1. observation x 3months w/mild hearing impairment 2. freq valsalva 3. medications if seasonal allergies/URI present

Middle Ear Flashcards by David Shelley

the eustachian tube links the (1) to the (2) and is _(3) long in adults

pharynx
middle ear
~35mm

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Eustachian Tube functions

Pressure equalization

Mucus drainage

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{Eustachian Tube} Children @ higher risk of obstruction & reflux of nasopharyngeal secretions & pathogens compared to adults b/c

Shorter ET
Horizontal ET
Immature Floppy elastic cartilage
Larger adenoids

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Essentials to diagnosis of Eustachian tube dysfunction (ETD)

Aural fullness
fluctuating hearing
discomfort w/ barometric pressure changes

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Most common Dilatory ETD

any inflammation

URI & allergies most common

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Tx of Dilatory ETD

Decongestants, antihistamine, or nasal steroids for URI/allergic rhinitis
quit smoking
behavioral modification/PPI

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Serous Otitis Media (SOM)

fluid in middle ear w/o acute signs of illness/inflammation

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SOM Tx

observation x 3months w/mild hearing impairment
freq valsalva
medications if seasonal allergies/URI present

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If SOM Tx fails what do you do

Pressure Equalization (PE) Tubes
Adenoidectomy
Endoscopic nasopharyngeal orifice widening

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Indication for Pressure Equalization (PE) Tubes

severe / recurrent AOM
hearing loss > 30dB w/o SOM
impending mastoiditis /intra-cranial complication
SOM > 3 months
chronic retraction of TM r/t ETD
Prevention / Tx of barotrauma
Autophony r/t Patulous Eustachian Tube
Craniofacial anomalies
middle ear dysfunction r/t radiation/surgery

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Essentials to AOM diagnosis

otalgia, w/ URI

Erythema & hypomobility of TM

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Diagnosis of AOM

PE findings: erythema, decreased mobility, bulging TM w/o landmarks.

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AOM most common pathogens

S. pneumoniae
H. influenza
S. pyogenes (GABHS)

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AOM Tx

Antibiotics (adults & kids <2yo) Amoxicillin &

antipyretics/analgesic : Motrin/Tylenol

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When to Tx AOM w/ observation

older than 2yo
healthy mild (fever <102.2F)
able to f/u & start antibiotics if gets worse

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Recurrent AOM Definition & Tx

> or = 3 episodes of AOM in 6 months
or = 4 episodes of AOM in 12 months;

Tx with PE tubes

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definition of Chronic Otitis Media (COM)

generally AOM becomes COM between 2 weeks to 3 month

w/chronic otorrhea through perforated TM

bacteria of COM

P. aeruginosa, Proteus species, S. Aureus

Presentation of COM

Hallmark purulent discharge that is continuous/intermittent
pain during exacerbation
chronic hearing loss r/t destruction of ossicular chain, TM, or both
TM perforation present

COM Tx

remove infected debris
topical antibiotics (oflox / cipro w/ dexamethasone) for exacerbations
Cipro 500mg PO BID 1-6weeks
Surgical repair of TM
Mastoidectomy

TM perforation Tx

oflox / Cipro otic if contaminated ear canals
Oral ABX if infection present
<25% of TM surface involvement heal spontaneously

Refer TM Perforation to ENT if

persists >6 week w/ or w/o drainage

perestent subjective hearing loss f/u w/ audiogram and ENT eval

Cholesteatoma

r/t chronic neg middle ear pressure;
Prolonged ETD w/ neg middle ear pressure –> draws upper flaccid portion of TM inward (pars flaccida);
makes squamous epi-lined sac fills w/dessquam keratin & get infected freq
bone errosion
in time errosion of inner ear involving CNVIII & intracranially spread

presentation of cholesteatoma

TM retraction pocket, perforation w/ keratin debris, or granulation tissue

imaging for Cholesteatoma

Tx of Cholesteatoma

1. Surgical excision | 2. PE tubes may be needed to prevent chronic neg pressure

presentation of Mastoiditis

fever posterior ear pain &/or local erythema Edema of pinna /displacement of auricle protruding auricle & loss of postauricular crease

What imaging should be performed if mastoiditis is suspected

what CT findings should prompt immediate ENT consult

coalescence of mastoid air cells r/t destruction of their bony septa

Tx of Mastoiditis

IV ABX | cefazolin 0.5-1.5g q 6-8hrs

Most common bugs for mastoiditis

S. pneumoniae H. influenza S. pyogenes

Tx of mastoiditis w/ ABX failure

myringotomy for culture & drainage mastoidectomy Definitive Tx

Classic Triad of Petrous Apicitis (Petrositis)

1. Retro-orbital pain 2. AOM 3. Abducens nerve paresis (CN VI)

Tx of facial Nerve Paralysis r/t AOM

myringotomy for drainage & culture IV ABX based on culture good prognosis

Tx of facial nerve paralysis r/t COM

surgical correction of cholesteatoma less favorable prognosis

Tx of meningitis due to AOM

myringotomy

Tympanosclerosis

scarring appear as milky white patches on TM limited to middle ear w/ formation of hyaline & calcification in TM leads to Chronic hearing loss r/t decreased mobility of TM & immob of ossicular chain

Diagnosis of Tympanosclerosis

clinical; pneumatic otoscopy demonstrates decreased / absent mobility

Otosclerosis

Familial; abnormal bony growth @ footplate of stapes = hearing loss

presentation of otosclerosis

slow progressive unilateral/bilat CHL | onset early in life 3rd/4th decade

Tx of otosclerosis

observe unilat / mild disease Amplification surgery (stapes prothesis)

physical findings & Sx's of barotrauma in middle ear

Sx's: aural fullness, pain, hearing loss, tinnitus, nausea, vomiting PE: TM retraction, hemotympanum, +/- perforation