middle ear advanced

Question 1

define serous otitis media

Answer 1

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

Question 2

when does serous otitis media occur in adults

Answer 2

after a URI, barotrauma, or chronic allergic rhinitis

Question 3

must not miss dx for persisten unilateral serous otitis media

Answer 3

nasopharyngeal carcinoma

Question 4

appearance of tympanic membrane in serous otitis media

Answer 4

dull, hypomobile, sometimes air bubbles

Question 5

does serous otitis media cause sensorineuro or conductive hearing loss?

Answer 5

conductive

Question 6

treatment of serous otitis media

Answer 6

oral steroids vs oral abx

if failed response- ventilation tubes

Question 7

define tympanosclerosis

Answer 7

calcification of the TM and middle ear structures from inflammation

Question 8

define myringosclerosis

Answer 8

calcification of the TM only

Question 9

does tympanosclerosis or myringosclerosis cause hearing loss?

Answer 9

tympanosclerosis

Question 10

what is a retraction pocket?

Answer 10

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

Question 11

what does chronic retraction and inflammation result in?

Answer 11

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

Question 12

define cholesteatoma

Answer 12

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

Question 13

symptoms of cholesteatoma

Answer 13

persistent, recurrent, foul smelling otorrhea

Question 14

treatment of TM perforation due to AOM

Answer 14

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

Question 15

etiology of chronic suppurative otitis media

Answer 15

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

Question 16

bacteria associated with chronic suppurative otitis media

Answer 16

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

Question 17

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

Answer 17

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

Question 18

treatment of chronic suppurative otitis media

Answer 18

culture drainage and treat with appropriate abx

Question 19

pathogenesis of mastoiditis

Answer 19

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

Question 20

most common affected age group for mastoiditis

Answer 20

60% younger than 2

Question 21

symptoms of mastoiditis

Answer 21

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

Question 22

imaging for mastoiditis

Answer 22

CT- initially looks like AOM

progression of disease shows coalescence of mastoid air cells

Question 23

pathogens of mastoiditis

Answer 23

S pneumo, H influenzae, and S pyogenes

Question 24

ddx of mastoiditis

Answer 24

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

Question 25

major complication of mastoiditis

Answer 25

meningitis or brain abscess

Question 26

treatment of mastoiditis

Answer 26

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

Question 27

prognosis for mastoiditis

Answer 27

good. typically full recovery

Question 28

essentials of diagnosis of acute otitis media

Answer 28

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

Question 29

ddx for acute otitis media

Answer 29

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

Question 30

pathophysiology of acute otitis media

Answer 30

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

Question 31

symptoms of AOM

Answer 31

otalgia, aural pressure, decreased hearing, and fever

Question 32

treatment of AOM

Answer 32

abx- amoxicillin and nasal decongestants | can use cefaclor or augmentin for resistant cases

Question 33

chronic otitis media essentials of dx

Answer 33

chronic otorrhea, TM perforation with conductive hearing loss

Question 34

most common bacteria causing chronic otitis media

Answer 34

P aeruginosa, Proteus, S aureus, and mixed anaerobes

Question 35

define cholesteatoma

Answer 35

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

Question 36

define otosclerosis

Answer 36

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

Question 37

middle ear neoplasia

Answer 37

rare | presents with pulsatile tinnitus and hearing loss

Question 38

nerves involved with middle ear neoplasia

Answer 38

VII, IX, X, XI, and XII

Question 39

treatment of middle ear neoplasia

Answer 39

surgery, radiotherapy or both

Question 40

ototoxic medication

Answer 40

aminoglycosides, loop diuretics, antineoplastic agents