MIDDLE EAR! Flashcards by Demetré Harris

What is the Eustachian tube

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

Functions:
Pressure equalization
Mucus drainage

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What are the two types of Eustachian tube D/o

Patulous Eustachian tube

Eustachian tube dysfunction (AKA Dilatory type)

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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

Patulous Estachian tube defect

RARE

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What are the common causes Eustachian tube defects

Rapid weight loss, NMD/o, idiopathic

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Should pt with patulous eastachian tube befects feet decongestants

NO!

Then need vent tubes and on rare occasions surgery

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What are the common causes of dilatory Eustachian tube dysfunction

MC- Diseases causing edema of the tubal lining

Viral URI
Allergy

Others

Irritants
Pregnancy

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What would you find on physical exam for a Dillatory dysfunction

A retracterd TM with decreased motility

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

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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What are the common caused of serous otitis media

Most common in children

URI, Allergies, barotruama

And if persistent think Naopharyngeal CA

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When does the Eustachian tube reach adult length

By age 6

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

Think

Serous Otitis media

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What is the Treatment for serous otitis media

Decongestants- oral and intranasal

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

Surgical interventions- laser or balloon dilation

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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

Acute otitis media

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What are the HSSM of acute otitis media

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

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What is the tx approach to acute otitis media

ANAGLESICS!!

Snap protocol if >2 yr old

If less than 2 or and adult then Targeted ABX

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What is SNAP protocol

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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1st line ABX for acute otitis media

What are the 2nd line for resistant strains?

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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What is the common skin ADE of Amoxiciilin

Amoxicillin Rash

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

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What defines recurrent Ottitis media and what is the Tx

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

Treat with topical fluoroquinolone- Ofloxacin drops

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What are the ways to prevent acute otitis media in kids

Breastfeeding
Pneumococcal conjugate vaccine
Avoid tobacco smoke
Avoid daycare

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What are the diffenent bacteria responsible for CHRONIC Otitis media

PSUEDOMONAS!

Proteus Spp
And STAPH!

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

Increased during URI and Water exposure

What is the Tx for Chronic Otitis Media

Remove any infected debris

Advise water precautions

Cipro x 1-6 weeks

Fluoroquinolones

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

Chronic drainage -Oral ciprofloxacin 500 mg daily for 1-6 weeks Exacerbations —Topical floroquinolone

What are the surgical treatment options for chronic otitis media

Surgical repair of TM- ENT referal Simultaneous mastoidectomy -If mastoid air cells are involved CT scan to determine mastoid involvement.

A pt with chronic otitis media presents with air cells in the mastoid on CT scan What is the tx option

mastoidectomy

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

Cholesteatoma and hearing loss Negative pressure leads to retraction pocket in the TM, + keratin debris

You see a epitympanic retraction pocket of the TM THINK

Cholesteatoma

What is the Tx approach to Cholesteatoma

SURGR!Y REFERAL! Need frequent follow ups becasue ETD is still prevalent and can reoccur

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

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!!!

S/s of mastoiditis

SPIKING fever and post auricular pain

Common pathogens of mastoiditis

HISS no M H. Flu Strep Strep No MOX

What does mastoiditis look like on CT scan

Decreased air in the mastoid

What is the Tx approach to mastoiditis

Admit!! IV Cefazolin 1 6-8 hours If ABX fail then mastoidectomy

What is grandenigo syndrome

Seep otalgia, Foul d/c, and retro orbital pain Assoc with petrous apicitis

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

Petrous Apicitis

What is the tx for petrous apicitis

Long term ABX | And Surgical drainage of the petrous apex to prevent meningitis

What is the cause of acial never paralysis

Bacterial neuro toxins

What is the Tx for a facial nerve paralysis

Myringotomy for drainage and culture ABX based on culture

What are the s.s of sigmoid sinus thrombosis

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

What is the imaging and Tx for sigmoid sinus thrombosis

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

What is the most common intracranial ear infection complication?

CNS infection 2/2 either S. Pneumo or H. Flue

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

Osteosclerosis

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

Usually spont. Resolves Advise on water precaution Common complication is infection after water exposure.

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

If CHL > 30 DB lasts over 3 months

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

At least month to track progression of healing

A pt presents wtih Pulsatile tinnitus What is the imaging and Tx?

MRA and MRV!! Refer for Surgery This is a high index for neoplasia

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

herpes zoster oticus

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

Refer!! | This could be cancer or osteomyelitis

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

TMJ dysfunction Treat with a soft diet and dental referral

What is the tx for Glossopharyngeal neuralgia

Pt with Present with an earache and reperated lanciating pain Treat with Carbamazepine q 8 hours

If barotruama worse on accent or decent

Descent

How can you prevent barotruama to the ear

Swallow, yawn, autoinflate on descent Oral decongestants several hours before landing Topical decongestant 1 hour before landing

What is the tx for severe hearing loss from barotruama

Myringotomy

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

First 15 feet

What is the most dangerous complication of barotruama on a dive

Perilymphatic fistula - Oval or round window ruptures - Immediate Emesis and vertigo - Very dangerous!