Outer & Middle Ear Flashcards
Cerumen impaction clinical presentation
A lot of cerumen and secretion in ear canal
Cerumen impaction causation
Self-induced trauma in ear drum
Cerumen impaction management
Mineral or olive oil for natural cleaning process
OR
irrigation by medical provider
HOW TO: irrigation
- use warm water
- directed stream at posterior canal
- only if TM is visualized **
- dry afterwards
potential suction by ENT
Foreign body
Risk factor: children
Insects can be immobilized with lidocaine or mineral oil
Removal with hook
Otitis externa clinical presentation
otalgia, ptitoris, swelling & inflammation, purulence, hyphae (fungus)
Otitis externa causation
Water immersion, local mechanical trauma (hearing aids, cotton tips), psuedomonas aeruginosa, gram - bacteria
or aspergillus or candida for fungal infections (overuse of abx)
RISK FACTORS: younger age, narrowed ear canals, psoriasis, eczema
Otitis externa management
Abx ear drops 7-10 days, 5+ drops 3-4 times a day
a) neomycin/polymyxcin B/ hydrocortisone (NOT USED IF PERFORATION EXPECTED)
b) Ciprodex (ciprofloxacin and dexamethasone) $$
need oral abx with cellulitis of pre-auricular tissue
MUST utilize wick if swollen shut as well as consider cleaning, suction, etc. to get where they need to go (CANNOT WITH PERFORATION)
avoid water for 7-10 days
FUNGAL: clotrimazole (lotrimin) or acetic acid
recurrent–> ENT
Malignant otitis externa clinical presentation
- copious foul discharge
- granulation tissue
- severe OE
- otalgia, headache, otorrhea
–fever>101
–peripheral lymphadenopathy
–resistance to topical treatment
Malignant otitis externa causation
pseudomonas aeruginosa 95%
RISK FACTORS:
-elderly, diabetes mellitus, immunocompromised
Malignant otitis externa management
Need CT scan to confirm, MRI to rule out abscess, need IV abx, admit to hospital, biopsy???
IV Fluoroquinolones (ciprofloxacin)
subsequent abx for several months
KIDS=IV cephalosporins
Pruritus
Itching; caused by too much cleaning, allergies
treated by oil drops, with inflammation topical steroid can help (refer to ENT)
Auricular hematoma clinical presentation
Cauliflower ear, caused by blunt trauma (wrestlers & boxers), blood developed between perichondrium and cartilage leads to fibrosis
Need surgery to sew layers back together (w/o treatment, deformity)
auricular hematoma treatment
I&D, bolster w/ antibiotic to keep shape, ciprofloxacin. Without this, hardens and loses shape
temporomandibular joint dysfunction causes
malocclusion (misaligned teeth)
displacement of condylar head
bruxism (grinding teeth)
trauma
acute synovitis (joint swelling)
arthiritis
dental caries or abcess
herpes zoster (shingles)
TMJ symptoms
Pain on opening and closing mouth
Radiating pain
Restricted jaw function (tight - catching mechanism)
Noise, popping, clicking, crepitus (popcorn popping)
TMJ exam
index finger on either side of face, pt open and closes mouth
- clicking or popping noises or sensation
- limited ROM
- subluxation (locking)
- deviation of jaw during movement
pain
TMJ management
avoid chewing, grinding
Analgesics (NSAIDS x 10-15 days)
massage, heating pad
evaluate after 2-4 weeks
muscle relaxers + NSAIDS
Tricyclic antidepressants at bedtime, gabapentin
short course of corticosteroids (5-7 days)
mood disorder –> CBT
cholesteatoma
OM complication – prolonged eustachian tube dysfunction
forms epithelial inclusion cyst –> destruction of middle ear ossicles, hearing loss
cholesteatoma types
congenital (embryonal) and acquired (from chronic or recurrent otitis media, TM rupture)
cholesteatoma clinical presentation
otalgia
headache
hearing loss
painless otorrhea
strong odor
middle ear deafness PEARLY GRAY-WHITE MIDDLE EAR MASS BEHIND TM
Cholesteatoma treatment
non-contrast CT
ENT referral
mastoidectomy surgery
abx 7-10 days to reduce inflammation/granulation
acute otitis media
precipitated by viral URI that causes eustachian tube obstruction
1) strep. pnuemoniae
2) h. influenzae
3) strep. pyogenes
4) moraxella catarrhalis
acute otitis media symptoms
otalgia
aural pressure
decreased hearing
Fever
erythema, retraction/bulging “DONUT” decreased mobility of TM, occasional bullae
acute otitis media 2nd conditions
acute mastoiditis - cefazolin and myringotomy for culture & drainage
myringitis - blistering and bullae on TM
labyrinthitis - inner ear inflammation
AOM management (adults)
amoxicillin
amoxicillin-clavulanate (resistant cases)
cefuroxime
cefpodoxime
recurrent –> long term sulfamethoxazole or lower dosing amoxicillin
AOM in children risk factors
family history
atopy (allergies, asthma, ezcema)
uri
low SE status
exposure to smoke
daycare
short term breastfeeding
prematurity
adenoid hypertrophy
craniofacial anomaly
pacifier use
AOM children symptoms
ear tugging, irritability, difficulty sleeping, decreased eating, change in behavior
recurrent definition
> 3 separate episodes in 6 months, >4 episodes in past 12 months with last in 6 monts
tympanometry
flat or nearly flat indicates impaired TM
AOM treatment (children)
tylenol and ibuprofen (no I <6 months)
antibiotics indicated for <6 months, bilateral AOM, or with strong atalgia, >48 hours, >39/102.2
amoxicillin
amoxicillin-clavulanate (if recieved a in last 30 days, unresponsive)
cephalosporin, cefdinir – PCN allergy
AOM treatment duration
10 days <2
7 days 2-5
5-7 days >6 yrs
recurrent = tympanostomy tubes and adenoidectomy
NO prophylatic antibiotics, follow up
AOM prevention
PCV vaccination
flu vaccine
breastfeeding
avoid smoke
tympanostomy tubes if recurrent
chronic otitis media
> 2 weeks of otorrhea, persisting 6 wks to 3 months
chronic middle ear inflammation with TM perforation and persistent or intermittent otorrhea
- P aeruginosa
- Proteus species
-staph aureus
chronic otitis media clinical
otorrhea - intermittent or continuous
pain UNCOMMON - TM perforated
conductive hearing loss, need CT of temporal bones, refer to ENT
chronic otitis media treatment
maintain dry ear
aural toilet (procedure to clean out debris)
1) ofloxacin, ciprofloxacin (often w dexamethasone, topical otic abx)
2) systemic antibiotics, oral ciprofloxacin
definitive = tympanoplasty/mastoidectomy
otitis media with effusion (OME)
most common cause of hearing impairment – poor ET function, URI, allergies
OME risk factors
genetics, allergies, smoke, GERD, obesity
OME clinical
air-fluid level or bubbles, dull TM
OME treatment
watchful waiting x3 months if no risk, autoinflation, OR tympanostomy
consider nasal steroid, oral antibiotics?
eustachian tube dysfunction
negative pressure results from viral URI, allergies
sense of fullness
impairment of hearing
popping or crackling sound
retraction of TM
ETD treatment
viral illness – systemic & intranasal decongestants w autoinsufflation
-pseudoephedirne
-oxymetazoline
allergic patients, intranasal corticosteroids, beclomethasone dipropionate
air pressure change should be avoided. if doesn’t resolve, tympanostomy tubes or balloon dilation of ET
barotrauma causation
result of sudden pressure change, sudden dysfunction
can clear w popping or time, or causes bleeding or fluid leakage, worst = fistula
barotrauma risks
colds, allergies, infections
barotrauma symptoms
otalgia, ears are stuffed, “need to pop”, extreme pain, vertigo, bleeding/fluid in ear, hearing loss
barotrauma treatment
swallow, yawn, pop ears,
OTC decongestants (pseudoephedrine)
topic decongestants - phenylephrine or oxymetazoline
keep kids upright, bottle/pacifier, special ear plugs
tympanic membrane perforation
hole in ear drum, caused by infection, trauma, unintentional/doctors
TMP symptoms
ear pain, otorrhea, hearing loss, whistling sound
hemotympanum
bloody otorrhea present only if TM ruptures, otherwise behind TM. consider ENT removal, vascular tumor?
inner ear fistula
due to trauma, stables –>vestibule
inner ear fistula causes
barotruama, rapid descent, explosion, straining
inner ear fistula clinical
hearing loss, disequilibrium, vertigo, mixed hearing loss, unilateral, definitive w surgical diagnosis
inner ear fistula management
oral corticosteroids, stool softeners to reduce straining, tympanotomy to enhance healing
otosclerosis
bony overgrowth of stapes which blocks conductions
CONDUCTIVE slow hearing loss, tinnitus (vertigo NOT common), confirm w CT scan
familial tendency
conservative hearing aids
stapedectomy w prothesis
