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IPAP Senior ENT > Middle Ear > Flashcards

Middle Ear Flashcards

1
Q

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

A
  1. pharynx
  2. middle ear
  3. ~35mm
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2
Q

Eustachian Tube functions

A

Pressure equalization

Mucus drainage

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3
Q

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

A

Shorter ET
Horizontal ET
Immature Floppy elastic cartilage
Larger adenoids

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4
Q

Essentials to diagnosis of Eustachian tube dysfunction (ETD)

A

Aural fullness
fluctuating hearing
discomfort w/ barometric pressure changes

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5
Q

Most common Dilatory ETD

A

any inflammation

URI & allergies most common

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6
Q

Tx of Dilatory ETD

A

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

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7
Q

Serous Otitis Media (SOM)

A

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

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8
Q

SOM Tx

A
  1. observation x 3months w/mild hearing impairment
  2. freq valsalva
  3. medications if seasonal allergies/URI present
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9
Q

If SOM Tx fails what do you do

A
  1. Pressure Equalization (PE) Tubes
  2. Adenoidectomy
  3. Endoscopic nasopharyngeal orifice widening
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10
Q

Indication for Pressure Equalization (PE) Tubes

A
  1. severe / recurrent AOM
  2. hearing loss > 30dB w/o SOM
  3. impending mastoiditis /intra-cranial complication
  4. SOM > 3 months
  5. chronic retraction of TM r/t ETD
  6. Prevention / Tx of barotrauma
  7. Autophony r/t Patulous Eustachian Tube
  8. Craniofacial anomalies
  9. middle ear dysfunction r/t radiation/surgery
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11
Q

Essentials to AOM diagnosis

A

otalgia, w/ URI

Erythema & hypomobility of TM

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12
Q

Diagnosis of AOM

A

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

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13
Q

AOM most common pathogens

A

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

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14
Q

AOM Tx

A

Antibiotics (adults & kids <2yo) Amoxicillin &

antipyretics/analgesic : Motrin/Tylenol

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15
Q

When to Tx AOM w/ observation

A

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

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16
Q

Recurrent AOM Definition & Tx

A

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

Tx with PE tubes

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17
Q

definition of Chronic Otitis Media (COM)

A

generally AOM becomes COM between 2 weeks to 3 month

w/chronic otorrhea through perforated TM

18
Q

bacteria of COM

A

P. aeruginosa, Proteus species, S. Aureus

19
Q

Presentation of COM

A
  1. Hallmark purulent discharge that is continuous/intermittent
  2. pain during exacerbation
  3. chronic hearing loss r/t destruction of ossicular chain, TM, or both
  4. TM perforation present
20
Q

COM Tx

A
  1. remove infected debris
  2. topical antibiotics (oflox / cipro w/ dexamethasone) for exacerbations
  3. Cipro 500mg PO BID 1-6weeks
  4. Surgical repair of TM
  5. Mastoidectomy
21
Q

TM perforation Tx

A
  1. oflox / Cipro otic if contaminated ear canals
  2. Oral ABX if infection present
  3. <25% of TM surface involvement heal spontaneously
22
Q

Refer TM Perforation to ENT if

A

persists >6 week w/ or w/o drainage

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

23
Q

Cholesteatoma

A

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

24
Q

presentation of cholesteatoma

A

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

25
Q

imaging for Cholesteatoma

A

CT

26
Q

Tx of Cholesteatoma

A
  1. Surgical excision

2. PE tubes may be needed to prevent chronic neg pressure

27
Q

presentation of Mastoiditis

A

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

28
Q

What imaging should be performed if mastoiditis is suspected

A

CT

29
Q

what CT findings should prompt immediate ENT consult

A

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

30
Q

Tx of Mastoiditis

A

IV ABX

cefazolin 0.5-1.5g q 6-8hrs

31
Q

Most common bugs for mastoiditis

A

S. pneumoniae
H. influenza
S. pyogenes

32
Q

Tx of mastoiditis w/ ABX failure

A

myringotomy for culture & drainage

mastoidectomy Definitive Tx

33
Q

Classic Triad of Petrous Apicitis (Petrositis)

A
  1. Retro-orbital pain
  2. AOM
  3. Abducens nerve paresis (CN VI)
34
Q

Tx of facial Nerve Paralysis r/t AOM

A

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

35
Q

Tx of facial nerve paralysis r/t COM

A

surgical correction of cholesteatoma

less favorable prognosis

36
Q

Tx of meningitis due to AOM

A

myringotomy

37
Q

Tympanosclerosis

A

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

38
Q

Diagnosis of Tympanosclerosis

A

clinical; pneumatic otoscopy demonstrates decreased / absent mobility

39
Q

Otosclerosis

A

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

40
Q

presentation of otosclerosis

A

slow progressive unilateral/bilat CHL

onset early in life 3rd/4th decade

41
Q

Tx of otosclerosis

A

observe unilat / mild disease
Amplification
surgery (stapes prothesis)

42
Q

physical findings & Sx’s of barotrauma in middle ear

A

Sx’s: aural fullness, pain, hearing loss, tinnitus, nausea, vomiting

PE: TM retraction, hemotympanum, +/- perforation

IPAP Senior ENT (7 decks)

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