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Clinical Medicine I > Outer & Middle Ear > Flashcards

Outer & Middle Ear Flashcards

1
Q

Cerumen impaction clinical presentation

A

A lot of cerumen and secretion in ear canal

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2
Q

Cerumen impaction causation

A

Self-induced trauma in ear drum

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3
Q

Cerumen impaction management

A

Mineral or olive oil for natural cleaning process
OR
irrigation by medical provider

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4
Q

HOW TO: irrigation

A
  • use warm water
  • directed stream at posterior canal
  • only if TM is visualized **
  • dry afterwards

potential suction by ENT

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5
Q

Foreign body

A

Risk factor: children
Insects can be immobilized with lidocaine or mineral oil
Removal with hook

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6
Q

Otitis externa clinical presentation

A

otalgia, ptitoris, swelling & inflammation, purulence, hyphae (fungus)

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7
Q

Otitis externa causation

A

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

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8
Q

Otitis externa management

A

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

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9
Q

Malignant otitis externa clinical presentation

A
  • copious foul discharge
  • granulation tissue
  • severe OE
  • otalgia, headache, otorrhea
    –fever>101
    –peripheral lymphadenopathy
    –resistance to topical treatment
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10
Q

Malignant otitis externa causation

A

pseudomonas aeruginosa 95%

RISK FACTORS:
-elderly, diabetes mellitus, immunocompromised

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11
Q

Malignant otitis externa management

A

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

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12
Q

Pruritus

A

Itching; caused by too much cleaning, allergies
treated by oil drops, with inflammation topical steroid can help (refer to ENT)

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13
Q

Auricular hematoma clinical presentation

A

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)

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14
Q

auricular hematoma treatment

A

I&D, bolster w/ antibiotic to keep shape, ciprofloxacin. Without this, hardens and loses shape

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15
Q

temporomandibular joint dysfunction causes

A

malocclusion (misaligned teeth)
displacement of condylar head
bruxism (grinding teeth)
trauma
acute synovitis (joint swelling)
arthiritis
dental caries or abcess
herpes zoster (shingles)

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16
Q

TMJ symptoms

A

Pain on opening and closing mouth
Radiating pain
Restricted jaw function (tight - catching mechanism)
Noise, popping, clicking, crepitus (popcorn popping)

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17
Q

TMJ exam

A

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

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18
Q

TMJ management

A

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

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19
Q

cholesteatoma

A

OM complication – prolonged eustachian tube dysfunction
forms epithelial inclusion cyst –> destruction of middle ear ossicles, hearing loss

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20
Q

cholesteatoma types

A

congenital (embryonal) and acquired (from chronic or recurrent otitis media, TM rupture)

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21
Q

cholesteatoma clinical presentation

A

otalgia
headache
hearing loss
painless otorrhea
strong odor
middle ear deafness PEARLY GRAY-WHITE MIDDLE EAR MASS BEHIND TM

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22
Q

Cholesteatoma treatment

A

non-contrast CT
ENT referral
mastoidectomy surgery
abx 7-10 days to reduce inflammation/granulation

23
Q

acute otitis media

A

precipitated by viral URI that causes eustachian tube obstruction

1) strep. pnuemoniae
2) h. influenzae
3) strep. pyogenes
4) moraxella catarrhalis

24
Q

acute otitis media symptoms

A

otalgia
aural pressure
decreased hearing
Fever
erythema, retraction/bulging “DONUT” decreased mobility of TM, occasional bullae

25
Q

acute otitis media 2nd conditions

A

acute mastoiditis - cefazolin and myringotomy for culture & drainage
myringitis - blistering and bullae on TM
labyrinthitis - inner ear inflammation

26
Q

AOM management (adults)

A

amoxicillin
amoxicillin-clavulanate (resistant cases)
cefuroxime
cefpodoxime

recurrent –> long term sulfamethoxazole or lower dosing amoxicillin

27
Q

AOM in children risk factors

A

family history
atopy (allergies, asthma, ezcema)
uri
low SE status
exposure to smoke
daycare
short term breastfeeding
prematurity
adenoid hypertrophy
craniofacial anomaly
pacifier use

28
Q

AOM children symptoms

A

ear tugging, irritability, difficulty sleeping, decreased eating, change in behavior

29
Q

recurrent definition

A

> 3 separate episodes in 6 months, >4 episodes in past 12 months with last in 6 monts

30
Q

tympanometry

A

flat or nearly flat indicates impaired TM

31
Q

AOM treatment (children)

A

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

32
Q

AOM treatment duration

A

10 days <2
7 days 2-5
5-7 days >6 yrs

recurrent = tympanostomy tubes and adenoidectomy
NO prophylatic antibiotics, follow up

33
Q

AOM prevention

A

PCV vaccination
flu vaccine
breastfeeding
avoid smoke
tympanostomy tubes if recurrent

34
Q

chronic otitis media

A

> 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

35
Q

chronic otitis media clinical

A

otorrhea - intermittent or continuous
pain UNCOMMON - TM perforated
conductive hearing loss, need CT of temporal bones, refer to ENT

36
Q

chronic otitis media treatment

A

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

37
Q

otitis media with effusion (OME)

A

most common cause of hearing impairment – poor ET function, URI, allergies

38
Q

OME risk factors

A

genetics, allergies, smoke, GERD, obesity

39
Q

OME clinical

A

air-fluid level or bubbles, dull TM

40
Q

OME treatment

A

watchful waiting x3 months if no risk, autoinflation, OR tympanostomy
consider nasal steroid, oral antibiotics?

41
Q

eustachian tube dysfunction

A

negative pressure results from viral URI, allergies
sense of fullness
impairment of hearing
popping or crackling sound
retraction of TM

42
Q

ETD treatment

A

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

43
Q

barotrauma causation

A

result of sudden pressure change, sudden dysfunction
can clear w popping or time, or causes bleeding or fluid leakage, worst = fistula

44
Q

barotrauma risks

A

colds, allergies, infections

45
Q

barotrauma symptoms

A

otalgia, ears are stuffed, “need to pop”, extreme pain, vertigo, bleeding/fluid in ear, hearing loss

46
Q

barotrauma treatment

A

swallow, yawn, pop ears,
OTC decongestants (pseudoephedrine)
topic decongestants - phenylephrine or oxymetazoline

keep kids upright, bottle/pacifier, special ear plugs

47
Q

tympanic membrane perforation

A

hole in ear drum, caused by infection, trauma, unintentional/doctors

48
Q

TMP symptoms

A

ear pain, otorrhea, hearing loss, whistling sound

49
Q

hemotympanum

A

bloody otorrhea present only if TM ruptures, otherwise behind TM. consider ENT removal, vascular tumor?

50
Q

inner ear fistula

A

due to trauma, stables –>vestibule

51
Q

inner ear fistula causes

A

barotruama, rapid descent, explosion, straining

52
Q

inner ear fistula clinical

A

hearing loss, disequilibrium, vertigo, mixed hearing loss, unilateral, definitive w surgical diagnosis

53
Q

inner ear fistula management

A

oral corticosteroids, stool softeners to reduce straining, tympanotomy to enhance healing

54
Q

otosclerosis

A

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

Clinical Medicine I (33 decks)

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