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OTO > middle ear > Flashcards

middle ear Flashcards

1
Q

eustacian tube links?

A

pharynx to the middle ear

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2
Q

Eustacian tube fx?

A

Equalize pressure

Mucus drainage

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3
Q

Children are at higher risk of eustacian tube issues due to?

A

1- Shorter ET
2- Horizontal ET
3- Immature floppy elastic cartilage
4- Larger adenoids

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4
Q

Eustacian tube reaches adult length by what age?

A

Age 6

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5
Q

ETD (eustacian tube dysfx) S/S to dx?

A

Aural Fullness
Fluctuating hearing
Discomfort with barometric pressure changes

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6
Q

ETD is at risk of developing?

A

Otitis media with effusion (OME) AKA - Serous Otitis Media (SOM)

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7
Q

How to assess TM integrity and eustachian tube patency

A

Valsalva maneuver

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8
Q

Difference between - DILATORY DYSFUNCTION (common) vs PATULOUS DYSFUNCTION (uncommon)?

A

Dilatory dysfx = stuck closed - cannot dilate

Patulous dyfx = stuck open

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9
Q

Dilatory dysfx can be due to?

A 
Any cause of inflam
-Infection – usually viral MC OR -Allergies MC
Pressure dysreg (altitudes)
Anatomic/congenital ABNL
-Downs, Turners
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10
Q

MC cause of ETD?

A

Allergies

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11
Q

Patulous dyfx can be due to?

A

Overly patent - hear my body fx - rare/benign
wgt loss as little as 6lbs
Scarring
Atrophy from neuromuscular d/o

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12
Q

Dilatory dysfx S/S

A

HL, TM retraction/effusion

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13
Q

Patulous dyfx S/S

A

– autophony, (TM appears normal without HL), movement of TM with inspiration and expiration

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14
Q

Dilatory dysfx TXT

A 
Decongestants for URI 
AH and/or nasal steroids for allergic rhinitis
Smoking cessation 
Behavioral mod/PPI – acid reflux
Frequent valsalva
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15
Q

Patulous dyfx TXT

A

Mild - ressure and educate, hydrate, NS spray

Sev - Surgery maybe (cartilage graft)

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16
Q

Serous Otitis Media AKA

A

Otitis Media with Effusion (OME)

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17
Q

SOM patho

A

ETD dilatory - blocked prolonged time >

Negative pressure middle ear pressure > transudation

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18
Q

SOM S/S

A

Middle ear fluid w/ut inflam/infection
Viscous bubbles
Conductive HL
Reduced TM mobility

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19
Q

PEDs get SOM due to?

A

narrow/horizontal ET

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20
Q

Adults may have h/o w/ SOM?

A

URI
CHronic seasonal allergies
barotrauma

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21
Q

Best way to Dx SOM?

A

Tympanometry

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22
Q

Adults w/ persistent (>3mo) unilateral SOM req?

A

R/O nasopharyngeal carcinoma w/ NP endoscopy

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23
Q

SOM TXT?

A

HL mild > Observe 3mo
Freq valsalva
Rx - if URI/allergic rhinitis (po) CCS, AH, Abx +-

Failure of TXT >
Pressure equalization tube placement
Adenoidectomy (relives nasal obstruct)
Endoscopic orifice widening

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24
Q

TM PE Tubes complications

A

PE tubes allow water to enter middle ear = recurrent infections.

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25
Q

TM PE tube surgery expectations?

A

In place 6-18mo > naturally fall out.

TM heals on its own.

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26
Q

AOM essentials of Dx

A

1 S/S - Otalgia often w/ URI

Erythema,
hypomobile TM

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27
Q

PE Tubes indications

A

Severe/recurrent AOM
SOM >3mo or >30dB HL
Chronic retraction of TM (ETD)
Surgery/rad/cranial involvement of middle ear

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28
Q

AOM is a sequeala of?

A

ETD

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29
Q

MC illnesses affecting children?

A

URI and OM

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30
Q

RFs of getting AOM?

A

Pacifer/bottle feed
Daycare
2nd hand smoke

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31
Q

What will protect infants from getting AOM?

A

Breastfeeding

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32
Q

AOM presents PEDs/Adults

A

Peds- Fever, irritable, crys, ear drainage, altered sleep

Adults - Fever, sudden otalgia onset in affected ear, Mastoid TTP, aural pressure, HL

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33
Q

Dx PE findings *

A

Decreased TM mobility, bulging TM w/out TM, erythema

Pneumatic otoscopy

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34
Q

MC bacteria of AOM

A

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

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35
Q

AOM TXT

A

Abx, antipyretics/analgesics (Ibuprofen, APAP)

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36
Q

AOM observe for TXT when?

A

> 2yo
Healthy and mild illness (<102.2 fever)
Able to F/U if worsens

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37
Q

AOM Abx indications for PEDs?

A

<2yo
no improvement in 48-72h of observation
more severe S/S

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38
Q

AOM 1st line Abx? Resistant?

A

Amoxicillin

-Amox-clav

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39
Q

AOM #1 S/S? needs what?

A

Otalgia - (po) analgesic

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40
Q

SNAP is an AOM concept for?

A

Safety-net approach to Abx prescription

- Prescribe Abx however educate pt/parent to only use Abx if no improvement after 2d

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41
Q

PEDs SE of taking amoxicillin?

A

Itchy maculopapular rash >72h of initiation (adults too)
- not an allergy/CI to future amoxicillin

Ensure not MONO

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42
Q

X-imm - persistent - recurrent AOM infection req?

A

Tympanocentesis for Cx

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43
Q

Severe otalgia/complications (mastoiditis/meningitis) req?

A

Myringotomy

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44
Q

Recurrent AOM def?

A

≥ 3 distinct episodes of AOM within 6 months, OR

≥ 4 episodes within 12 months

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45
Q

Recurrent AOM TXT in young children?

A

PE Tubes

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46
Q

COM essentials of Dx *

A

Chronic otorrhea +- otalgia

TM perf w/ conductive HL (ossicular chain destroyed)

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47
Q

COM is a sequela of?

A

Recurrent AOM

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48
Q

COM time frame to call it as such?

49
Q

COM is defined as?

A

Chronic infection of middle ear/astoid that results in Chronic otorrhea thru perforated TM

50
Q

COM bacteria?

A

Different from AOM

  • P aeruginosa
  • Proteus species
  • S aureus
  • anaerobic bacteria
51
Q

Hallmark COM S/S?

A

Purulent D/C thats continuous or intermittent that increases w/ URI or water exposure

52
Q

Is pain common w/ COM?

A

No - uncommon (+- exacerbations)

53
Q

TXT of COM?

A 
Remove debris
Earplugs for water
(top) Abx drops (ofloxacin, cipro, dexamethasone)
(po) cipro
Surgical TM repair
Mastoidectomy
54
Q

Complications of otitis media?

A 
Perf TM
Cholesteatoma
Masoiditis
Facial paralysis
CNS inf (otogenic meningitis)
55
Q

TM perf occurs w/ otitis media due to?

A

Purulence draing down path of least resistance

56
Q

TM perf TXT

A

Combo (po)/(top) Abx
- Otic - cirpo or ofloxacin for contaminated ear canals
(po) Abx if infection is present
PVT water into ear

57
Q

TM perf CI rx

A

Aminoglycosides
Alcohol
Polymyxin/neomycin

58
Q

TM perf heals spontaneously if

A

<25% involvement

59
Q

Refer TM perf when?

A

Persists >6w

60
Q

Chronic perf occurs when/patho?

A

All 3 layers perf >
If Squamous layer and cuboidal layer meet >
Fibrous layer stop growing

61
Q

Chronic perf TXT?

A

Tympanoplasty

62
Q

Cholesteatoma is?

A

Epidermal inclusion cyst behind tympanic membrane

63
Q

Cholesteatoma is due to?

A

Prolong ETD dysfx/Chronic NEG middle ear pressure
Draws upper flaccid portion of TM in (pars flaccida) >
Creastes squam epi lined sac fill with keratin >
Chroniclly infected

64
Q

Cholesteatoma presents as?

A

TM retraction

Perf w/ keratin debris/granulation

65
Q

SOC for Cholesteatoma?

66
Q

Cholesteatoma TXT?

A

Surgical excise - (recurrence common due to inability to remove entire lesion)

ETD dysfx still remains > PE tubes PVT NEG pressure

67
Q

Mastoiditis evolves from?

A

Inadq TXT of AOM/COM

68
Q

Mastoiditis presents as?

A

Fever, posterior ortalgia and/or erythema over mastoid
Edema of the pinna or displacement of auricle
Protruding auricle & loss of postauricular crease

69
Q

Mastoiditis mgmt?

A

CT > Positive > Refer

70
Q

Mastoiditis CT findings?

A

coalescence of the mastoid air cells due to destruction of their bony septa

71
Q

Mastoiditis TXT

A

IV ABX (cefazolin)

72
Q

Mastoiditis offending organisms

A

S pneumoniae,
H influenzae,
S pyogenes

73
Q

Mastoiditis Abx TXT fails reflex?

A

Myringotomy for culture and drainage

Mastoidectomy

74
Q

What is definitive TXT of mastoiditis?

A

Mastoidectomy - surgical drainage is definitive treatment

75
Q

Petrous apicitis AKA?

A

Petrositis

76
Q

Petrous apicitis is?

A

Rare AOM complication - infection spreads w/in temporal bone of the petrous apex

77
Q

Petrous apicitis classic triad presentation?

A

(Gradenigo syndrome):

  • Retro-orbital pain
  • AOM (foul smelling discharge)
  • CN VI palsy (abducens) lateral rectus/eye abduction)
78
Q

Petrous apicitis Dx?

A

Gradenigo syndrome triad +

Rad - bony destructivion of petrous apex

79
Q

Petrous apicitis TXT?

A

prolonged Abx based on Cx and surgical drainage

80
Q

Facial palsy ass/w AOM - notes? Patho/TXT/prognosis

A

Inflam of CN VII in middle ear
TXT: myringotomy for drainage and Cx, + IV Abx
Good prognosis

81
Q

Facial palsy ass/w COM - notes?

A

Evolves slowly - due chronic CN VII pressure by cholesteatoma
TXT: surgical correction of cholesteatoma
Less favorable prognosis than AOM

82
Q

MC intracranial complication of ear infections? TXT?

A

Otogenic meningitis - myringotomy

83
Q

Tympanosclerosis is

A

Formation of hyaline deposits and calcification in the TM

84
Q

What causes Tympanosclerosis plaques?

A

Injuries to the eardrum, PET and chronic disease in the middle ear

85
Q

Tympanosclerosis evolve to what S/S?

A

Deposits cause CHL due to decrease mobility of TM and immobilization of ossicular chain.

86
Q

Tympanosclerosis Dx

A

Pneumatic otoscopy - decreased/absent mobility

87
Q

Otosclerosis is

A

ABNL bony growth on footplate of stapes that results in HL (max 60dB) > impedence of sound through ossicular chain

88
Q

Otosclerosis max HL?

89
Q

Otosclerosis presents as?

A

Slow progressive unilateral or bilateral CHL

Onset in early life (3rd-4th decade)

90
Q

Dx of Otosclerosis req to R/O other causes of CHL w/?

A

CT/MRI
Weber/Rinne
Tympanometry

91
Q

Otosclerosis TXT? Mild/sev

A

Unilateral and mild CHL - Observation
NL cochlear Fx + speech discrimination - Amplification

Sev- Surgery: stapes prosthesis (stapedectomy)

92
Q

Barotrauma is? due to?

A 
If equalization does not occur > 
TM will retract from negative pressure >
-Air travel
-Diving
-Blast injuries
93
Q

Barotrauma PE findings?

A

TM retraction, hemotympanum, +/- perforation

94
Q

Barotrauma Dx?

95
Q

Barotrauma PVT?

A

Avoidance - Swallow, Yawn, Valsalva, chew gum
Rx - Pseudoephedrine/Oxymetazoline - prior to descent
Ventilating tubes if freq flier

96
Q

Barotrauma TXT?

A

Most resolve spon
TXT if ETD
- analgesics
-Abx PRN

97
Q

When to refer Barotrauma to ENT?

A 
Severe otalgia, 
HL,
Vertigo, 
>4-5d persistence, 
Blast injury
98
Q

When/how to TXT Barotrauma?

A

Ossicular disruption or perilymphatic fistula

- Myringotomy (Also PVT)

99
Q

Impact injury or explosive acoustic trauma can cause?

A

TM perforation
Hemotympanum
Disruption of ossicular chain

100
Q

TM perf - notes

A

Heal spon usually

LRG perf may req tympanoplasty

101
Q

Hemotympanum can occur due to?

A

Blunt trauma

Extreme barotrauma

102
Q

Hemotympanum TXT?

A

None - heals spon over several weeks

103
Q

> 30dB CHL >3mo may indicate?

A

Disruption of ossicular chain

104
Q

Disruption of ossicular chain TXT?

A

Middle ear exploration w/ reconstruction of ossicular chain and TM repair

105
Q

Mgmt for TM?

A

Signs of inf > Abx
HL
Refer ENT/Audiology PRN

106
Q

Mgmt for TM w/out comorbids/HL?

A

Observe
Avoid water in ears (No swimming)
F/U 2-3mo

107
Q

Primary middle ear tumors type?

A

Glomus tumor

108
Q

Glomus tumors patho

A

arise i middle ear or in jugular bulb with upward erosion into hypotympanum

109
Q

Glomus tumors present as?

A

Pulsatile tinnitus and CHL

LRG tumors > CN neuropathies

110
Q

Glomus tumors PE

A

Vascular mass may be visible behind intact TM

111
Q

Glomus tumors TXT?

A

requires surgery, radiotherapy, or both

112
Q

Pulsatile tinnitus finding always reqs?

A

magnetic resonance angiography and venography to rule out a vascular mass

113
Q

Earache w/ pain out of proportion?

A

Herpes zoster oticus, esp. when vesicles in EAC or auricle

114
Q

Earache w/ Persistent pain and discharge?

A

Osteomyelitis of the skull base or cancer

115
Q

Non-otologic causes of earche

A

TMJ dysfx (chewing - bruxism or malocclusion)
CN V, VII, IX, X and upper cervical nerve issues
Glossopharyngeal neuralgia
Inf/neoplasma of oropharynx, hypopharynx, and larynx

116
Q

Repeated episodes of severe lancinating otalgia (pain in the back of the throat and in the ear) indicate?

A

Glossopharyngeal neuralgia

117
Q

Glossopharyngeal neuralgia mgmt after TXT failures?

A

Microvascular decompression of CN IX is required

118
Q

TMJ dysfx mgmt?

A

Soft diet, heat to masticatory muscles, massage, NSAIDs, and dental referral

119
Q

Persistent earache reqs?

A

refer to R/O cancer of upper aerodigestive tract

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