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Middle ear- advanced lecture > middle ear advanced > Flashcards

middle ear advanced Flashcards

1
Q

define serous otitis media

A

transudation of fluid due to prolonged eustachian tube dysfunction with resultant negative middle ear pressure

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2
Q

when does serous otitis media occur in adults

A

after a URI, barotrauma, or chronic allergic rhinitis

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3
Q

must not miss dx for persisten unilateral serous otitis media

A

nasopharyngeal carcinoma

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4
Q

appearance of tympanic membrane in serous otitis media

A

dull, hypomobile, sometimes air bubbles

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5
Q

does serous otitis media cause sensorineuro or conductive hearing loss?

A

conductive

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6
Q

treatment of serous otitis media

A

oral steroids vs oral abx

if failed response- ventilation tubes

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7
Q

define tympanosclerosis

A

calcification of the TM and middle ear structures from inflammation

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8
Q

define myringosclerosis

A

calcification of the TM only

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9
Q

does tympanosclerosis or myringosclerosis cause hearing loss?

A

tympanosclerosis

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10
Q

what is a retraction pocket?

A

chronic inflammation and negative pressure causes invagination of the pars tensa or pars flaccida.
produces atrophy and atelectasis

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11
Q

what does chronic retraction and inflammation result in?

A

adhesive otitis- predisposes to formation of cholesteatoma or fixation and erosion of the ossicles

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12
Q

define cholesteatoma

A

greasy or pearly white mass in a retraction pocket or perforation- causes destruction of temporal bone
Hallmark is painless otorrhea

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13
Q

symptoms of cholesteatoma

A

persistent, recurrent, foul smelling otorrhea

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14
Q

treatment of TM perforation due to AOM

A

ototopical abx for 10-14 days. refer for hearing evaluation. if it doesn’t heal on it’s own, surgery can correct.

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15
Q

etiology of chronic suppurative otitis media

A

persistent otorrhea with tympanostomy tubes or TM perforation. has ongoing purulent ear drainage. may be associated with cholesteatoma
chronic infection with mucosal edema, ulceration, granulation tissue, and polyp formation

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16
Q

bacteria associated with chronic suppurative otitis media

A

P aeruginosa, S aureus, Proteus, Klebsiella pneumoniae, and diphtheroids

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17
Q

if chronic suppurative otitis media fails culture directed treatment, what is the ddx?

A

foreign body, neoplasm, langerhan’s cell histiocytosis, tuberculosis, granulomatosis, fungal infection, or petrositis

18
Q

treatment of chronic suppurative otitis media

A

culture drainage and treat with appropriate abx

19
Q

pathogenesis of mastoiditis

A

infection from middle ear spreads to the mastoid portion of temporal bone into air-filled spaces

20
Q

most common affected age group for mastoiditis

A

60% younger than 2

21
Q

symptoms of mastoiditis

A

postauricular pain, fever, outwardly displaced pinna
mastoid is indurated and red, swollen, and fluctuant
mastoid is tender
AOM almost always present

22
Q

imaging for mastoiditis

A

CT- initially looks like AOM

progression of disease shows coalescence of mastoid air cells

23
Q

pathogens of mastoiditis

A

S pneumo, H influenzae, and S pyogenes

24
Q

ddx of mastoiditis

A

lymphadenitis, parotitis, trauma, tumor, histiocytosis, OE, furuncle

25
Q

major complication of mastoiditis

A

meningitis or brain abscess

26
Q

treatment of mastoiditis

A

IV abx- depends on culture, must cross blood-brain barrier

if no improvement in 24-48 hours requires sugery- tympanostomy tube and culture vs I and D vs cortical mastoidectomy

27
Q

prognosis for mastoiditis

A

good. typically full recovery

28
Q

essentials of diagnosis of acute otitis media

A

moderate to severe bulging of the TM
or
mild bulging of TM and less than 48 hours of otalgia
or
middle ear effusion by pneumatic otoscopy or tympanometry

29
Q

ddx for acute otitis media

A

otitis media with effusion, bullous myringitis, mastoiditis, or middle ear mass

30
Q

pathophysiology of acute otitis media

A

eustachion tube dysfuntion causing negative pressure and effusion
bacterial colonization- S pneumo, H influenzae, M catarrhalis
viral URI
smoke exposure- prolongs inflammatory response, impedes drainage of middle ear
immunocompromised- IgA deficiency causes reccurent AOM
bottle feeding- reduced AOM
season- surge in respiratory viruses in winter
day care- exposure to URIs
genetic- cause is unknown
age- 1-3 greatest risk

31
Q

symptoms of AOM

A

otalgia, aural pressure, decreased hearing, and fever

32
Q

treatment of AOM

A

abx- amoxicillin and nasal decongestants

can use cefaclor or augmentin for resistant cases

33
Q

chronic otitis media essentials of dx

A

chronic otorrhea, TM perforation with conductive hearing loss

34
Q

most common bacteria causing chronic otitis media

A

P aeruginosa, Proteus, S aureus, and mixed anaerobes

35
Q

define cholesteatoma

A

variety of chronic otitis media, most commonly due to eustachian tube dysfunction
inward migration of tympanic membrane creating a squamous epithelium-lined sac- fills with desquamated keratin and becomes infected.
Can erode bone, destroy ossicular chain, erode inner ear, effect the facial nerve and spread intercranially

36
Q

define otosclerosis

A

lesions of footplate of the stapes impede passage of sound, causing conductive hearing loss
lesions can impede on the cochlea causing sensory hearing loss

37
Q

middle ear neoplasia

A

rare

presents with pulsatile tinnitus and hearing loss

38
Q

nerves involved with middle ear neoplasia

A

VII, IX, X, XI, and XII

39
Q

treatment of middle ear neoplasia

A

surgery, radiotherapy or both

40
Q

ototoxic medication

A

aminoglycosides, loop diuretics, antineoplastic agents

Middle ear- advanced lecture (1 decks)

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