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Senoir 21-2 > MIDDLE EAR! > Flashcards

MIDDLE EAR! Flashcards

1
Q

What is the Eustachian tube

A

Tube that links the pharynx to the middle ear
~35mm long in adults

Functions:
Pressure equalization
Mucus drainage

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2
Q

What are the two types of Eustachian tube D/o

A

Patulous Eustachian tube

Eustachian tube dysfunction (AKA Dilatory type)

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3
Q

A pt presents with a Eustachian tube d/o that is worse when exercising and better with a URI

Has S/s of aural fullness and increased auto phony

Think

A

Patulous Estachian tube defect

RARE

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4
Q

What are the common causes Eustachian tube defects

A

Rapid weight loss, NMD/o, idiopathic

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5
Q

Should pt with patulous eastachian tube befects feet decongestants

A

NO!

Then need vent tubes and on rare occasions surgery

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6
Q

What are the common causes of dilatory Eustachian tube dysfunction

A

MC- Diseases causing edema of the tubal lining

  • Viral URI
  • Allergy

Others

  • Irritants
  • Pregnancy
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7
Q

What would you find on physical exam for a Dillatory dysfunction

A

A retracterd TM with decreased motility

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8
Q

What is the tx for Eustachian tube dysfunction after a viral illness

A
  • Pseudoephedrine 60 mg po q 4-6 hrs and/or
  • Oxymetazoline 0.05% spray q 8-12 hrs (<3-5 days)

-Autoinflation- if no active infection

INS!!!
(Fluticasone, or betamethasone)

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9
Q

What are the common caused of serous otitis media

A

Most common in children

URI, Allergies, barotruama

And if persistent think Naopharyngeal CA

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10
Q

When does the Eustachian tube reach adult length

A

By age 6

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11
Q

A child presents with a dull hypo mobile TM with bubble behind r the TM with conductive hearing loss

Think

A

Serous Otitis media

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12
Q

What is the Treatment for serous otitis media

A

Decongestants- oral and intranasal

Intranasal corticosteroids
With autoinflation (Valsalva)- if no URI!!!

Surgical interventions- laser or balloon dilation

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13
Q

A pt presents with ear pain, recent URI, HL, and aural pressure, with a white/yellow TM, and dilated blood vessels
And a hypomobile TM with occasional Bullae
+FEVER

Think

A

Acute otitis media

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14
Q

What are the HSSM of acute otitis media

A 
“HiSSM”
Haemophilus influenzae
Streptococcus pneumoniae
Streptococcus pyogenes 
Moraxella catarrhalis (kids)
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15
Q

What is the tx approach to acute otitis media

A

ANAGLESICS!!

Snap protocol if >2 yr old

If less than 2 or and adult then Targeted ABX

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16
Q

What is SNAP protocol

A

Safety Net Approach to Prescribtions

Clinical suspicion of AOM
Give prescription for ABX
Parent doesn’t fill Rx unless child’s condition worsens or does not improve in 48 hours
Proven to lessen # of filled Rx

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17
Q

1st line ABX for acute otitis media

What are the 2nd line for resistant strains?

A

First line-

Kids- Amoxicillin 80-90 mg/kg/day (divided into 2 doses)
Adults- 1g q 8hrs

5-7 day course!!!

PCN allergic
Azithromycin

2nd line:

Second line- for resistant strains
Amoxicillin/clavulanate (Augmentin)
Cefuroxime
Cefpodoxime

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18
Q

What is the common skin ADE of Amoxiciilin

A

Amoxicillin Rash

It’s not a big deal
But do a monspot to r/o mono

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19
Q

What defines recurrent Ottitis media and what is the Tx

A

3-4 bouts in 6 months or 5-6 bouts/year

Daily sulfamethoxazole or amoxicillin for 1-3 months

If ABX fail->ear tubes

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20
Q

A. A myringotomy tube for otitis media presents with bloody or purulent D/c what with the Tx approach

A

Treat with topical fluoroquinolone- Ofloxacin drops

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21
Q

What are the ways to prevent acute otitis media in kids

A

Breastfeeding
Pneumococcal conjugate vaccine
Avoid tobacco smoke
Avoid daycare

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22
Q

What are the diffenent bacteria responsible for CHRONIC Otitis media

A

PSUEDOMONAS!

Proteus Spp
And STAPH!

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23
Q

What are the provicating factors that lead to pain with chronic otitis media

A

Increased during URI and Water exposure

24
Q

What is the Tx for Chronic Otitis Media

A

Remove any infected debris

Advise water precautions

Cipro x 1-6 weeks

Fluoroquinolones

25
Q

What is the Rx for chronic Otitis media drainage and exacerbations ?

A

Chronic drainage
-Oral ciprofloxacin 500 mg daily for 1-6 weeks

Exacerbations
—Topical floroquinolone

26
Q

What are the surgical treatment options for chronic otitis media

A

Surgical repair of TM- ENT referal

Simultaneous mastoidectomy
-If mastoid air cells are involved
CT scan to determine mastoid involvement.

27
Q

A pt with chronic otitis media presents with air cells in the mastoid on CT scan

What is the tx option

A

mastoidectomy

28
Q

A pt with chronic Eustachian tube dysfunction is at risk of developing what condition

A

Cholesteatoma and hearing loss

Negative pressure leads to retraction pocket in the TM, + keratin debris

29
Q

You see a epitympanic retraction pocket of the TM

THINK

A

Cholesteatoma

30
Q

What is the Tx approach to Cholesteatoma

A

SURGR!Y REFERAL!

Need frequent follow ups becasue ETD is still prevalent and can reoccur

31
Q

What is the major progression of complication in a pt with Cholesteatoma

A

Bone erosion can lead to destruction of the mastoid and destruction of the ossicualr chain

Resulting in hearing loss
-dizzyness, facial nerve palsy’s
And eventually meningitis and brain abscess!!!

32
Q

S/s of mastoiditis

A

SPIKING fever and post auricular pain

33
Q

Common pathogens of mastoiditis

A

HISS no M

H. Flu
Strep
Strep

No MOX

34
Q

What does mastoiditis look like on CT scan

A

Decreased air in the mastoid

35
Q

What is the Tx approach to mastoiditis

A

Admit!!
IV Cefazolin 1 6-8 hours

If ABX fail then mastoidectomy

36
Q

What is grandenigo syndrome

A

Seep otalgia, Foul d/c, and retro orbital pain

Assoc with petrous apicitis

37
Q

A pt presents with deep otalgia, Foul d/c, Retro orbital pain and 6ht nerve palsy

Think

A

Petrous Apicitis

38
Q

What is the tx for petrous apicitis

A

Long term ABX

And Surgical drainage of the petrous apex to prevent meningitis

39
Q

What is the cause of acial never paralysis

A

Bacterial neuro toxins

40
Q

What is the Tx for a facial nerve paralysis

A

Myringotomy for drainage and culture

ABX based on culture

41
Q

What are the s.s of sigmoid sinus thrombosis

A

Spiking fever, chills, ICP, HA, N/V/ lethargy and papiledema

42
Q

What is the imaging and Tx for sigmoid sinus thrombosis

A

MRV!!

Treat with IV ABX
+ surgical ligation of the internal jugular if an embolus forms

43
Q

What is the most common intracranial ear infection complication?

A

CNS infection

2/2 either S. Pneumo or H. Flue

44
Q

This is a familial disease where the ossicle of the ear harden progressively and become hypomobile

Sound doesnt pass through the bones

Treated ti hearing aid of stapes prosthesis

May even lead to prem HL is the cochlea are affected

Think

A

Osteosclerosis

45
Q

What is the general appraoch to truama to the ear/ TM

A

Usually spont. Resolves

Advise on water precaution

Common complication is infection after water exposure.

46
Q

When should you refer someone with truama to the ear to ent

A

If CHL > 30 DB lasts over 3 months

47
Q

What is the pt f/u after trauma to the ear/tm

A

At least month to track progression of healing

48
Q

A pt presents wtih Pulsatile tinnitus

What is the imaging and Tx?

A

MRA and MRV!!

Refer for Surgery

This is a high index for neoplasia

49
Q

A pt presents with pain out of proportion and vessicles on the EAC

Think

A

herpes zoster oticus

50
Q

What is the treatmetn appraoch for a pt with persistent pain and drainage from the ear

A

Refer!!

This could be cancer or osteomyelitis

51
Q

What is the high index DDx for a pt with pain with chewing or grinding teeth and a ear ache

A

TMJ dysfunction

Treat with a soft diet and dental referral

52
Q

What is the tx for Glossopharyngeal neuralgia

A

Pt with Present with an earache and reperated lanciating pain

Treat with Carbamazepine q 8 hours

53
Q

If barotruama worse on accent or decent

A

Descent

54
Q

How can you prevent barotruama to the ear

A

Swallow, yawn, autoinflate on descent

Oral decongestants several hours before landing

Topical decongestant 1 hour before landing

55
Q

What is the tx for severe hearing loss from barotruama

A

Myringotomy

56
Q

If you can not equalize your ear pressures on a dive when should you abort ( at what feet)

A

First 15 feet

57
Q

What is the most dangerous complication of barotruama on a dive

A

Perilymphatic fistula

  • Oval or round window ruptures
  • Immediate Emesis and vertigo
  • Very dangerous!

Senoir 21-2 (77 decks)

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