Midterm - Ear Exam

Question 1

The opening to the external ear (between the pinna and external auditory canal) is called?

Answer 1

External auditory meatus

Question 2

Why causes cauliflower ear?

Answer 2

Aka auricular hematoma

Caused by blunt trauma
- blood collect between the cartilage and perichondrium

Requires immediate treatment/attention to avoid permanent deformity

Question 3

What is gouty tophi

Answer 3

Hard, usually no tender to mildly tender nodules

• deposition of monosodium urate crystals
• history of painful monoarticular arthritis

Question 4

What does frostbite on the ear look like? feel like

Answer 4

Initially skin blanches, then later appears whitish and waxy

Loss of sensation

*rewarm ear to decease chance of necrosis

Question 5

What does basal cell carcinoma on the ear look like?

Answer 5

Pearly or translucent lesions with telangiectasias and central ulceration

*usually localized skin cancer

Question 6

What does actinic keratosis on the ear look like?

what causes it?

Is it cancerous?

Answer 6

• secrete, dry, rough adherent scaly lesion(s)
• occur on habitually sun-exposed skin
• precancerous. Can lead to squamous cell carcinoma

Question 7

What does squamous cell carcinoma on the ear look like?

Answer 7

Non-healing ulcer with raised edges

*occasionally metastasizes, higher risk on ear

Question 8

What are you looking for with ear inspection/palpating?

Answer 8

• erythema, swelling
• lumps, tenderness
• pain when push on tragus or pull on pinna?
  > consider external auditory canal infection (otitis externa)

Question 9

What are you looking for with an otoscope exam?

Answer 9

Lesions, discharge, swelling, foreign bodies

Question 10

What are the signs of acute otitis externa?

Answer 10

Thick discharge (otorrhea)
Erythema
Swelling of the ear canal
Ear pain if you push on the tragus

Question 11

What typically causes acute otitis externa?

How is it treated?

Answer 11

Bacterial infection. Excessive moisture (swimmer’s ear), dermatological disease (eczema), aggressive cleaning

• eczema side note: if itchy, patient stick things in ear, skin break serves as entry site for bacteria

Same day referral to PCP or urgent care for antibiotics, usually drops

Question 12

Purpose of ear wax (cerumen)

Answer 12

• trap dust, micro-organisms, other debri
• slight odor discourages insects
• moisturize canal

Question 13

Cerumen is produced in the ______ of the canal, varies in texture and color, and the canal (can/cannot) self clean

Answer 13

• external 1/3
• can self-clean
• if obstructed, wax needs to be removed

Question 14

Risk factors for cerumen build up

Answer 14

• mostly idiopathic
• history of prior impaction
• > 65 years old
• attempts to clean ear (pushes cerumen deeper into canal)
• increased hair in ear canal
• hearing aids, ear buds, ear plugs
• narrow or tortuous canal

Question 15

Treatment options for cerumen impaction

Answer 15

• manual removal
  > ear curettes, cerumen spoon, refer to ENT for suction
• cerumenolytics = softening agents into ear canal for 3-4 days
  > water based, oil based, or hydrogen peroxide (oil preferrred for diabetics and patients with dry ears)
  > may be used alone or along with irrigation but otoscopy follow up within 3-5 days needed
• irrigation
  > old, hardened, impacted cerumen may need drops to soften before irrigation is attempted

Question 16

what is Malignant otitis externa

Causes

Symptoms

Answer 16

Infection of the external auditory canal that progresses into temporal bone = osteomyelitis

Pseudomonas aeruginosa. Most likely in elderly patient with diabetes

Severe, deep-seated pain that gets worse over weeks to months, external ear swelling and pursuant otorrhea

Question 17

If malignant otitis externa affects cranial nerves, patient needs ____ for evaluation and ____ for treatment

Answer 17

CT scan

IV antibiotics

Question 18

What is Ramsay Hunt Syndrome? What are other names for it?

Answer 18

Acute facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal & pinna

Herpes zoster oticus, “shingles of the ear”

Question 19

What is bullous myringitis?

What is it associated with?

What is the prognosis

Answer 19

Localized form of otitis externa, blister, hemorrhagic lesions in the deep external canal or on the tympanic membrane. Causes severe otalgia

Upper respiratory infection

Self-limiting

Question 20

What is exostosis?

Answer 20

New bone growth in the bony portion of the isthmus

Question 21

A ______ exostosis is usually benign, asymptomatic and if large, can be problematic for hearing

Answer 21

Singular exostosis

Question 22

A _____ exostosis is often acquired from chronic cold water exposure (surfer’s ear)

Answer 22

Multiple exostoses

Question 23

Ear drum perforation results from what (2 things)

Answer 23

• usually from pure lent infection of the middle ear

- can be from trauma to the ear

Question 24

How is a perforated ear drum managed?

Answer 24

• avoid getting any water in the ear
• if severe hearing loss, refer to ENT
• if not healed in a few weeks, refer to ENT

Question 25

More serious perforations involve

Answer 25

Tympanic membrane margins

- predispose to acquired cholesteatoma (middle ear growth)

Question 26

What is a Cholesteatoma? What does advanced cholesteatoma look like?

Answer 26

Squamous epithelium form the ear canal grows into the eardrum/ middle ear

*can eventually erode surrounding tissues

Advanced = membrane landmarks not visible, erosion of the middle ear, loss of hearing