ISE ENT 4 (Ear disorders)

Question 1

connections of middle ear

Answer 1

anteriorly with nasopharynx via eustachian tube
posteriorly with mastoid air spaces via the aditus ad antrum

Question 2

structures typically visible through the TM

Answer 2

incus
malleus handle
malleus lateral process

Question 3

what is tinnitus

Answer 3

perception of sound without external stimulation
-most prevalent bet 40 and 70y

Question 4

sudden hearing loss

Answer 4

occurs over 3 days

Question 5

Meniere’s disease

Answer 5

hearing loss
tinnitus
vertigo

Question 6

treatment of idiopathic sensorineural hearing loss

Answer 6

prednisone 60mg OD x 7-14 days
follow-up within 2 weeks

Question 7

most common organisms causing otitis externa

Answer 7

Pseudomonas
S aureus
S epidermidis
Enterobacteriaceae

Question 8

topical agentss for acute otits externa that are safe with perforations

Answer 8

Ciprofloxacin, dexamethasone
Ofloxacin

Question 9

Other topical ear agents

Answer 9

Ciprofloxacin, hydrocortisone
2% acetic acid solution
Acetic acid, hydrocortisone

Neomycin/polymyxin B/hydrocortisone
-ototoxic; avoid in chronic otitis externa

Question 10

ear antifungals

Answer 10

topical clotrimazole 1% solution
oral fluconazole

Question 11

causes of malignant otitis externa

Answer 11

Pseudomonas
MRSA

Question 12

features of malignant otitis externa

Answer 12

persistent otitis externa despite 2-3 weeks of topical antimicrobial therapy

severe otalgia
edema of EAC
otorrhea

granulation tissue

Question 13

nerve involvement in malignant otitis externa

Answer 13

first:
CN VII

severe:
CN IX
CN X
CN XI

Question 14

treatment of malignant otitis externa

Answer 14

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

Question 15

most common bacteria in acute OM

Answer 15

S pneumoniae
H influenzae
MRSA
Pseudomonas

Question 16

most common bacteria iin chronic OM

Answer 16

S aureus
Pseudomonas
Aspergillus
Anaerobes

Question 17

treatment of acute OM

Answer 17

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

Question 18

perforation of TM in OM heals within

Answer 18

1 week

Question 19

remarks on mastoiditis

Answer 19

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

Question 20

intracranial complications of OM

Answer 20

most common:
meningitis and brain abscess

most prevalent causative organisms:
S pneumoniae
N meningitidis

Question 21

give another complication of acute OM

Answer 21

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

Question 22

live objects in the ear should be drowned with

Answer 22

2% lidocaine solution

Question 23

softening of cerumen

Answer 23

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

Question 24

TYMPANIC MEMBRANE PERFORATION

Answer 24

almost always occurs in the pars tensa, usually anteriorly or inferiorly