute otitis media:
- bacteria/viruses
Otitis media with effusion:
- Probably due to incomplete resolution of AOM or eustachian tube obstruction
What is the incidence of OM?
- More common in winter months
- Most common in 6 mos - 3 yrs
- Lowest incidence in breast fed babies
What are the risk factors for OM?
- Daycare attendance
- Craniofacial abnormalilties
- URI
- Allergic rhinitis
- 2nd hand cigarette smoke
- 1st episode of AOM <12 mos old
- Bottle feeding while in supine position
What are the assessment findings for AOM?
- Ear pain/irritability
- Decreased TM mobility
- Distorted landmarks
- Displaced light reflex
- Dull, opaque TM
- Possible bulging TM
- Fever
- GI symptoms (n/v)
- Diminished hearing
- Pulling on ear
- Dizziness
What are the assessment findings for OME?
- Usually asymptomatic
- Dull TM
- Decreased mobility
- Visible air-fluid interface (bubbles)
- Visible air bubbles
- Diminished hearing
Name 3 differential diagnosis for otitis media
- Otitis externa may present like AOM with TM rupture
- Tumors (cholesteatoma)
- Referred pain from jaw or teeth
What diagnostic studies are suggested for otitis media?
- Pneumatic otoscopy
- Tympanometry to measure TM compliance
- Considere referral for tympanocentesis to obtain culture (rarely performed)
What prevention measures can be taken with regards to otitis media?
- Breastfeeding
- Avoid cigarette smoke exposure
- Do not put baby to sleep in horizontal position with bottle
- Antibtx prophylaxis for recurrent AOM (controversial)
What are the non pharmacological management for OM?
- Local heat
- Myringotomy
- Swallowing to help the eustachian tube ventilate
- Patient and family education regarding treatment, disease, comfort measures, etc.
What pharmacological management can be taken for OM?
- Analgesics (acetaminophen, ibuprofen, otalgic drops)
- Oral antibiotics PCN - Amoxicillin considered 1st line - unless pt has had antibtx exposure in last 90 days
- Amoxcillin/clavulanate 875 mg 1 tab q12 x10 days - 1st line if antibitx in last 90 days or pt has severe illness
