MDT EAR Eustachian Tube Dysfunction, TM PERF

Question 1

The _____ is a tube that links the nasopharynx to the middle ear.

Answer 1

Eustachian tube

Question 2

What represents a spectrum of disorders
involving an impairment in the functional valve of the Eustachian tube of the middle ear?

Answer 2

Eustachian tube dysfunction (ETD)

Question 3

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.

Answer 3

excessively open, or dilatory dysfunction

Question 4

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.

Answer 4

True

Question 5

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”

Answer 5

Eustachian Tube Dysfunction

Question 6

Differential Diagnosis for ETD

Answer 6

(1) Tympanic membrane perforation
(2) Barotrauma
(3) Meniere disease

Question 7

True/False
Radiologic studies are performed for routine cases.

Answer 7

False
not performed for routine cases

Question 8

What test would you order for conductive hearing loss to established baseline with condition?

Answer 8

Audiometric testing

Question 9

What are some med options for ETD

Answer 9

(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

Question 10

Routine follow up care PRN for mild ETD cases. Chronic cases, monitor pressure equalization tubes how often?

Answer 10

every 6-12 months

Question 11

Complications for ETD

Answer 11

(1) Hearing Loss
(2) Morbidity related to hearing compromise
(3) Chronic ear infections

Question 12

______ can occur secondary to middle-ear infections or as a result of barotrauma, blunt/penetrating/acoustic trauma, or, on rare occasions, lightning
strikes.

Answer 12

TM perforations

Question 13

When perforation is secondary to blunt or noise trauma, the perforation almost always occurs in the ______, usually anteriorly or inferiorly

Answer 13

Pars tensa

Question 14

What is the largest area of the TM, has only a few cell layers thick and thus is easily torn.

Answer 14

The pars tensa

Question 15

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).

Answer 15

TM Perf

Question 16

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).

Answer 16

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

Question 17

DDX for TM perf

Answer 17

(1) Barotraumas
(2) Otitis Media
(3) Foreign bodies

Question 18

If there is a TM perf secondary to penetrating trauma what must be done within 24 hours?

Answer 18

Refer to an otolaryngologist

Question 19

True/False
TM Perf Patients should be instructed not to allow water to enter the canal of the ear.

Answer 19

True

Question 20

True/False
Use of earplugs should be avoided to prevent water from entering the affected ear.

Answer 20

FALSE
Use earplugs

Question 21

Complications of TM perf

Answer 21

(1) Chronic perforations
(2) Ossicular chain disruption (will require middle ear exploration).

Question 22

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.

Answer 22

Cholesteatoma

Question 23

The most common cause of Cholesteatoma is what?

Answer 23

prolonged eustachian tube dysfunction, with inward migration of the upper flaccid portion of the tympanic membrane

Question 24

_____ is a benign tumor (composed of stratified squamous epithelium) in the middle ear or mastoid.

Answer 24

Cholesteatoma

Question 25

DDx for Cholesteatoma

Answer 25

(1) Inner ear erosion (2) Chronic otitis media

Question 26

What studies is ordered for cholesteatoma?

Answer 26

Computerized tomography (CT) to visualize the bony destruction

Question 27

How is this treated?

Answer 27

Surgical marsupialization of the sac or its complete removal

Question 28

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?

Answer 28

Marsupialization

Question 29

What are complications of Cholesteatoma

Answer 29

(1) Bone erosion (2) Inner ear erosion with facial nerve and intracranial involvement (3) Death