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ICM Unit 3 HEENT > Otitis, Hearing, and Equilibrium > Flashcards

Otitis, Hearing, and Equilibrium Flashcards

1
Q

Cerumen Impactation

A

usually self-induced (q-tip or digital trauma)

UNIlateral hearing loss and/or pain

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2
Q

Cerumen Impactation Tx

A

pt - detergent ear drops +irrigation (Hydrogen peroxide)

clinical - mechanical removal, suction, or irrigation (warm water NOT cold and ONLY if TM intact)

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3
Q

Foreign Bodies

A

MC kids

may or may not have FB sensation
+/- otorrhea

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4
Q

Foreign Bodies - to remove

A

loop or hook, alligator forceps (NOT blindly)

irrigation of inorg. objects

DO NOT IRRIGATE BEANS, SEEDS OR INSECTS (may swell)

insects subdued w/ lidocaine

send to ENT if unsuccessful or ED

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5
Q

Otitis externa

A

infxn of external ear canal

MC hx of water exposure or mechanical trauma

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6
Q

Otitis externa - causative agents

A

Bacteria = G- nods (Pseudo, Proteus)
Fungi = Aspergillus

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7
Q

Otitis externa - Clin Pres

A

ear pain
ear tenderness
otorrhea (foul-smelling)

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8
Q

Otitis externa - PE

A

Moving auricle (or pinna) PAIN
Erythema and edema of ear canal skin
Purulent exudate (wet or dry)
TM ? erythematous or not visualized

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9
Q

Otitis externa - TX

A

Protect ear from additional moisture, gently remove purulent debris

ABX drops + CS
(fluoroquinolone otic drops - ofloxacin 1st, ciprodex (cipro+dexamethasone) for mod-severe; IV severe

AG’s ototoxic

FUNGAL infxn
(acetic acid otic drops)
(clotrimazole otic drops)
Tolnaftate is TM integrity ?
Itraconazole if systemic

ANALGESICS

5+ drops 3-4 times a day

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10
Q

Otitis externa - Prevention

A

Drying agents for swimmers

50/50 solution vinegar and rubbing alcohol, frequ water exposure

avoid ear plugs, headphones

hair dryer, washcloth around edge of external ear and clean thoroughly daily

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11
Q

Necrotizing (malignant) Otitis Externa

advanced cases affects …

A

GRANULATIONS in ear canal
Persistent foul aural discharge
Advacned cases - CN palsies (CN 6,7,9,10,11,12)

Pain over mastoid

confirm w CT or MRI

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12
Q

Necrotizing (malignant) Otitis Externa - Tx

A

Hospitalization

prlonged ANTIPSEUDOMONAL IV abx (fluoroquinolone)

debridement of canal or drainage

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13
Q

Necrotizing (malignant) Otitis Externa - Complications

A

cranial neuropathy

sinus thrombosis

Intracranial infxns

High mortality (immunocomp)

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14
Q

External Ear Pruritis causes

A

Seb. derm
Eczema
Psoriasis
Self-induced

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15
Q

External Ear - Neoplasia Causes

A

External ear (SCC, BCC, Melanoma)

External ear canal (SCC, Bx/further eval

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16
Q

External Ear Pruritus tx

A

Low-mid topical steriods
Oral antihistamines

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17
Q

Eustachian Tube Dysfunc

A

air trapped w/i middle ear becomes absorbed and NEG pressure results

MC viral URI or allergy

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18
Q

Eustachian tube Dysfunction - Clin Pres

A

Fullness in ear
Popping or crackling sound when swallowing or yawning
Discomfort w/ barometric pressure changes
Recurrent or chronic otitis media

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19
Q

Eustachian tube Dysfunction - PE

A

Retracted TM
Decreased mobility on pneumatic otoscopy

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20
Q

Eustachian tube Dysfunction - Dx

A

clinical

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21
Q

Eustachian tube Dysfunction - Tx

A

For post-acute Viral = transient; DECONGESTANTS (oral or nasal)
autoinflation

Allergy-mediated = oral antihist; Intranasal STEROID prep; desensitize; 2-6 wks

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22
Q

Eustachian tube Dysfunction - AVOID

A

air travel
rapid alt change
underwater diving

during active phase

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23
Q

Serous Otitis Media

A

Otitis Media w/ Effusion (OME)

Middle ear infxn w/o inflammation
Prolonged ETD = neg middle ear press = fluid

MC kids

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24
Q

Serous Otitis Media - Clin Pres

A

Fullness in ear
Clear fluid behind TM
Dull, retracted TM
Conduc hearing loss

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25
Q

Serous Otitis Media - TX

A

NO use abx ; watchful waiting

audiology exam and ENT if persistent

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26
Q

Barotrauma

A

Diff. equalizing press. placed on middle ear

Forceful nose blowing, air travel, underwater diving

MC DESCENDING

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27
Q

Barotrauma - Preventative

A

autoinflation (before descending)
Oral decongestants hrs in advance
Nasal decongestant 1 hr before descent

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28
Q

Barotrauma - if persistent on the ground

A

More decongestants
Myringotomy provides immed relief
Tympanostomy tubes if freq flyer

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29
Q

Barotrauma : Diving

A

First 15 ft of descent

can lead to TM rupture or hemotympanum (middle ear squeeze)

Sensory hearing loss and vertigo

can be assoc w/ decompression sickness

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30
Q

Acute Otitis Media

A

bacterial or viral infxn usually after URI

presence of fluid in middle ear w/ acute onset of s/s of middle ear inflammation

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31
Q

Acute otitis media Bacterial pathogens

A

Streptococcus pneuomoniae
Haemophilus influenza
Moraxella catarrhalis

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32
Q

Acute otitis media - Risk factors

A

ETD (including obstruction of ET by mass - adenoids)

Craniofacial abnormalities (cleft palate)

Recurrent URI
Bottle feeding or supine baby feeds (reflux into ear)

Second hand smoke

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33
Q

Acute otitis media - Clin Pres

A

Otalgia, rapid onset
Ear discharge
Infants = irritability, disturbed sleep, feeding problems, ear pulling

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34
Q

Acute otitis media - PE

A

Erythematous, bulging, decreased TM
Purulent effusion
Otorrhea
Tender auricular nodes
Tender Mastoid

35
Q

Acute otitis media - tx

A

Observation
Abx
Analgesics
F/u plan (48-72 hrs)

Absolutely need abx for = <6mo, severe s/s; mod/severe otalgia, otalgia >48 hrs, temp >102.2
Poor f/u potential
Toxic appearance

36
Q

Acute otitis media ABX

A

5-10 days
1st: Amoxicillin
PCN allergy: cefdinir, cefuroxime, azithromycin

2nd line: Augmentin

Analgesia: tylenol or ibuprofen for pain/F

ENT -persis/recurrent AOM

37
Q

Chronic otitis media

A

consequence of recurrent AOM

present >6 wks

perforation of TM common - otosclerosis, polyps

38
Q

Chronic otitis media - Pathogens

A

P aeruginosa, Proteus species, Staph. aureus

39
Q

Chronic otitis media - Clin Pres

A

PURULENT aural discharge
unlikey painful except acute exacerbations
conductive hearing loss or ossicular destruction?

40
Q

Chronic otitis media- TX

A

Remove debris
Wear ear plugs if water exposure
Topical abx
Surgery to repair TM

41
Q

Cholesteatoma

A

growth of keratinizing epithelium thru TM perforation - cyst or pouches

from neg pressure from chronic ETD

42
Q

Cholesteatoma - other

A

can increase in size and erode ossicles, mastoid, or semicircular canal

leads to hearing loss

43
Q

Cholesteatoma - Tx

A

complete removal or marsupialization of sac if on important structure (facial n or semicirc. canals)

44
Q

Acute Otitis Media

extracranial complications

A

subperiosteal abscess
petrous apicitis
labyrinthine fistula
Facial n paralysis

45
Q

Acute Otitis Media

intracranial complications

A

Meningitis
Epi/subdural Abscess
Brain abscess
Lateral Sinus thrombophlebitis

46
Q

Mastoiditis

A

after several wks inadequately treated AOM

Postauricular pain and erythema w/ spiking fever

47
Q

Mastoiditis - CT imaging shows

A

COALESCENCE of mastoid air cells from destruction of bony septa

48
Q

Mastoiditis - Tx

A

Empiric IV abx
Myringotomy for culture and drainage (hospital)
Mastoidectomy (surgical drainage from fail med treatment)

49
Q

Otosclerosis

A

abnormal bone resorption and deposition in middle ear that can lead to hearing loss

genetic (autosomal dominant w/ incomplete penetrance)

50
Q

Otosclerosis will have

A

CONDUCTIVE HEARING LOSS (lesions on oval window/stapes

age 20-40

51
Q

Otosclerosis - Tx

A

hearing aid, surgical prosthetic, replacement of stapes

52
Q

Cochlear otosclerosis

A

lesions impinging the cochlea

permanent SENSORY hearing loss

53
Q

Middle Ear Neoplasia

A

primary middle ear tumors rare

glomus tumors may arise in middle ear or jugular bulb

do not spread

54
Q

Middle Ear Neoplasia - Clin pres

A

PULSATILE TINNITUS AND HEARING LOSS

may see vascular mass behind TM

55
Q

Middle Ear Neoplasia -Tx

A

radiation, surgery, or both

56
Q

Hyperacusis

A

excessive sensitivity to sound

cochlear dysfunction - “recruitment” - abnormal sensitivity to loud sounds despite a reduced sensitivity to softer sounds

57
Q

Hyperacusis - causes

A

Noise trauma (MC)
Ear dz (TMJ, Meinere’s Dz, Lyme Dz)
Migraines
Psychological reasons

58
Q

Tinnitus SUBJECTIVE

A
  • perception of sound in absence of sound source
    (subcortical auditory problem, not inner ear)
59
Q

Tinnitus SUB - Causes

A

Hearing loss
Medications: ASA, antiHTN, AG’s
Trauma: Barotrauma, loud noise
Systemic dz
Metabolic

60
Q

Tinnitus SUB- Workup

A

audiometry
MRI, MRA, venography?

61
Q

Tinnitus SUB-Tx

A

Masking
medical management
Cochlear implant

62
Q

Tinnitus OBJECTIVE

A

perception of sound caused by internal body sound
(underlying vascular or mechanical disorder)

63
Q

Tinnitus OBJECTIVE - Causes

A

VASCULAR
Pulse synchronous
AV malformation
HTN
Vascular tumor
Benign intracranial HTN

MECHANICAL
patulous ET -abnormal opening
palatal myoclonus - rapid clicking by contraction of ET

64
Q

Vertigo

A

sensation of motion when there is no motion
OR
exaggerated sense of motion in response to mvmt

65
Q

Vertigo - DX

A

duration and assocation w/ hearing loss key to DX

diff b/w central and peripheral etiology

66
Q

Vertigo - Peripheral

A

SUDDEN onset
tinnitus/ hearing loss
HORIZONTAL nystagmus common
N/V

67
Q

Vertigo - Central

A

GRADUAL onset
more severe and debilitating
NO associated auditory symp
VERTICAL nystagmus may occur

68
Q

Labyrinthitis

A

acute onset of continuous, SEVERE VERTIGO LASTING DAYS TO A WEEK

unilateral assoc hearing loss and tinnitus

Recovery several weeks

unknown cause

69
Q

Labyrinthitis - Tx

A

consider abx (pot infxn of inner ear)
vestibular suppressants (meclizine)

70
Q

Meniere’s Disease

A

MOST CASES IDIOPATHIC

EPISODIC VERTIGO LASTING 20 MINS - HRS, HEARING LOSS, TINNITUS, UNILATERAL AURAL PRESSURE

71
Q

Meniere’s Dz - TX

A

LOW SALT DIET AND DIURETICS (ACETAZOLAMIDE)

72
Q

BPPV

(benign paroxysmal positional vertigo)

A

vertigo spells w/ changes in head position
last 10-15 sec (bending over or rolling over in bed)

vertigo clusters may persist days

otoliths out of position

73
Q

BPPV - Dx

A

Dix Hallpike test

74
Q

BPPV - Tx

A

Epley maneuver
(constant repetition of positional changes causes “ habituation”

75
Q

Sensorineural Hearing Loss

A

damage to cochlea or neural pathways to inner ear to brain

most bilateral symmetric hearing loss

76
Q

Sensorineural Hearing Loss - causes

A

MC Presbyacusis
(progressive, high frequ, bilateral)

Ototoxicity
(drugs: AG’s, loop diuretics, neoplastics)
Irreversible hearing loss

Noise Trauma - 2nd MC cause

Physical trauma

Idiopathic (sudden sensory hearing loss)
Hereditary
Autoimmune

77
Q

Sensorineural Hearing Loss - tx

A

mentions corticosteriods in some or other immunosuppressives

78
Q

Conductive hearing loss

A

issues w/ sound transmission to hearing nerve

79
Q

Conductive hearing loss - causes

A

impacted cerumen
ETD (often from URI, allergic rhinitis)

80
Q

Conductive hearing loss - Tx

A

treat underlying cause

often corrected medically or surgically

81
Q

Acoustic Neuroma

A

slow-growing tumor of vestibular or cochlear n.

Benign but can damage surround structures

uncommon, linked to NF2

82
Q

Acoustic Neuroma - clin pres

A

UNILATERAL SENSORINEURAL HEARING LOSS
dizziness, hearing loss, tinnitus (MC)

may have decreased feeling on side of face, drooping of face, unsteady walk

83
Q

Acoustic Neuroma - Dx

A

enhanced MRI of brain

ICM Unit 3 HEENT (6 decks)

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