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Clin Specialties - EMed > Lecture 1 - ENT > Flashcards

Lecture 1 - ENT Flashcards

1
Q

What questions are important to ask when assessing a pt with hearing loss?

A 
Sudden or gradual?
One ear or both?
Associated sxs? Tinnitus?
Conductive or sensory?
Recent illness?
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2
Q

What can cause sensory hearing loss?

A 
Acoustic trauma 
Acoustic neuroma
Presbycusis
Menieres disease
Noise damage 
Ototoxic drugs 
Infectious (Mumps, measles, herpes, syphilis, meningitis)
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3
Q

Hematoma of the pinna can cause what kind of hearing loss?

A

Conductive hearing loss

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4
Q

What is the treatment for hematoma of the pinna?

A

Incision or needle aspiration of hematoma
Auricular pressure dressing with 48 hour follow up
ABX prophylaxis

Fill in the ear with vaseline gauze
Then take 4x4 and cut out the shape of the ear

“If the dressing falls off, come back in and we’ll put it back on”

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5
Q

Cerumen impaction treatment

A

Not usually an emergency, but can cause pain, pressure, vertigo, and hearing loss

Irrigation is the best way

30-60 cc syringe with a soft silicone catheter and warm water

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6
Q

What age group is most common to have otic foreign bodies?

A

<8 years age

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7
Q

What is the ideal way to remove a foreign body from the ear canal?

A

Irrigation

DO NOT use if TM is ruptured or if the FB is an insect

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8
Q

Otitis Externa

A

Inflammation or infection of canal or auricle (or both)

May have fever, hearing changes, otorrhea, canal swelling/fullness

Often seen with recent water exposure

Tenderness with tragal palpation or with traction of the external ear
Periauricular adenitis may be present, but it is not necessary for the dx

TM may be inflamed but it should be normally mobile on insufflation

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9
Q

What are the different types of otitis externa?

A

Acute: MC (swimmers ear)

Chronic: >6 weeks (FB, hearing aids)

Eczematous: dermatologic conditions

Necrotizing/malignant

Abscess, folliculitis, cellulitis

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10
Q

How do you dx otitis externa?

A

Typically just by hx and pe

Can do blood glucose
High res CT “thin temporal cuts” —if progression to malignant OE or mastoiditis

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11
Q

What is the treatment of otitis externa?

A

Topical
Non-ototoxic only
ABX drops (psuedomonas coverage)

Ofloxacin (3-4 drops bid or ciprodex)

Acetic acid solution (for bacterial, eczema and fungal etiologies)

Admission if necrotizing

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12
Q

What are the signs and sxs of mastoiditis?

A 
Fever or chills 
Pain 
Swelling
Erythema at mastoid process
Typically an extension of AOM or AOE

S. Pneumoniae
S pyogenes
S aureaus

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13
Q

What is the treatment for mastoiditis?

A 
ENT consultation 
Admission 
IV abx: cefotaxime 1g IV q24h 
Or 
Ceftriazone 1-2g IV q 24 hours
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14
Q

What can cause TM perforation?

A 
Trauma (red flag for abuse) 
FB 
Iatrogenic
OM
Scuba, air travel
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15
Q

What are the signs and sxs of TM perforation?

A

Sxs

  • otorrhea
  • hearing changes/tinnitus
  • pain

Signs

  • size perforation as percent of membrane
  • traumatic perforations often lack discharge
  • weber lateralizes to side of perforation
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16
Q

What is the treatment for TM perforation?

A 
Keep ear dry 
Refer to ENT and audiology 
TM perforation from infectious etiology 
-cortisporin otic suspension 1 drop qid
-ciprofloxacin ophthalmic 
Traumatic TM perforation 
-no ABX needed unless signs of infection develop 
-urgent referral if hearing loss and/or vertigo
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17
Q

What are the signs and sxs of barotrauma?

A 
Abrupt onset of pain, feeling of fullness in ear
Conductive hearing loss
Dizziness
Tinnitus
Vertigo
N/V
Transient facial paralysis 
TM rupture with valsalva maneuver 
Crying in children
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18
Q

Who is most common to experience barotrauma?

A 
Air travelers
Scuba divers
Decompression 
Hyperbaric oxygen chambers 
Rapid pressure change 
Blast injuries
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19
Q

What is the treatment for barotrauma?

A

Open the eustachian tube: chew gum, valsalva maneuver, yawn, infants/kids should drink something during the landing/takeoff
Divers descend/ascend slowly

Meds:
Antihistamines
Decongestants
ABX to prevent infection 
Surgery if severe
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20
Q

What should you keep in mind for a pt with middle ear hematoma?

A

Trauma —evaluate for other signs of trauma

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21
Q

What is the treatment for middle ear hematoma?

A

Watchful waiting

No ABX unless signs of infection develop

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22
Q

What is the prognosis for middle ear hematoma?

A

Hearing can go back to baseline if the ossicles have no been fractured or dislocated

Hearing should return to normal in 6-8 weeks

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23
Q

What are the different types of otitis media?

A

acute otitis media
Chronic otitis media
Recurrent AOM
Otitis media with effusion

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24
Q

AOM

A

Acute otitis media

Almost always viral —will go away on their own —BUT for child under 2 we treat with ABX

Usually antecendent sxs of URI

Sxs: 
Adult: 
Ear pain, hearing loss, tinnitus (MC) 
Children: 
Fever, irritability, otorrhea, lethargy, otaliga of sudden onset, ear tugging, poor sleeping, poor feeding 
Signs: 
Eardrum mobility decreased 
Eardrum bulging 
No light reflex 
Not able to see bony landmarks 
Redness

Give the pt a prescription for ABX but tel them not to fill it for a few days and instead try NSAIDs and decongestants

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25
What are the signs of AOM in adults?
Ear pain Hearing loss Tinnitus
26
What do you tell a person coming in for ear pain that is traveling tomorrow?
Serous? Bollous? AOM 100% they’re going to get TM perforation if they are to fly tomorrow DOCUMENT
27
What is the first line treatment for AOM?
Amoxicillin 500mg PO tid x 7-10 days Second line augmentin
28
Peripheral vertigo
Abrupt onset ``` Benign positional vertigo Acute vestibular neruonitis Suppurrative labyinthis Menieres disease Acoustic neuroma ```
29
Central vertigo
Gradual process ``` Cerebrovascular disease Cerebellar degeneration Migraine MS EtOH intoxication Tumors of the brainstem or cerebellum Phenytoin toxicity ```
30
What questions do you need to ask when evaluating vertigo?
``` Recent use of vestibulotixic drugs Caffeine intake Nictoine use EtOH use Head trauma ``` Spinning? Was the room spinning? Were you spinning? Which direction?
31
What is the management for peripheral vertigo?
IV hydration (for pts with prolonged nausea or poor fluid intake) Medications: Mecliizine (antivert) 25-50mg PO q 8-12 hours OR Diazepam (valium) 5-10mg IV or 2-4mg IM
32
Vestibular Neuronitis
Labyrinthitis Signs/sxs: Vertigo, dizziness, hearing loss (fluctuating), N/V, tinnitus, malaise, nystagmus Be sure to think of other possibilities: Stokes can cause vertigo, dehydration can cause vertigo, think of ALL the possibilities
33
What advice do you have for pts with vertigo having an acute attack?
Lie still with eyes closed in a darken room
34
What are the signs and sxs of Meniere’s disease?
Unilateral hearing loss Tinnitus Vertigo with sudden onset and short duration (1-24h) Intense, recurrent, vertigo associated with N/V and distress, ear pressure, nystagmus during attacks
35
How do you treat miniere's disease?
low salt diet meds for vertigo surgery for severe cases refer to ENT
36
“I just KEEP getting nosebleeds”
Refer to ENT | Possible polyps
37
Which artery is most commonly responsible for posterior nose bleeds?
Sphenopalantine artery
38
How do you treat epistaxis?
``` Have pt blow their nose Afrin (oxymetazoline) - vasoconstrict Direct pressure for 20 minutes 2% lidocaine with epinephrine Cauterize using silver nitrate (no more than 5 seconds) Add bactiracin to the cauterized area Pack the nose if cautery doesnt work ```
39
Rapid rhino is made by what material?
Hydrocolloid fabric
40
Who gets admitted in regards to epistaxis?
All posterior epistaxis
41
How long are noses packed for epistaxis?
Actual duration will vary according to the pts particular needs Anterior pack at least 24-48 hours —the pts need to come back to see you —moisten the packing before removing it Posterior pack —refer to ENT —packing must retain for 72-96 hours Prophylaxis for TSS since this is a foreign body (cephalexin, amoxicllin, bactrim)
42
Perennial allergic rhinitis
Occurs all year and is usually caused by home or workplace airborne pollutants
43
How can you tell the difference between sinusitis and rhinitis?
Both have nasal congestion Sinusitis has HA, facial pain, postnasal drip, cough, fever Rhinitis has clear rhinorrhea, itching red eyes, nasal crease, seasonal sxs
44
What is the most common cause of sinusitis?
Viral
45
Chronic sinusitis is defined by what?
>12 weeks
46
Septal Hematoma
trauma to anterior portion of nasal septum tearing of submucosal blood vessels blood accumulates between mucopericondrium and septal cartilage may be unilateral or bilateral can result in: septal abscess septal perforation catilage destruction with saddle nose deformity can occur up to 72 hours after injury tx: I and D
47
How do you treat septal hematoma?
``` I and D topical anesthesia (1:1 mix of oxymetazoline and 4% topical lidocaine) #11 blade scalpel frazier suction nasal saline nasal packing ```
48
What is a mainstay of pain treatment for dental injuries?
dental block NO OPIODS
49
Ellis Classification System
tooth fracture 1 = enamel alone (chipped tooth, cosmetic) 2 = dentin 3 = pulp (emergent)
50
What is the treatment for type 3 tooth fracture?
at risk for bacterial penetration irrigate with saline, dry it then cover with calcium hydroxide paste or foil refer to dental asap (within 24 hours)
51
Sialoadenitis
infection of the major salivary glands by retrograde transmission of bacteria from oval cavity via the salivary duct tx: lemon heads ABX: Pen VK if you think its infected
52
Sialolithiasis
formation of hardened deposits in the ductal salivary gland system colicky postprandial pain and swelling ``` tx: lemon drops NSAIDs antibiotic coverage of staph increase oral intake ```
53
Why do we treat strep throat?
risk of bad sequele: rheumatic fever glomerulonephritis
54
What is the treatment for pharyngitis?
``` PCN Erythromycin Cefuroxime Clarithromycin Azithromycin ```
55
Who get admitted for pharyngitis?
dehydrated pts
56
What is one of the most common infections of the neck?
peritonsillar abscess
57
Hot potato voice
peritonsillar abscess
58
What are the signs and sxs of peritonsillar abscess?
``` lateral, progressively worsening sore throat fever dysphagia otalgia odynophagia ``` swollen tonsil with contralateral uvular deviation trismus (inability to open your mouth) cervical lymphadenopathy
59
How do you dx peritonsillar abscess?
neck CT (soft tissue) with control gold standard: needle aspiration
60
What is the treatment for peritonisllar abscess?
I and D or needle aspiration ABX (augmentin or clindamycin) Fluids Steroids
61
What is augmentin is not available to treat peritonsillar abscess, what else can you use?
clindamycin
62
How do you needle aspirate a peritonsillar aspiration?
``` pt sitting upright have suction available benzocaine spray lidocaine with epinephrine needle guard (so you only go in ever so slightly - only 0.5cm) ```
63
What is the workup for pharyngeal foreign bodies?
indirect or direct fiberoptic laryngoscopy xray of soft tissue Chest xray barrium swallow or gastrografin if you suspect esophageal perforation

Clin Specialties - EMed (11 decks)

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