Otology Flashcards
When performing the weber test, which type of hearing loss is louder in the affected ear?
unilateral conductive
When performing the weber test, which type of hearing loss is louder in the unaffected ear?
unilateral sensorineural
When performing the rinne test, AC > BC is indicative of which type of hearing loss?
sensorineural
When performing the rinne test, BC>AC is indicative of which type of hearing loss?
conductive
The ______________ is the measure of the ear drum pressure and fluid. What diagnosis does it help support?
tympanogram, otitis media
________________ is the destruction of the cochlear hair cells or disruption of CN8 pathway
sensorineural hearing loss
What is the most common cause of sensorineural hearing loss?
presbycusis
What diagnostic tools are used to diagnose sensorineural hearing loss?
weber, rinne, audiogram, MRI w and w/o contrast
This type of hearing loss is unilateral and occurs within hours or days. Its associated symptoms are tinnitus and dizziness. It can improve spontaneously but improved odds with high dose oral steroids or steroid injections.
Sudden sensorineural hearing loss
If there is no improvement when treating sudden sensorineural hearing loss, the patient will be sent for an MRI of the brain/IAC without contrast to rule out what?
acoustic neruoma
Which condition is the perception of sound in the head that can present with ringing in ears, swishing, clicking, hissing, buzzing and blowing.
tinnitus
When does tinnitus become concerning?
if its unilateral, constant, pulsatile
What is the work up ordered for patients with tinnitus?
labs: FTA-ABS, CBC, ANA, sed rate, RF, thyroid function, Lyme
imaging: MRI-unilateral, vertigo, pulsatile, CT- cholesteatoma
What is the treatment for tinnitus?
hearing protection, coping strategies, amplification, counseling, tinnitus maskers
What is the impaired transmission of sound along the external auditory canal, across the ossicles and through the oval window known as
conductive hearing loss
What is the most common cause of conductive hearing loss?
cerumen impaction
What diagnostic tools are used to diagnose conductive hearing loss?
weber, rinne, audiogram, CT temporal bone w/o contrast
A female patient presents with abnormal bone growth around the stapes which has caused her to have conduction hearing loss. The patient had a tympanogram done which came out normal. What is the diagnosis?
otosclerosis, tends to be congenital
A patient who is a wrestler presents with trauma to the external ear which resulted in swelling and tenderness upon palpation. If left untreated, this could develop into cauliflower ear. What is the diagnosis and what is the treatment?
auricular hematoma (blood that collects between the auricle). the treatment is incision and drainage with compression dressing to prevent reaccumulation
A patient presents to the clinic with a history of hearing loss, fullness and discomfort. Upon examination, the pt has conductive hearing loss. What is the likely diagnosis?
cerumen impaction
What is the treatment plan for a cerumen impaction?
ear currette, lavage with warm water and peroxide. olive oil softens wax, NEVER irrigate if TM perforation is present
What are the complications of having a foreign body in your ear?
infection, granulation tissue, laceration of the ear canal, rupture of TM
A patient presents with ear erythema/edema, otorrhea, and tenderness with movement of the auricle. The TM moves normally with pneumatic otoscopy. This patient has a history of otalgia, otorrhea and hearing changes. What is the dx?
otitis externa “swimmer’s ear”
What are the causes of otitis externa?
trauma, fungus, moisture, dermatitis
What differentiates otitis externa from otitis media?
in otitis externa, the main PE finding will be that if you pull on the patients ear or use an otoscope, they will jump back from you.
What are the organisms associated with otitis externa?
pseudomonas, staph aureus, fungal-candida, aspergillus niger (otomycosis)
What are the meds for otitis externa?
topical antibiotic/corticosteroids, acetic acid otic, clotrimazole, oral antibiotics, debridement, ear wick
_______________ is a fungal infection of the outer ear. What dont you want to treat this patient with?
otomycosis. You do not want to irrigate because you will be feeding the fungus with moisture and you also dont want to give antibiotics
Which is the main drug that is used to treat the middle ear?
Fluoroquinolone type drops such as floxin, ciprofloxacin and ciprodex (its safe)
Which otic GTTs are ototoxic?
corticosporin (contains neomycin)
acetic acid not ototoxic but is painful if TM is perforated
T/F in the treatment of otitis externa, you never want to treat with oral meds alone.
True, higher concentration of topical otics tx increases efficacy, less about resistance
What is the treatment protocol for otitis externa? (how long to treat/etc)
treat with antibiotic drops 7-10 days, dry ear care/avoid manipulation, recheck in 1-2 weeks, if no improvement: culture and sensitivity, consider pseudomonas or MRSA
What are treatment options for otitis externa (fungal)
vosol otic drops, vosol HC otic drops if swelling present and clotrimazole
An elderly diabetic patient presents to the office. He appears sick and feels uncomfortable when moving his head. Upon doing a PE, you identify that the patient has foul aural discharge, deep otalgia and cranial nerve pasly. What is the dx?
malignant otitis externa
What bacteria causes malignant otitis externa ?
pseudomonas
Which dx involves osteomyelitis of the temporal bone ?
malignant otitis externa
What is the treatment for malignant otitis externa?
IV Cipro, debridement
This type of dx involves vesicles in the external auditory canal, severe pain, sensorineural hearing loss
viral otitis externa: herpes zoster oticus
What is the treatment for herpes zoster oticus?
acyclovir and steroids
What is the dx of a patient who has viral otitis externa and CN7 palsy?
Ramsey Hunt Syndrome (mimics bell’s palsy)
A patient presents with pain, a rash, facial nerve palsy and hearing loss. What is the dx
Ramsay-Hunt Syndrome
What are the complications associated with Ramsay-Hunt syndrome
permanent hearing loss, permanent weakness of the facial nerve, eye damage, post herpetic neurlagia
What is the history, cause, of TM perforation? How would you manage it?
history: pain, hearing loss
cause: trauma, barotrauma, acute infection, cholesteatoma
management: treat infection, keep ear dry, sx
What can a person develop if they get frequent ear infections?
tympanosclerosis
This is condition is defined as having blood behind the ear
hemotympanum
What is the cause of ramsay-hunt syndrome?
varicella-zoster virus (chicken pox) involved the VII facial nerve
What can barotrauma result in?
hemotypanum, tympanic membrane perforation, or middle ear infection
What is bullous myringitis and what is the bacteria associated with it and was is the treatment?
fluid filled hemorrhagic blebs on the TM, mycoplasma
pneumoniae. treatment is I&D
A patient presents to the office and complains of decreased hearing, their ears feeling full, and popping. This patient also states that they have allergies and sinusitis. What would you expect to find when doing the PE and what is the dx?
PE: retracted tympanic membrane
DX: eustachian tube dysfunction
What is Eustachian Tube dysfunction?
inflammation of the eustachian tube that results in negative middle ear pressure
What are the treatment options for eustachian tube dysfunction?
correcting rhinitis causes: smoking, allergies, sinusitus, pregnancy, decongestant spray abuse, reflux
decongestants(oral/nasal), valsalva, nasal steroid spray, oral steroids, antihistamine spray
This is a middle ear effusion that results from eustachian tube dysfunction
serous otitis media
__________ is the main cause of serous otitis media
upper respiratory infection
When doing a PE on a patient with serous otitis media, what would you expect to find?
translucent effusion, TM immobile on pneumatic otoscopy, flat tympanogram with conductive hearing loss, weber lateralizes to the affected ear
What would the history of a patient with serous otitis media be?
otalgia, pressure, hearing loss
T/F You want to use antihistamines on a patient with serous otitis media
False, DO NOT
What treatment options are there for patients with serous otitis media?
oral/intranasal steroids, expectorants, oral/intranasal decongestants, myringotomy w or w/o PE tubes
A patient came in complaining of otalgia and hearing loss. When taking their history, you find out that they recently had a viral URI. What would you expect to find when doing the PE?
AOM
TM erythema/bulging, TM immobile on pneumatic otoscopy, conducive hearing loss, flay tymp, weber lateralizes to the affected ear
This is a type of bacterial infection of the middle ear that is often precipitated by a viral URI
acute otitis media
What is the initial drug of choice when treating acute otitis media?
amoxicillin
When should you consider treatment for acute otitis media? What class of meds would you use?
if its mild, analgesics
A 4 year old patient presents with a history of having difficulty hearing along with speech and balance problems. Upon examination, you notice that there is a thick “glue” like fluid behind the ear drum. What is the dx?
chronic otitis media
Under which circumstances would you place a PE tube in a patient?
pt has hearing loss with speech and language delay, if there was failure for OME to resolve, if they have recurrent acute otitis media
What is the goal of tympanosotomy tubes (PE)
ventilation of the middle ear, it is a temporary bypass of the eustachian tube
Cholesteatoma, mastoiditis, meningitis are all complications of which condition?
otitis media
What is cholesteatoma?
keratin and squamous epithelium overgrowth in the middle ear which can destroy ossicles, painless otorrhea, CHL and flat tympanogram
What is mastoiditis?
infection of the mastoid bone that involves post-auricular pain/erythema, fever, and local adenopathy
What are the ototoxic drugs for sensorineural hearing loss?
aminoglycosides, furosemide, cisplatin, vancomycin, aspirin
For a patient with otitis externa, there is usually no use of ORAL antibiotics unless it is associated with what?
cellulitus of auricle, face and neck
A patient comes in with otitis exrerna. You are unsure about the status of the TM. What treatment would be best for this patient?
FQ +/- topical steroid
This condition is defined as osteomyelitis of the temporal bone
Malingnant otitis media
Under what circumstance would you order a CT for a patient with TM perforation?
if they pt has suspected cholesteatoma
What is the etiology of chronic otitis media?
psuedomonas, staph aureus, allergies, cigarette smoke, daycare, siblings in school
