MDT EAR Eustachian Tube Dysfunction, TM PERF Flashcards
The _____ is a tube that links the nasopharynx to the middle ear.
Eustachian tube
What represents a spectrum of disorders
involving an impairment in the functional valve of the Eustachian tube of the middle ear?
Eustachian tube dysfunction (ETD)
ETD can be classified as a patulous dysfunction, in which the Eustachian tube is _______ or ________in which there is failure of the tubes to dilate appropriately.
excessively open, or dilatory dysfunction
True/False
Under normal circumstances the Eustachian tube is closed but can open to release a small amount of air to equalize pressure between the middle ear and the surrounding atmosphere.
True
PT has these issues what would you suspect?
(1) Severe Ear Pain
(2) Fullness or “under water sensation”.
(3) Hearing loss or “muffled hearing”
(4) Tinnitus
(5) “Popping or snapping noises”
Eustachian Tube Dysfunction
Differential Diagnosis for ETD
(1) Tympanic membrane perforation
(2) Barotrauma
(3) Meniere disease
True/False
Radiologic studies are performed for routine cases.
False
not performed for routine cases
What test would you order for conductive hearing loss to established baseline with condition?
Audiometric testing
What are some med options for ETD
(a) Pseudoephedrine 60mg q4-6h PRN
(b) Oxymetazoline 1-2 sprays each nostril q12h PRN (limit use to 3 days)
(c) Fluticasone propionate (Flonase) 1-2 sprays each nostril daily PRN
(d) Cetirizine (Zyrtec) 5-10mg PO daily PRN
(e) Fexofenadine (Allegra) 60mg PO BID PRN
Routine follow up care PRN for mild ETD cases. Chronic cases, monitor pressure equalization tubes how often?
every 6-12 months
Complications for ETD
(1) Hearing Loss
(2) Morbidity related to hearing compromise
(3) Chronic ear infections
______ can occur secondary to middle-ear infections or as a result of barotrauma, blunt/penetrating/acoustic trauma, or, on rare occasions, lightning
strikes.
TM perforations
When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the ______, usually anteriorly or inferiorly
Pars tensa
What is the largest area of the TM, has only a few cell layers thick and thus is easily torn.
The pars tensa
pt has these issues what would you suspect?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
TM Perf
pt has these issues how would you TREAT this?
Acute onset of pain and hearing loss; associated vertigo or tinnitus (usually transient, unless injury to inner ear); nausea and vomiting; history of recurrent ear infections.
PE findings
Visible perforation of the tympanic membrane; otorrhea (pus, blood, or clear fluid from canal).
Foreign material is suspected to remain in the canal or in the middle ear so place on systemic antibiotics.
(a) Augmentin 875 mg PO BID x 7 days OR
(b) Doxycycline 100mg PO BID x 7 days
DDX for TM perf
(1) Barotraumas
(2) Otitis Media
(3) Foreign bodies
If there is a TM perf secondary to penetrating trauma what must be done within 24 hours?
Refer to an otolaryngologist
True/False
TM Perf Patients should be instructed not to allow water to enter the canal of the ear.
True
True/False
Use of earplugs should be avoided to prevent water from entering the affected ear.
FALSE
Use earplugs
Complications of TM perf
(1) Chronic perforations
(2) Ossicular chain disruption (will require middle ear exploration).
What would you suspect?
PT has an hx of prolonged eustachian tube dysfunction
Otoscopic examination revealed an epitympanic retraction pocket or a marginal tympanic membrane perforation that exudes keratin debris, or granulation tissue.
Cholesteatoma
The most common cause of Cholesteatoma is what?
prolonged eustachian tube dysfunction, with inward migration of the upper flaccid portion of the tympanic membrane
_____ is a benign tumor (composed of stratified squamous epithelium) in the middle ear or mastoid.
Cholesteatoma
DDx for Cholesteatoma
(1) Inner ear erosion
(2) Chronic otitis media
What studies is ordered for cholesteatoma?
Computerized tomography (CT) to visualize the bony destruction
How is this treated?
Surgical marsupialization of the sac or its complete removal
What is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit, so that the site remains open and can drain freely?
Marsupialization
What are complications of Cholesteatoma
(1) Bone erosion
(2) Inner ear erosion with facial nerve and intracranial involvement
(3) Death
