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Second Pass Half Blood Prince > Otolaryngology > Flashcards

Otolaryngology Flashcards

1
Q

Define the following:
OM
AOM
OME
COM
ROM

A

Otitis media - inflammation of the middle ear

acute otitis media - presence of a middle ear effusion with signs and symptoms of an acute infection

Otitis media with effusion - is a middle ear effusion without signs or symptoms of acute infection

Chronic otitis media prolonged discharge from the ear through perforation of the tympanic membrane. Typically last six weeks or longer

Recurrent otitis media is three or more episodes of acute in six months or four episodes within one year

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2
Q

Age range for AOM

A

Peak 6 months 15 months years
Can be over 2 years
Less than 6 not common still have coverage from materal antibodies

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3
Q

5 risk factors for AOM? Two protective RF?

A

Modifiable - smoking, pacifier use, daycare
Not modifiable - poor, male, non hispanic white, family history, craniofacial abnormalities

Breastfeeding and pneumococcal vaccination protective

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4
Q

What does TM look like in AOM?

A

ditinctly erythemaous
Opacification
Bubbles
Air fluid levels
Buldging
Retraction or lack of movement with pneumatic otoscopy

remember the eustachaian tube is blocked creating negative pressure, why its retracted
I think AOM looks like a cervix

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5
Q

Treatment of choice AOM for:
standard
Mild to moderate pen allergic
Severe pen allergic

A

Amox 90mg/kg divided BID either 7 or 10 days
mild to mod - ceftriaxzone or cefuroxime
mod to severe - clinda or azithromycin
NSAIDs for everyone

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6
Q

What is considered treatment failure, 2 reasons why it happens in AOM, and what do they get?

A

Lack of improvement in signs and symptoms

Wrong disgnosis or antibiotic resistance

Amox/clav or ceftrixzone
Refferal to peds ID or ENT

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7
Q

Who can we use a watch and wait apporach in for AOM and antibiotics? Who can we not?

A

Older than 6 months and less than 2 years:
Healthy children
Unilateral
Dont have severe symptoms
Dont have ottorhea
Symptoms <48 hours
Dont have a temp over 39

Over 2 years:
Dont have severe illness
Dont have ottorhea
Can be seen in 2-3 days

All adults need to be treated

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8
Q

Who gets 10 days of antibiotics vs who might be able to get 7 days for AOM?

A

10 days
Younger than 2
Recurrent infection
TM perforations

7 days
Older than 2
First time infection
Does not have severe symptoms

*CPS guidelines say low risk duration is now 5 days

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9
Q

A kid has tubes
What are the 2 ways they present?
How do you treat them?

A

If tube is patent eythema plus discharge = infection
If tube is blocked same as other kids with buldging and imobility

Ciprodex BID 7 days

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10
Q

Who might you consider tubes in?

A

Reccurent or complicated AOM
Espcially if:
hearing loss, structural damage, concern about speech and language problems

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11
Q

What are two classifications of AOM complications? What is one complication unique to chronic cases?

A

Infratemporal - mastoiditis, facial nerve paralysis, conductive and perceptive hearing loss

Intracranial complications - meningitis, intracranial abscess

Cholesteatoma - mass of keratin producting sqaumous epithelial cells that migrate and accumulate in middle ear leading to rapidly expanding mass trapped behind TM

Needs to be removed surgically otherwise you get hearing loss, temporal bone destruction and cranial invasion (just gets going and going)

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12
Q

What is bullous myringitis?

A

Get bullae on TM, treat as regular AOM

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13
Q

What is ottitis conjunctivitis syndrome and the causative agent?

A

Get both at the same time
most common is influenza

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14
Q

What is the Rosens differential for AOM?

A

OME
OE
Otic FB

Trauma
Mastoiditis
Reffered pain

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15
Q

What do you do with small little perforations of TM?

A

Typically go away on their own

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16
Q

What are three discharge instructions for everyone?

One discharge consideration for adults?

A

NSAIDs for pain
Come back in 2-3 days if no improvement
See family doctor in 12 weeks to make sure effusion has resolved

Adults think about outpatient ENT - assess for ?carcinoma. Complications in kids also go to ENT

17
Q

What is the pathophysiology of OE?

A

External auditory canal has sqamous epithelial cells and a layer of cerumen that is protective

Lots of humidity, high temp or maceration of the skin from trauma and this layers breaks down -> bacteria -> infection

18
Q

What is your treatment approach for standard cases? Who requires systemic antibtiocs?

A

Standard:
Clean the ear canal
Ciprodex drops BID for 10 days

Systemic: PO Cipro BID 7 days if infections extends beyond the canal or patients are immunocompromised (including bad DM)

19
Q

4 ways to improve delivery of drops in OE?

A

1 - clean out the ear with irrigation
2 - lay down for 5 minutes post drops
3 - use a wick, put drops on wick, leave in place 2-3 days then follow up
4 - consult ENT to come and debride if really bad

20
Q

What antibiotics can you not give a perforated TM?

A

Aminoglycosides (the mycins - gent, tobra, streptomycin, neomycin)

21
Q

3 varients of EOM that are not NMOE?

A

Otomycosis - fungal infection. Itching most common symptoms, candida and aspergillious most common bugs. Usually immunocompromised or tropical

Furunculosis - small erythematous and well circumscribed infections of cartilagenous external ear canal from staph aureus

Herpes zoster oticus aka ramsey hunt - Varicella zoster of auricle. Can have facial paralysis.

22
Q

What is the severe OE you worry about? How does it happen? What are 2 chracteristic findings? How is it diagnosed? What is the management?

A

Necrotizing Malignant Otitis Externa
Agressive form of OE with high mortality in patients who are immunocompromised and DM (over 50% have DM)

Infection starts as per normal in external canal but then progresses through periauricular tissue to the cartilagenous-bony juntion of the external auditory meatus -> can keep going right into temporal bone

CN 7 facial paralysis (remember it sits right under the ear)
Granulation tissue on the floor of the ear canal

No single diagnostic crtieria - think about it if refractory, severe, looks bad. Can confirm bony involvement with CT

Cipro +/- Pip/tazo for 6-8 weeks
ENT consult if refractory for surgical management

23
Q

What is most common supurlative complication of OM? Who are some special populations it can occur in? Most common bugs and physcial findings?

A

Mastoiditis

Leukemia, kawasaki, sarcoma of temporal bone, cochlear ear implant

Bugs - strep pneumo most common, psuedomonas, fusobacterium if recent abx

Exam - red, swollen, tender protuding ear

24
Q

Why do you image mastoiditis? What is the management?

A

CT for intracranial involvement - a must if neurologic symptoms or failure to improve

Consult ENT, need IV antibiotics
without recurrent acute otitis media or recent antibiotic use, vancomycin at a dose of 15 mg/kg IV (uptodate says amp/sulbactam, vanco ceftrixzone probably reasonable)

Patients who have had an episode of acute otitis
media within the past 6 months, or in patients with recent antibiotic use need pseudo coverge:
cefepime, at a dose of 50 mg/kg IV (max 2 g) in pediatric patients, or 2 g IV in adults.
(up to date says do tazo vanco)

*Up to date says pip/tazo

25
Q

What is the Dave Hamilton alternative to Rinne and Weber?

A

Hum test

Have them hum. If the sound goes to the bad ear first (the one they say is having difficulty). If it goes to the good or normal ear first, it is sensioneural.

Just like rhinne and weber this works on the same principle that if you have conductive hearing vibrating or putting something vibrating directly on the bad side will make it louder

26
Q

What is sudden sensorineural hearing loss defined as? What is the sterotypical presentation?

A

Acute hearing loss greater than 30dB
Ovevr at least 3 frequencies
Over a test period of less than 3 days

Someone in 50s or 60s, who waited to come in becuase they thought ear was just blocked, also has tinnitus

27
Q

When do you image hearing loss?

What is treatment?

A

Only if you think space occupying lesion

Promt ENT consult
Steroids 1mg/kg/day up to 60mg then taper 10-14 days
Alternatives HBO, steroids, intratympanic steroids

28
Q

What proportion of nose bleeds are anterior?

A

90%

29
Q

Which patient getting a nosebleed is a red flag and why?

A

Less than 2 years old
Consider inflicted injury or a bleeding disorder

30
Q

Outline your apporach to epistaxis

A

Blow the nose
Examine with floor of nose parralel to floor
Otrivan or oxymetalazone 2 sprays
Topical lidocaine with epi
Compress 10-15 minutes
Look again, ?caudery (peripheral to center, not the septum, cant do if actively bleeding)
Pack anterior
Pack the other side
Remove and treat as posterior
ENT for embolization

31
Q

How do you pack posterior epistaxis?

A
32
Q

Who does Rosen’s say gets antibiotics with packing? When do they come back?

A

Going to be in longer than 48 hours
Immunocompromised
Valvular heart disease

Come backin 48 hours for removal

33
Q

What is the nasopulmonary reflex?

A

Theoretical risk that posterior epistaxis patients develop hypoexemia
Probably due to cardio, pulmonary disease like OSA, sedation
Admit and place on pulse Ox for monitoring

34
Q

What are salivary glands and their respective ducts?

A
35
Q

What is sialothiasis? What is infectious version?
What are risk factors, classic presentation, and treatment?

A

Stones of salivary galnds, most common submandibular
Sialandentitis - infection of salivary gland

RF - (dry) anticholinergic, dehydrated, diuretics, smoking or trauma

Classic story is pain with drooling in middle aged person. Can image PRN

Tx - manual massage, sialogogues, NSAIDs and amox/clav if you think ifnection
Larger than 5mm or in proximal duct needs ENT

36
Q

What is the rule of 80s for neck masses?

A

Neck masses that are not of the thyroid will be cancer in 80% of adults, and 80% of those will be malignant

In kids 80% are benign - typically infectious or inflammatory that we treat with amox/clav and follow-up in 2 weeks

37
Q

In adults what are red flag nhead and neck features for malignancy you should send to ENT?

A

For neck masses - does not get better in 2 weeks
Enlarged (>1.5cm) or fixed
Matted cervical lymph nodes
Hoarseness > 2 weeks
Mass in parotid or thyroid gland

Reffered ear pain
Unilateal ottis media with effusion

38
Q

What is rosens differential for neck masses?

A

Second Pass Half Blood Prince (13 decks)

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