ORDINARIO OTORRINO

Question 1

Sjogren syndrome

Answer 1

Autoimmune disease
● Parotid enlargement
● Xerostomia
Salivary gland enlargement
Bilateral
SS-A or SS-B antibodies
Diagnosis confirmation → Microscopic examination of biopsy (oral mucosa)

TREATMENT: Symptomatic and supportive → Steroids and topical steroids eye drops for severe eye symptoms
-For severe recurrent parotid infections → Superficial parotidectomy

PROGNOSIS: Malignant lymphoma or lymphoepithelial carcinoma (high risk)

Question 2

PTYALISM (also known as hypersalivation or sialorrhea)

Answer 2

-Saliva hyperproduction
-Inflammation, cerebral palsy (principally), often affects women in the early stages of pregnancy, medications
-Treatment
● Medication → Drying agents
○ Antihistamines
○ Antidepressants
● Surgery
○ Selective neurectomy of the chorda tympani nerve
○ Salivary gland excision
○ Affected duct ligation or transposition

Question 3

NECROTIZING OTITIS EXTERNA (skull base osteomyelitis “Malignant or Necrotizing Otitis Externa)

Answer 3

caused by bacterial infection of the EAC (Pseudomona aeruginosa 90%)

-Immunocompromised (VIH and diabetes) patients with intense otalgia, otorrhea, hipoacusia, fullness, pruritus, edema and erythema of the EAC, granulation tissue at the bony cartilaginous junction and cranial neuropathy at advanced stages.

-DIAGNOSIS:
- LABS: ESR/VSG and CPR/PCR
- Culture

• IMAGES:
• CT (bony changes)
• MRI (soft tissue changes, intracranial abnormalities)
• Gammagraphy scan with Technetium [Tc-99]
• Biopsy is required to rule out malignancy

– Long standing otalgia (worse at night)
- Otorrhea, HL, Aural fullness, Pruritus, Facial Palsy.

***As the disease advances to involve the temporal bone, granulation tissue is seen on the floor of the EAC at the osseocartilaginous junction and is pathognomonic.

TREATMENT
● Long-term parenteral antibiotics (6 wks)
○ Patient it’s usually interned
○ Expensive
● Aminoglycosides (tobramycin)
● Antipseudomonal B-lactam antibiotics:
○ PIP-TZB (Piperacilina Tazobactam), Cefepime, Ceftazidime
○ Ciprofloxacin, Ofloxacin → Outpatients (fluoroquinolones)
● Hyperglycemia and Immunosuppression control
● Surgical debridement
● Hyperbaric oxygen → Refractory to treatment

Question 4

Para qué sirve la maniobra de Rinne y Weber?

Answer 4

para diferenciar entre hipoacusia neurosensorial y conductiva

Question 5

Características de la prueba de Weber

Answer 5

-Diapasón en frente
-Sirve para revisar via ósea
-oido sano: weber normal
- si se escucha más de un lado: lateralización
SORDERA NEUROSENSORIAL
el sonido se lateraliza al oído sano

SORDERA CONDUCTIVA
el sonido se lateraliza al oído afectado

Question 6

Características de la prueba de Rinne

Answer 6

“risa hasta el mastoides”
-diapasón sobre la apófisis mastoides y después en la oreja
EVALÚA VÍA AÉREA

Sonidos sin alteraciones: rinne positivo (sano)
Si no escucha de un lado: negativo (hipoacusia conductiva)

Question 7

ACUTE OTITIS MEDIA

Answer 7

Acute suppurative, Purulent OM with a rapid onset of symptoms:
○ Pyrexia, Otalgia.
Very symptomatic
Heavy pain with high fever

Bacterias
● S. pneumoniae
● H. influenzae
● M- catarrhalis

● Otalgia
● Fever
● Decreased appetite
● URI
● Fatigue

Medical management AOM
Spontaneous resolution
Antibiotics → Amoxicillin (1ST LINE) with clavulanic acid Decongestants
Vasoconstrictors

Manifestations of AOM include otalgia, pyrexia, thickened or bulging tympanic membrane, hearing loss, and otorrhea.

Question 8

RECURRENT AOM

Answer 8

• 3 or more episodes in a 6 month period.
  ● 4 or more episodes in a 12 month period with complete resolution of symptoms
  between episodes.

Question 9

Otitis media with effusion

Answer 9

Manifestations of OME include persistent conductive hearing loss, dull or immobile tympanic membrane, and flat tympanogram.

Question 10

Gradenigo syndrome

Answer 10

Complicación poco frecuente de otitis media aguda

triada:
- otitis media aguda, parálisis unilateral del VI par craneano y dolor retroorbitario

Question 11

Labyrinthitis

Answer 11

Complication of AMO
-sudden sensorineural hearing loss, severe vertigo, and nystagmus accompanied by nausea and vomiting. In the setting of middle ear infection, bacterial infection can invade through the round window causing acute suppurative labyrinthitis.

Question 12

Otitic hydrocephalus

Answer 12

Otitic hydrocephalus is defined as increased intracranial pressure secondary to AO or OME. This is a rare complication that presents with headaches, lethargy, and papilledema with no meningeal signs or evidence of intracranial abscess.

Question 13

Otoscopy in AOM and OME

Answer 13

Otoscopy in AOM classically demonstrates a thickened, hyperemic, immobile TM

Patients with OME are often asymptomatic or may present with decreased hearing. Otoscopy classically demonstrates a dull gray­tinged or yellow­tinged, immobile TM. If the TM is clear, bubbles or air fluid levels can be elucidated. Tympanometry and audiometry are complementary diagnostic tools used in evaluating patients with OME.

Question 14

OTITIS EXTERNA

Answer 14

● Pseudomona aeruginosa
● S. aureus

Factors
Humidity, maceration, heat, absence of cerumen, alkaline pH

Acute <3 months
Chronic >3 months

Symptoms
Otalgia
Otorrhea
Aural fullness Pruritus
Occlusion of the EAC Hearing loss
The tympanic membrane usually is normal, but it’s difficult to see due to the edema and otorrhea.
Treatment
Debridement of the EAC
Analgesia (NSAIDs, opioids, topical steroid)
ORAL ANTIBIOTICS ARE NOT INDICATED (The medication will not reach the ear easily) Culture → Refractory
● It’s not useful Otic drops
● Acetic and boric acid, gentian violet, thimerosal, alcohol
● Ofloxacin, ciprofloxacin, polymyxin B, neomycin, tobramycin Avoid water exposure → Close the ear in the bath