ISE ENT 4 (Ear disorders) Flashcards
connections of middle ear
anteriorly with nasopharynx via eustachian tube
posteriorly with mastoid air spaces via the aditus ad antrum
structures typically visible throught the TM
incus
malleus handle
malleus lateral process
what is tinnitus
perception of sound without external stimulation
-most prevalent bet 40 and 70y
sudden hearing loss
occurs over 3 days
Meniere’s disease
hearing loss
tinnitus
vertigo
treatment of idiopathic sensorineural hearing loss
prednisone 60mg OD x 7-14 days
follow-up within 2 weeks
most common organisms causing otitis externa
Pseudomonas
S aureus
S epidermidis
Enterobacteriaceae
topical agentss for acute otits externa that are safe with perforations
Ciprofloxacin, dexamethasone
Ofloxacin
Other topical ear agents
Ciprofloxacin, hydrocortisone
2% acetic acid solution
Acetic acid, hydrocortisone
Neomycin/polymyxin B/hydrocortisone
-ototoxic; avoid in chronic otitis externa
ear antifungals
topical clotrimazole 1% solution
oral fluconazole
causes of malignant otitis externa
Pseudomonas
MRSA
features of malignant otitis externa
persistent otitis externa despite 2-3 weeks of topical antimicrobial therapy
severe otalgia
edema of EAC
otorrhea
granulation tissue
nerve involvement in malignant otitis externa
first:
CN VII
severe:
CN IX
CN X
CN XI
treatment of malignant otitis externa
Ciprofloxacin 400 mg IV every 8 hours
selected cases of early infection:
ciprofloxacin 750 PO 2-3x daily
Possible surgical debridement with otolaryngology
if septic:
cover MRSA and pseudomonas
most common bacteria in acute OM
S pneumoniae
H influenzae
MRSA
Pseudomonas
most common bacteria iin chronic OM
S aureus
Pseudomonas
Aspergillus
Anaerobes
treatment of acute OM
Amoxicillin 1000mg tid
alt:
amoxicillin-clavulanate 2000/125mg BID
cefdinir 300mg BID
cefpodoxime 200mg BID
if unresponsive after 72 hours, consider changing to
amoxicillin-clavulanate
levofloxacin
moxifloxacin
if OM with effusion
same antimicrobials but for 3 weeks
perforation of TM in OM heals within
1 week
remarks on mastoiditis
Mastoiditis with bony involvement requires admission for IV antibiotics, tympanocentesis, and myringotomy
most common pathogents:
S pneumoniae
S pyogenes
Pseudomonas
tx:
ceftriaxone 2g IV, or
levofloxacin 750 mg IV
if recurrent
vacomycin +pip/taz, or
imipenem
I&D of subperiosteal abscess or mastoidectomy may ultimately be required
intracranial complications of OM
most common:
meningitis and brain abscess
most prevalent causative organisms:
S pneumoniae
N meningitidis
give another complication of acute OM
LATERAL SINUS THROMBOSIS
-most common symptom: headache
-papilledema, 6th nerve palsy, vetigo
-tx: cefepime 2g IV, metronidazole 500mg IV, vancomycin 1g IV
otolaryngology should be consulted for expected mastoidectomy
live objects in the ear should be drowned with
2% lidocaine solution
softening of cerumen
half-strength hydrogen peroxide
mineral oil
Debrox
for 30 minutes
use body-temperature irrigant to minimize development of vertigo
irrigate along the superior portion of the external 1/3 of EAC
TYMPANIC MEMBRANE PERFORATION
almost always occurs in the pars tensa, usually anteriorly or inferiorly
